Inconsistent Treatment Research Articles

Inconsistent treatment estimates from mis-specified logistic regression analyses of randomized trials.

When the difference between treatments in a clinical trial is estimated by a difference in means, then it is well known that randomization ensures unbiassed estimation, even if no account is taken of important baseline covariates. However, when the treatment effect is assessed by other summaries, for example by an odds ratio if the outcome is binary, then bias can arise if some covariates are omitted, regardless of the use of randomization for treatment allocation or the size of the trial. We present accurate closed-form approximations for this asymptotic bias when important normally distributed covariates are omitted from a logistic regression. We compare this approximation with ones in the literature and derive more convenient forms for some of these existing results. The expressions give insight into the form of the bias, which simulations show is usable for distributions other than the normal. The key result applies even when there are additional binary covariates in the model.

Does consistency improve accuracy in multiple—based valuation?

In this paper we analyze the impact of consistency upon the accuracy of corporate values estimates provided by multiple-based valuation methods. Based on a sample with more than 6000 firm years from German firms we find consistent multiple definitions outperform in most cases inconsistent ones. The first layer consistency requirement of properly matching entity figures and equity figures increases the valuation accuracy in all cases. In a deeper analysis with respect to consistent enterprise value definitions, in the majority of cases consistent definitions still outperform inconsistent ones. We find that consistent treatment of financial leases, pensions and minority interest generally increases the valuation accuracy. However for balance sheet variable accounts payables we find mixed evidence: the inclusion results in a higher valuation accuracy for all enterprise value multiples, whereas under our hypothesis it should only do so for the EV/sales multiplier. For investments in associates and joint ventures, an inconsistent treatment also results in a higher valuation accuracy. Within the class of consistently defined multiples EBITDA multiples have the highest valuation performance followed by EBIT, net income and sales based multiples.

Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic.

BackgroundTreating severe childhood obesity has proven difficult with inconsistent treatment results. This study reports the results of the implementation of a childhood obesity chronic care treatment protocol.MethodsPatients aged 5 to 18 years with a body mass index (BMI) above the 99th percentile for sex and age were eligible for inclusion. At baseline patients’ height, weight, and tanner stages were measured, as well as parents’ socioeconomic status (SES) and family structure. Parental weight and height were self-reported. An individualised treatment plan including numerous advices was developed in collaboration with the patient and the family. Patients’ height and weight were measured at subsequent visits. There were no exclusion criteria.ResultsThree-hundred-thirteen (141 boys) were seen in the clinic in the period of February 2010 to March 2013. At inclusion, the median age of patients was 11.1 years and the median BMI standard deviation score (SDS) was 3.24 in boys and 2.85 in girls. After 1 year of treatment, the mean BMI SDS difference was −0.30 (95% CI: −0.39; −0.21, p < 0.0001) in boys and −0.19 (95% CI: −0.25; −0.13, p < 0.0001) in girls. After 2 years of treatment, the mean BMI SDS difference was −0.40 (95% CI: −0.56; −0.25, p < 0.0001) in boys and −0.24 (95% CI: −0.33; −0.15, p < 0.0001) in girls. During intervention 120 patients stopped treatment. Retention rates were 0.76 (95% CI: 0.71; 0.81) after one year and 0.57 (95% CI: 0.51; 0.63) after two years of treatment. Risk of dropout was independent of baseline characteristics. Median time spent by health care professionals was 4.5 hours per year per patient and the mean visit interval time was 2.7 months. The reductions in BMI SDS were dependent on gender, parental BMI, and family structure in girls, but independent of baseline BMI SDS, age, co-morbidity, SES, pubertal stage, place of referral, hours of treatment per year, and mean visit interval time.ConclusionsThe systematic use of the TCOCT protocol reduced the degree of childhood obesity with acceptable retention rates with a modest time-investment by health professionals.

Applicability and safety of dual-frequency ultrasonic treatment for the transdermal delivery of drugs

Low-frequency ultrasound presents an attractive method for transdermal drug delivery. The controlled, yet non-specific nature of enhancement broadens the range of therapeutics that can be delivered, while minimizing necessary reformulation efforts for differing compounds. Long and inconsistent treatment times, however, have partially limited the attractiveness of this method. Building on recent advances made in this area, the simultaneous use of low- and high-frequency ultrasound is explored in a physiologically relevant experimental setup to enable the translation of this treatment to testing in vivo. Dual-frequency ultrasound, utilizing 20kHz and 1MHz wavelengths simultaneously, was found to significantly enhance the size of localized transport regions (LTRs) in both in vitro and in vivo models while decreasing the necessary treatment time compared to 20kHz alone. Additionally, LTRs generated by treatment with 20kHz+1MHz were found to be more permeable than those generated with 20kHz alone. This was further corroborated with pore-size estimates utilizing hindered-transport theory, in which the pores in skin treated with 20kHz+1MHz were calculated to be significantly larger than the pores in skin treated with 20kHz alone. This demonstrates for the first time that LTRs generated with 20kHz+1MHz are also more permeable than those generated with 20kHz alone, which could broaden the range of therapeutics and doses administered transdermally. With regard to safety, treatment with 20kHz+1MHz both in vitro and in vivo appeared to result in no greater skin disruption than that observed in skin treated with 20kHz alone, an FDA-approved modality. This study demonstrates that dual-frequency ultrasound is more efficient and effective than single-frequency ultrasound and is well-tolerated in vivo.

Defining the anterior nucleus of the thalamus (ANT) as a deep brain stimulation target in refractory epilepsy: Delineation using 3 T MRI and intraoperative microelectrode recording

BackgroundDeep brain stimulation (DBS) is a minimally invasive and reversible method to treat an increasing number of neurological and psychiatric disorders, including epilepsy. Targeting poorly defined deep structures is based in large degree on stereotactic atlas information, which may be a major source of inconsistent treatment effects.Aim of the studyIn the present study, we aimed to study whether a recently approved target for epilepsy (anterior nucleus of thalamus, ANT) is visualized in clinically established 3 T MRI and whether ANT is delineated using intraoperative microelectrode recording (MER). We have especially focused on individual variation in the location of ANT in stereotactic space. We also aimed to demonstrate the role of individual variation in interpretation of MER data by projecting samples onto AC–PC (anterior and posterior commissure) and ANT-normalized coordinate systems.MethodsDetailed analysis of ANT delineations in 3 T MRI short tau inversion recovery (STIR) images from eight patients undergoing DBS for refractory epilepsy was performed. Coronal and sagittal cross-sectional models of ANT were plotted in the AC–PC coordinate system to study individual variation. A total of 186 MER samples collected from 10 DBS trajectories and 5 patients were analyzed, and the location of each sample was calculated and corrected accordingly to the location of the final DBS electrode and projected to the AC–PC or coordinate system normalized to ANT.ResultsMost of the key structures in the anatomic atlas around ANT (mammillothalamic tract and external medullary lamina) were identified in STIR images allowing visual delineation of ANT. We observed a high degree of anatomical variation in the location of ANT, and the cross-sectional areas overlapped by study patients decreased in a linear fashion with an increasing number of patients. MER information from 10 individual trajectories correlated with STIR signal characteristics by demonstrating a spike-negative zone, presumably white matter layer, at the lateral aspect of ANT in ANT-normalized coordinate system as predicted by STIR images. However, MER information projected to the AC–PC coordinate system was not able to delineate ANT.ConclusionsANT is delineated in 3 T MRI by visualization of a thin white matter lamina between ANT and other nuclear groups that lack spiking activity. Direct targeting in the anterior thalamic area is superior to indirect targeting due to extensive individual variation in the location of ANT. Without detailed imaging information, however, a single trajectory MER has little localizing value.

Doing Good and Doing Bad: Why Are Firms Socially Inconsistent?

As a new perspective for understanding firms’ social practices, we introduce the concept of Corporate Social inconsistency (CSi) to describe firms’ inconsistent treatment of stakeholders by simulta...

Inconsistent treatment of professors hurts university

Case name: Benison et al. v. Ross et al., No. 13‐2554 (6th Cir. 09/03/14).

Multi-environment probability density function approach for turbulent CH4/H2 flames under the MILD combustion condition

The multi-environment probability density function approach has been applied to simulate turbulent CH4/H2 flames under moderate or intense low-oxygen dilution (MILD) conditions. In order to circumvent excessive computational burden, the direct quadrature method of moments (DQMOM) has been adopted as an alternative approach to solve the transported probability density function (PDF) equation. The multi-environment PDF approach has the form of a conventional Eulerian scheme and retains the desirable property of a particle-based method. In this study, the joint-composition PDF is approximated using the two-environment PDF, expressed via the combination of weights and abscissas on the composition and physical space. Micromixing is represented by the IEM model, and the chemical mechanism is based on detailed chemistry. In terms of the unconditional means and conditional statistics for temperature and mass fractions of species and pollutants, the predicted profiles are in reasonable agreement with experimental data. Numerical results clearly indicate that the two-environment PDF transport model has the capability to realistically predict the effects of oxygen mass fraction on the flame lift-off, auto-ignition, flame structure, and NOx formation characteristics in turbulent CH4/H2 jet flames issuing from a jet in hot coflow (JHC). It was also found that the two-environment PDF approach reproduces the sensitivity of the CO and CO2 peak levels versus the O2 concentration variation, as well as the peak levels of NO conditional fluctuations under the MILD combustion condition. Even if considerable discrepancies in the unconditional means exist mainly due to inconsistent treatment of weight combination and shortcomings of singularity treatment procedure, the present three-environment PDF model well captures the measured high-level conditional temperature and CO fluctuations on the fuel-lean side where the local extinction occurs via mixing of the shrouded cold air and the vitiated flame field.

“Low down Dirty Rat”: Popular and Moral Responses to Possums and Rats in Melbourne

Possums and rats are both found in large numbers in the city of Melbourne, Australia. The two species share much in common, including an ability to flourish among humans and a predisposition for building nests in houses and eating food and plants intended for humans. Yet despite numerous similarities possums and rats are afforded strikingly different levels of protection before the law. The death of a possum must be justified and carried out painlessly. The same does not apply to rats, who may be exterminated freely and in ways that are painful. Considered from the perspective of the principle of “unnecessary suffering” we find that such inconsistent treatment is difficult to justify. We find that the rat’s historical association with disease may account for some of our animosity towards the species. Popular culture, which accords favorable treatment to possums and adopts contradictory attitudes to rats, appears to influence our attitudes in important ways. Our study does not demonstrate one way or the other whether rats are often used to represent undesirable characteristics because many humans have an aversion to them, or whether we have an aversion to them because of the cultural messages that encourage us to perceive of rats as abject. Rather, our conclusion is that human cruelty to animals is contradictory and irrational and that when another species potentially threatens human lives and human self-interest we react brutally and without due consideration.

Testing the impartiality of surveys to measure differential risk perception

The paper addresses the validation of opinion measurement by survey, specifically how the “readings” or views are consolidated for policy use into a single figure held to be representative of the population as a whole. While the sample mean might seem the obvious choice, a number of influential safety studies have employed a more complicated metric, the Valuation Index, as discussed within, to assess whether more should be spent to protect against some hazards than others. The question arises as to whether the Valuation Index treats the views of the different people in the survey sample impartially or not.The Valuation Index possesses the property of reciprocality, in the sense that the Index of the reciprocal is equal to the reciprocal of the Index. Jensen’s inequality reveals that this reciprocality comes at the price of an inconsistent treatment of the individual’s view whenever there is any difference of opinion in the sample. The Valuation Index is found to be non-unique, in that a Second Valuation Index can be constructed using equivalent arguments. Thus if the Valuation Index is valid, then so must be the Second Valuation Index, but the latter returns a different value, implying a contradiction that can be resolved only by regarding neither as valid.Crucially, both the Valuation Index and the Second Valuation Index fail the test of structural view independence. Both indices are biased and thus neither is a valid measure for consolidating human opinions.The finding has particular importance for the UK because opinion surveys interpreted using the Valuation Index have been influential in the changes to safety policy brought in for UK rail transport, where the amount recommended to avert death in multiple fatality accidents since 2003 has been reduced to about a third of what it used to be.

On the role of experience in ethical decision making at work

Previous research has produced contradictory results on whether and how “experience” relates to ethical decision making in the workplace. Maintaining that these divergent findings result from underspecified and inconsistent treatments of experience in the business ethics literature, we build theory around experience and its connection to ethical decision making. To this end, we draw upon and advance research on ethical expertise, defined as the degree to which one is knowledgeable about and skilled at applying moral values within a given work context. We also unpack the nature and consequences of two forms of ethical expertise, convergent and divergent. Building on this foundation—and seeking to reconcile the contradictory results around experience and ethical decision making—we theorize factors associated with the acquisition of ethical expertise in the workplace. We conclude by discussing the implications of our theorizing for business ethics scholarship and expertise research.

Dxtbx: the diffraction experiment toolbox.

Data formats for recording X-ray diffraction data continue to evolve rapidly to accommodate new detector technologies developed in response to more intense light sources. Processing the data from single-crystal X-ray diffraction experiments therefore requires the ability to read, and correctly interpret, image data and metadata from a variety of instruments employing different experimental representations. Tools that have previously been developed to address this problem have been limited either by a lack of extensibility or by inconsistent treatment of image metadata. The dxtbx software package provides a consistent interface to both image data and experimental models, while supporting a completely generic user-extensible approach to reading the data files. The library is written in a mixture of C++ and Python and is distributed as part of the cctbx under an open-source licence at http://cctbx.sourceforge.net.

Tu2004 Therapy of Zenker's Diverticulum With Flexible Endoscopy Versus a Rigid Endoscopic Approach: a Matched Cohort Study

Introduction The effortful swallow (ES) is designed to increase tongue base to posterior wall contact in patients with reduced oropharyngeal pressure, hereby improving bolus clearance. However, the effect of bolus volume and consistency on swallowing during this maneuver is unclear. Hence, we aim to quantify the effect of ES on pressure flow metrics and its interaction with bolus volume and consistency in healthy subjects. Material and Methods 12 healthy controls (6M, 6F, mean age 32 years, 21-53 years) swallowed 3 bolus consistencies (liquid, semisolid, and solid) in 2 bolus volumes (small [5ml-2cm2] or large [10ml-4cm2]). All swallows were recorded with combined high resolution manometryimpedance (36P12Z catheter) and analyzed using AIMplot software, deriving swallowmetrics for the pharynx and upper esophageal sphincter (UES). Different mixed models were estimated with each AIM metric as dependent variable, and volume, consistency and head posture as within-subject independent variables. Pairwise differences were tested using posthoc t-tests corrected for multiple comparisons. Results No significant effect of ES on pharyngeal peak pressure was found (p=0.4) (Figure 1). ES significantly increased time from nadir impedance to pharyngeal peak pressure (p<0.0001) (Figure 2), indicating improved bolus propulsion compared to the head neutral position. Discussion This study shows that ES does not increase the strength of the pharyngeal contraction, but rather influences its timing with bolus flow. We believe this observation may be clinically relevant as ES is often the maneuver of choice in patients with pharyngeal hypocontractility. Our finding may contribute to the understanding of inconsistent treatment success while using this swallow maneuver.

Self-consistent treatment of tidal variations in the geocenter for precise orbit determination

We show that the current levels of accuracy being achieved for the precise orbit determination (POD) of low-Earth orbiters demonstrate the need for the self-consistent treatment of tidal variations in the geocenter. Our study uses as an example the POD of the OSTM/Jason-2 satellite altimeter mission based upon Global Positioning System (GPS) tracking data. Current GPS-based POD solutions are demonstrating root-mean-square (RMS) radial orbit accuracy and precision of \({<}1\) cm and 1 mm, respectively. Meanwhile, we show that the RMS of three-dimensional tidal geocenter variations is \({<}6\) mm, but can be as large as 15 mm, with the largest component along the Earth’s spin axis. Our results demonstrate that GPS-based POD of Earth orbiters is best performed using GPS satellite orbit positions that are defined in a reference frame whose origin is at the center of mass of the entire Earth system, including the ocean tides. Errors in the GPS-based POD solutions for OSTM/Jason-2 of \({<}4\) mm (3D RMS) and \({<}2\) mm (radial RMS) are introduced when tidal geocenter variations are not treated consistently. Nevertheless, inconsistent treatment is measurable in the OSTM/Jason-2 POD solutions and manifests through degraded post-fit tracking data residuals, orbit precision, and relative orbit accuracy. For the latter metric, sea surface height crossover variance is higher by \(6~\hbox {mm}^{2}\) when tidal geocenter variations are treated inconsistently.

Particle production in relativistic heavy-ion collisions: A consistent hydrodynamic approach

We derive relativistic viscous hydrodynamic equations invoking the generalized second law of thermodynamics for two different forms of the non-equilibrium single-particle distribution function. We find that the relaxation times in these two derivations are identical for shear viscosity but different for bulk viscosity. These equations are used to study thermal dilepton and hadron spectra within longitudinal scaling expansion of the matter formed in relativistic heavy-ion collisions. For consistency, the same non-equilibrium distribution function is used in the particle production prescription as in the derivation of the viscous evolution equations. Appreciable differences are found in the particle production rates corresponding to the two non-equilibrium distribution functions. We emphasize that an inconsistent treatment of the non-equilibrium effects influences the particle production significantly, which may affect the extraction of transport properties of quark-gluon plasma.

Effectiveness for Older Infants To Start Cranial Remodeling Treatment with Wearing Helmet in Positional Plagiocephaly

INTRODUCTION: Infants have malleable and fast-growing cranial bones, and are therefore at risk of developing skull deformation if their head often remains in the same position. There were several studies for optimal time to start cranial remodeling treatment with wearing helmet. Along some research studies, starting helmet therapy early (age 5 to 6months) is important and leads to a significantly better outcome in a shorter treatment time. However, there is insufficient literature for effectiveness of helmet therapy for older infants. Therefore, the aim of this present study is to evaluate effectiveness of cranial remodeling treatment with wearing helmet for older infants (>= 18months). METHODS: The study was designed as a retrospective study of 30 infants with positional plagiocephaly without synostosis who were started from January 1, 2008 to August 1, 2011. All of the patient was aged over 18 months when they were started cranial remodeling treatment with wearing helmet. Every child underwent a computerized tomography before starting helmet therapy to exclude synostoses of the cranial sutures and performed CT once again after completion of therapy who have had satisfactory result. In every child anthropometric measurements were taken through CT scan and using spreading calipers. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. RESULTS: The discrepancy of CVA and CVAI of all the patients significantly decreased after treatment with cranial molding helmet for older infants (>= 18 months). The treatment lasted 14.5 months on average, was well tolerated and had no complication. In addition, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the wearing time per day was less than twenty hours. CONCLUSION: With the increasing incidence and rising awareness of parents, management of positional plagiocephaly by wearing cranial molding helmet has become a matter of growing medical interest. There are still a lot of different, inconsistent treatment regimens, and helmet therapy itself is controversial for older infants. This study shows that treatment by cranial remodeling orthosis is effective, well tolerated for older infants and has no morbidity. This therapeutic option should always be taken up for these older infants before other cranial remodeling surgery or abandonment for treatment.

Treatment of the infrared contribution: NLO QED evolution as a pedagogic example

We show that the conventional prescription used for DGLAP parton evolution at NLO has an inconsistent treatment of the contribution from the infrared (IR) region. We illustrate the problem by studying the simple example of QED evolution, treating the electron and photon as partons. The deficiency is not present in a physical approach which removes the IR divergency and allows calculation in the normal 4-dimensional space.

WE-G-108-01: A Computer Assisted Treatment Events Recognition System (CATERS) For Radiation Therapy

Purpose: To develop an automated treatment event detection system to safeguard radiation therapy patients by analyzing electronic treatment records and reporting treatment events. Methods: CATERS is to make the treatment monitoring process more efficient by offloading repetitive tasks to the computer. Treatment events are defined as possible deviations from physician's intention, such as inconsistent or wrong treatment parameters. CATERS consists of a user interface, the CATERS core, and a data interface. CATERS core is responsible for all logic analysis and treatment event recognition. Through the user interface, users can access CATERS from either mobile devices or desktop computers. The data interface provides methods for retrieving electronic treatment records. A five months study was conducted to compare CATERS with manual chart checks. Results: From July 2012 to November 2012, 491 patients were treated at our clinics for total of 7692 fractions. From these fractions, 553 events were detected by CATERS, none of the events has significant dosimetric impacts on patient treatments. On average, it takes about one second to check one patient. During the trial, CATERS was able to efficiently detect all events that were discovered with a manual chart check when used side-by-side. The top three types of events were couch position override (3.2%), cone beam CT frequency (1.85%), and significant couch position deviation (1.31%). CATERS is clinically deployed and routinely used by all the physicists in our clinics. Conclusion: CATERS offers an effective method to detect and report treatment events. With CATERS, radiation treatments can be monitored and treatment events can be reported on a daily or even an hourly basis. Caters has the potential to improve treatment check efficacy and minimize the possibility of a misadministration.

Continuous controversy about radiation oncologists’ choice of treatment regimens for bone metastases: should we blame doctors, cancer-related features, or design of previous clinical studies?

Recent studies from Italy, Japan and Norway have confirmed previous reports, which found that a large variety of palliative radiotherapy regimens are used for painful bone metastases. Routine use of single fraction treatment might or might not be the preferred institutional approach. It is not entirely clear why inter-physician and inter-institution differences continue to persist despite numerous randomized trials, meta-analyses and guidelines, which recommend against more costly and inconvenient multi-fraction regimens delivering total doses of 30 Gy or more in a large number of clinical scenarios. In the present mini-review we discuss the questions of whether doctors are ignoring evidence-based medicine or whether we need additional studies targeting specifically those patient populations where recent surveys identified inconsistent treatment recommendations, e.g. because of challenging disease extent. We identify open questions and provide research suggestions, which might contribute to making radiation oncology practitioners more confident in selecting the right treatment for the right patient.

Benefit dependency: The pros and cons of using “caseload” data for national and international comparisons

AbstractPolicy‐makers in advanced welfare states have increasingly expressed concerns over large numbers of working‐age people claiming social security support. Accordingly, policies aimed at reducing the level of “benefit dependency” have gained prominence. However, such policies rest on shaky empirical evidence. Systematic collections of national “caseload” data are rare, social security programmes overlap and administrative categories vary over time. The internationally inconsistent treatment of national transfer programmes provides a further challenge for cross‐national comparisons. This article first identifies and discusses several of these problems, and ways in which they may be addressed. It then employs administrative claimant data from six European countries as a way of illustrating trends over time and across countries. The underlying aim is to explore the scientific potential of benefit recipient numbers as an indicator for welfare state change over time and across countries.