Carotid endarterectomy for asymptomatic patients. Assessing results of a quantitative synthesis

Carotid endarterectomy (CE) surgery for asymptomatic patients remains controversial despite hundreds of published studies and recent randomized trials. Safety and efficacy are assessed using a quantitative synthesis method derived from meta-analysis and a "critical multiplist" inference approach. In addition, multivariate analyses reveal that use of a surgical shunt could further improve CE outcomes. Methods are examined for both their "confirmatory" and "exploratory" value.     

Oestrogen therapy and endometrial cancer

The most controversial issue related to prolonged estrogen therapy is the possible relationship of this therapy to the etiology and pathogenesis of breast and uterine cancer. The imprecise nature of the relevant data does not allow full definition of the rish. To maintain proper perspective, smoking 20 cigarettes a day increases the risk of death from lung cancer 17 times; the risk from estrogens is less than that. There is no controversy over the use of estrogens for short-term relief of menopausal symptoms. The Mulley and Mitchell paper referred to was opinion based on no direct research and an inadequate knowledge of the literature. The early symptoms of estrogen dificiency, hot flushes and atrophic vaginitis, respond to short-term estrogen therapy, which in addition, provides a "mental tonic" effect. It is not justifiable to withhold such therapy from the normal informed patient requesting it, provided no contraindications exist. The patient should be reevaluated at frequent intervals, and the proper selection of drug, dosage, and therepeutic regimen administered. This can be accomplished, including research, through a menopause clinic.     

The clinical assessment of cancer tests: a statistical approach to the prediction of "false positive" rates from controls

As the sensitivity of the new in vitro cancer detection techniques increases, a larger number of "false positive" results can be expected from control populations apparently free from malignant disease at the time of the test. An attempt is made to predict the number of unexplained positives, together with the expected age and sex distribution, using published cancer registration statistics. The predicted numbers are compared with the observed numbers of unexplained positives in two clinical trials of the MEM test.     

SUPPRESSION OF PERIOD DOUBLING CHATTER IN HIGH-SPEED MILLING BY SPINDLE SPEED VARIATION

Spindle speed variation is a well known technique to suppress regenerative machine tool vibrations, but it is usually considered to be effective only for low spindle speeds. In the current paper, spindle speed variation is applied to the high speed milling process, at the spindle speeds where the constant speed cutting results in period doubling chatter. The stability analysis of triangular and sinusoidal shape variations is made numerically with the semi-discretization method. It is shown that the milling process can be stabilized by increasing the amplitude of the spindle speed variation, while the frequency of the variation has no significant effect on the dynamic behaviour. The results are validated by experiments. Based on the analysis of the machined workpieces, it is shown that the surface roughness can also be decreased by the spindle speed variation technique.     

H] Tryptamine and 3H-water as diffusible internal standards for measuring brain extraction of radio-labeled substances following carotid injection

Urinary amino acid excretion was determined in 31 leukemic patients and 29 normal individuals by rapid gas chromatographic analysis of 16 amino acids as their N-acetyl-n-propyl esters. The leukemic patients were concurrently undergoing, or had recently completed, chemotherapy. It was found that aspartic acid, threonine, and serine were of significance in distinguishing between patients "on" therapy and those "off" therapy. Patients with advanced disease have the greatest aminoaciduria, although both the normal and leukemic populations have wide individual ranges. Within both populations, men excrete a greater variety and quantity of amino acids than women. It is concluded that analysis of urinary amino acids represents a history of complex metabolic events, which is potentially useful for evaluating patient response to chemotherapy in leukemia.     

Family centered maternity care: its relationship to perinatal regionalization and neonatal intensive care

For several months prior to birth a major portion of a family's attention, conversation, thought, and often worry, is directed toward the idea of a new child. This prolonged attention and anticipation contribute to making childbirth an emotionally charged experience. In psychological terms, it is therefore a critical period of peak motivation for learning, and a time to peak susceptibility to reinforcement. Theory, reason, and scientific evidence indicate thng with childbirth and early postpartum experiences, can significantly affect subsequent parental behaviors, the child's central environment influence. Evidence strongly suggests that these parental attitudes and behaviors so crucial to the child's ultimate well-being are learned rather than derived instinctually, and therefore they are malleable and can be taught, directed, and corrected. Through education and reinforcement it is possible to encourage parental behaviors and child interactions which are products of feelings of control, competence, accomplishment, understanding, and caring. Similarly we can recognize and work toward replacing attitudes, feelings, and behaviors that express fear, worry, and insecurity about the child. Over the past 50 years major changes have occurred in the practice of obstetrics and newborn pediatrics. Other major changes will necessarily occur as we move toward perinatal regionalization. Changes instigated solely on physiologic data can have unrecognized collateral effects on the psychological component of the childbirth experience. All concerned health care personnel, especially obstetricians and pediatricians, can insist that the importance of desirable mother-father-child interactions be recognized and that practices fostering them be afforded a high priority. I would like to endorse a comment from a recent article by Richmond concerning the advent of behavioral pediatrics by adding that behavioral obstetrics is also "an idea whose time has arrived".     

Evaluation of a Computer-Assisted, 2-D Virtual Reality System for Training People With Intellectual Disabilities on How to Shop.

Objective: To evaluate the effectiveness of a 2-D virtual reality (VR) program for training people with intellectual disabilities to shop. Study Design: Pretest and posttest quasi-experimental design. Participants: Sixteen persons with intellectual disabilities (age 17-23 years; IQ = 40-54). Intervention: A VR program or a conventional program training them in supermarket-shopping skills. Main Outcome Measure: Checklist for supermarket-shopping skills. Results: Participants in both training groups showed significant improvement. There was no significant difference in effectiveness between the two methods. Conclusions: The VR program appears effective in training people with intellectual disabilities in an important community living skill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Object-oriented CAD for Hydraulic Circuits of Pressing Machines

１ＩｎｔｒｏｄｕｃｔｉｏｎＴｈｅｅｘｐｅｒｔｓｙｓｔｅｍｓａｐｐｒｏａｃｈｉｓｃｕｒｅｎｔｌｙｂｅｉｎｇａｐｐｌｉｅｄｔｏｃｏｍｐｕｔｅｒ－ａｉｄｅｄｄｅｓｉｇｎ（ＣＡＤ）ｆｏｒｓｉｍｐｌｅｈｙｄｒａｕｌｉｃｃｉｒｃｕｉｔｓ．Ｍｏｓｔｏｆｔｈｅｅｘｐ...     

Oscillation and convergence behaviours exhibited in an ‘unstable’ second‐order digital filter with saturation‐type non‐linearity

This letter explains the oscillatory behaviours exhibited in a second‐order digital filter with saturation‐type non‐linearity via the Hopf bifurcation theorem. It is shown that depending on the bifurcation parameter, the state variables may converge to zero even when the eigenvalues of the system matrix are outside the unit circle. Copyright © 2004 John Wiley & Sons, Ltd. abstract     

Hinging hyperplane based regression tree identified by fuzzy clustering and its application

Hierarchical fuzzy modeling techniques have great advantage since model accuracy and complexity can be easily controlled thanks to the transparent model structures. A novel tool for regression tree identification is proposed based on the synergistic combination of fuzzy c-regression clustering and the concept of hierarchical modeling. In a special case (c = 2), fuzzy c-regression clustering can be used for identification of hinging hyperplane models. The proposed method recursively identifies a hinging hyperplane model that contains two linear submodels by partitioning operating region of one local linear model resulting a binary regression tree. Novel measures of model performance and complexity are developed to support the analysis and building of the proposed special model structure. Effectiveness of proposed model is demonstrated by benchmark regression datasets. Examples also demonstrate that the proposed model can effectively represent nonlinear dynamical systems. Thanks to the piecewise linear model structure the resulted regression tree can be easily utilized in model predictive control. A detailed application example related to the model predictive control of a water heater demonstrate that the proposed framework can be effectively used in modeling and control of dynamical systems.