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PubMed1999

Prognostic impact of second cancer on the survival of early breast cancer patients.

Although numerous reports have been published on the incidence of second cancers after adjuvant therapy for early breast cancer, there have been few studies on the effect of the development of second cancer on overall survival (OS) of the patients. 1857 female patients younger than 80 years of age with operable breast cancer with UICC Stages I, II, and III who entered 3 trials of adjuvant therapy were studied for the detection of recurrence and second cancer. The median follow-up period for surviving patients was 12 years (range, 5-25 years). 384 of recurrence and 119 of second cancers occurred. 465 deaths were recorded, the causes of which were designated to be due to recurrence of breast cancer in 326 patients, second cancers in 57, and due to other causes in 82. Many background factors that were significantly related to recurrence did not influence the incidence of and death by second cancers after mastectomy: age and menopausal status alone were related. The difference in the Kaplan-Meier curves between the event (recurrence and second cancers)-free and relapse-free survivals indicates the incidence of second cancers is a significant event in post-operation course of early breast cancer patients (P=0.0001). The survival curve of patients who were free from recurrence- and second cancer-death is shown to be significantly lower than that of those free from breast cancer-specific death (P=0.0355), suggesting that death by second cancers is significantly influential to the overall survival. According to the Cox regression model using a recurrence or second cancers as time-dependent variables, the diagnosis of a recurrence or second cancer is shown to be highly significant to OS of the patients (hazard ratio: 49.3, and 6.3, respectively). Second cancers are shown to be not statistically significantly influential to the breast cancer specific survival (P=0.0637), nor a recurrence to second cancer specific survival (P=0.2285). In spite of heterogeneous distribution of sites of second primary cancers and their different natural histories, the incidence of second cancer has a significant effect on the postoperative survival of early breast cancer patients. In the survival analysis of early breast cancer patients, we have to estimate the contribution of second cancers to properly evaluate the effect of treatment.

Adult↗
PubMed2004

[A meta-analysis of the effects of smoking prevention programs in Korea].

PURPOSE: The purpose of this paper was to describe the characteristics of smoking prevention programs in Korea, to estimate overall effect size of Korean smoking prevention programs, and to investigate effect size variations by program modality and instruction method. METHOD: Meta-analysis was performed on 21 programs in 20 studies. RESULT: The estimation of overall effect size for knowledge and attitude was not possible because effect sizes were not homogeneous in this meta-analysis. However, effect sizes of studies that were socially influential programs or active/interactive methods were larger than information-oriented programs or passive/non-interactive methods in the pictures. The effects for behavioral outcomes were generally not as positive and not statistically significant. Q statistics showed that variations among effect sizes within program modality and instruction method classifications were heterogeneous. CONCLUSION: The results from this meta-analysis support the continued use of socially influential programs and active/interactive methods for smoking prevention programs. Because behavioral effect might be the fundamental objective of smoking prevention programs, the present results indicate that smoking prevention programs should consider adopting more effective programs.

Health Promotion↗
PubMed2005

Factors influencing the choice of specialty of Australian medical graduates.

OBJECTIVE: To identify the relative importance of extrinsic determinants of doctors' choice of specialty. DESIGN: A self-administered postal questionnaire. SETTING: Australian vocational training programs. PARTICIPANTS: 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. MAIN OUTCOME MEASURES: Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. RESULTS: In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. CONCLUSIONS: Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.

Adult↗
PubMed2004

Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy.

BACKGROUND: Increasing use of colonoscopy for colorectal cancer screening and surveillance of colorectal adenomas after polypectomy has given rise to concerns about the availability of endoscopic resources in the United States. Guidelines recommend surveillance after polypectomy at 3 to 5 years for a small adenoma, and follow-up is not advised for hyperplastic polyps. The intensity of physicians' surveillance is largely unstudied. OBJECTIVE: To survey practicing gastroenterologists and general surgeons about their perceived need for the frequency of surveillance after polypectomy, to compare survey responses to practice guidelines, and to identify factors influencing their recommendations for surveillance. DESIGN: Survey study conducted by the National Cancer Institute. SETTING: A nationally representative study of physicians in the United States. PARTICIPANTS: 349 gastroenterologists and 316 general surgeons. MEASUREMENTS: Questionnaires mailed in 1999 and 2000 assessed physicians' recommendations for surveillance after polypectomy in asymptomatic, average-risk patients. RESULTS: Response rates were 83%. Among gastroenterologists (317 of 349) and surgeons (125 of 316) who perform screening colonoscopy, 24% (95% CI, 19.3% to 28.7%) of gastroenterologists and 54% (CI, 44.9% to 62.5%) of surgeons recommend surveillance for a hyperplastic polyp. For a small adenoma, most physicians recommended surveillance colonoscopy and more than 50% recommended examinations every 3 years or more often. Physicians indicated that published evidence was very influential in their practice (83% [CI, 78.8% to 87.2%] of gastroenterologists and 78% [CI, 72.5% to 86.8%] of surgeons). By contrast, only half of respondents reported that guidelines were very influential. LIMITATIONS: The study was based on physicians' self-reported practice patterns. Results may overestimate or underestimate the performance of surveillance colonoscopy. CONCLUSIONS: Some surveillance colonoscopy seems to be inappropriately performed and in excess of guidelines, particularly for hyperplastic polyps and low-risk lesions such as a small adenoma. These results suggest unnecessary demand for endoscopic resources.

Adenoma↗
PubMedDate not supplied

A theory of shoe wear pattern influence incorporating a new paradigm for the podiatric medical profession.

Qualitative analysis of shoe wear patterns collected from a questionnaire evaluating podiatric physicians' experiences in this area suggests that wear patterns could indicate causative function within a known pathologic context. Several different functions are suggested by patterns associated with each of the pathologic entities involved, and analysis of the relationship between patterns and reasons given by respondents for pattern-form variations show the strongest associations to be with functionally termed conditions. A basic model is proposed to present factors important in wear pattern production, suggesting that a new concept of primary walking intention is more influential than foot pathologies in wear pattern formation and that external factors are also influential, with the combined factors being described as the "holistic foot function." This model may provide a variety of benefits to podiatric medicine; as shoe wear patterns are records of the usual long-term activity of the functioning foot, this paradigm could form a basis for podiatric medical practice.

Foot↗
PubMedDate not supplied

Characterization of spermatozoa by planar morphometry.

OBJECTIVE: To define the morphometric characteristics of normal sperm heads, and compare them to sperm head measurements used to define normal morphology using strict criteria. DESIGN: Computerized image analysis of selected normal and abnormal seminal fluid specimens collected for routine male fertility studies. SETTING: Research laboratory at the Department of Medical Technology, Bowling Green State University, Bowling Green, OH. PATIENTS: Sixty adult male patients who submitted semen samples for routine analysis. Fifty percent had normal seminal fluid analysis results. The remaining 50% demonstrated abnormal sperm morphology. CRITERION STANDARD: Microscopic evaluation of sperm head morphology. Sperm fitting the criteria of normal as defined by WHO (1987 and 1992) and Kruger (1988) were classified as normal. Sperm with a post nuclear area of less than 40% were classified as acrosomal deficient. MAIN OUTCOME MEASURES: Measurements made from stained seminal fluid smears included sperm head area, perimeter, acrosomal area, percent acrosome, Ferret's diameters, aspect ratio, shape factor, and specific length. Normal sperm heads (NL group) were compared to sperm heads demonstrating an acrosomal deficiency (AD group) for statistically significant differences using multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA). Stepwise discriminant analysis was used to remove duplicating variables. Discriminant analysis was used to classify the sperm heads into NL and AD groups. Receiver-operating characteristic (ROC) curves were applied to the 2 most influential variables in order to identify a cutoff that best distinguishes normal from acrosomal deficient sperm heads. RESULTS: MANOVA and ANOVA showed all 10 variables to be statistically significant (p < .002). Discriminant analysis correctly assigned 98.7% of the normal sperm heads to the NL group and 99.0% of sperm with acrosomal deficiency to the AD group. The percent acrosome and acrosomal area were determined to be the 2 most influential variables. ROC analysis identified a cutoff of 3.6 mu2 for acrosomal area as having the highest sensitivity and specificity (99.7% and 88.0%, respectively). Similarly, a cutoff of 44% for percent acrosome gave a sensitivity of 92.3% and a specificity of 88.7%. The coefficient of variation (CV) for each of the 10 variables determined from 20 day-to-day replicates of a normal semen smear ranged from 2.6% to 8.4%. CONCLUSION: Computerized image analysis is able to define a reference range for sperm head area, percent acrosome, and acrosomal area that may be used to differentiate normal form abnormal sperm heads. Maximum and minimum Ferret's diameters measure sperm head length and width, respectively. Mean maximum Ferret's diameter, minimum Ferret's diameter, and maximum-minimum Ferret's diameter ratio correspond closely to the WHO (1987) midpoint for normal sperm head length, width, and length-width ratio. The average percent acrosome of normal sperm heads determined by morphometry closely correlate to the WHO (1992) and Kruger (1988) midpoints for percent acrosome.

Acrosome↗
PubMed1999

Effectiveness of nurse executives: measurement of role factors and attitudes.

This article describes the outcome of a survey of 40 nurse executives and 56 influential colleagues. Both groups agreed that leadership was the most important quality for the executive role. The nurses' primary focus was resolution of patient care problems. Influential colleagues stated resource allocation and initiation of change were two qualities needing improvement. The nurses rated themselves high in confidence about their job responsibilities, scored relationships as the most satisfying attribute, and cited provision of quality health care as the greatest advantage of their position. The greatest disadvantage was lack of administrative support. The results suggest the educational preparation needed for nurse executives.

Attitude of Health Personnel↗
PubMed1999

[Radical prostatectomy in clinically localized prostatic adenocarcinoma. Factors influencing biochemical progression free survival].

MATERIAL AND METHOD: Study of biochemical progression (PSA > 0.5 ng/ml) and biochemical progression-free survival in 160 patients diagnosed with clinically localized prostate adenocarcinoma who underwent radical prostatectomy at the University Clinic in Navarra between 1988-1997. RESULTS: At the end of the study, 120 patients (75%) are alive and free of progression, 33 (20%) are alive and in progression, 3 (1.9%) died of cancer, and 4 (2.5%) died for other causes. Biochemical progression occurred in 43/160 (27%) patients. Progression is related to previous PSA, both in absolute terms and divided into greater or smaller than 15 ng/ml; to Gleason grade greater or smaller than 7 or divided into 2-4, 5-7, 8-10; to pathological stage and to urethro-vesical junction stenosis. Biochemical progression-free survival (BPFS) in the univariate study is related to PSA (the ideal prognostic cut-off value being 15 ng/ml); to Gleason, specially when divided into 2-4, 5-7, 8-10; to the pathological stage and to margins. The multivariate study evidences that the single most influential factors are PSA (divided as greater or smaller than 15 ng/ml), Gleason grade (divided into: 2-4, 5-7, 8-10) and margins involvement. There are 3 highly reliable risk groups based on PSA, Gleason and clinical stage. When these are introduced as variables in the multivariate study, they appear as the strongest predictive variables. CONCLUSIONS: The influential factors on progression-free survival are PSA (15 ng/ml being the best prognostic cut-off value), Gleason grade (divided into 2-4, 5-7, 8-10) and margins' positivity, which are the single most significant pathological factor ahead of clinical stage. Serum PSA, clinical stage and Gleason grade allow to define three reliable risk groups.

Adenocarcinoma↗
PubMed1999

Quantitative structure-activity relationship (QSAR) analysis of surfactants influencing attachment of a Mycobacterium sp. to cellulose acetate and aromatic polyamide reverse osmosis membranes.

A series of 23 neutral, anionic, and zwitterionic surfactants were tested at a concentration of 0.1% wt/vol for their influence on attachment of a Mycobacterium sp. to cellulose acetate (CA) and polyamide (PA) reverse osmosis (RO) membranes. Four cell attachment bioassays were used: (1) semiconcurrent addition of surfactant and bacteria to RO coupons (standard assay); (2) surfactant pretreatment of RO membranes (membrane pretreatment assay); (3) surfactant treatment of adsorbed cells (detachment assay); and (4) surfactant pretreatment of mycobacteria (cell pretreatment assay). Seventeen surfactants inhibited attachment to PA membranes, whereas 15 inhibited attachment to CA in standard assays and, in 13 cases, the same surfactant inhibited attachment to both PA and CA. Despite greater cell attachment to PA than CA, surfactants were typically more effective in the former membrane system. More surfactants were effective in impairing cell attachment than in promoting detachment and a number enhanced attachment in membrane pretreatment assays, suggesting surface modification of RO membranes. Cell pretreatment inhibited attachment to CA membranes, suggesting the bacterial surface was also a target for detergent activity. Multivariate regression and cluster analyses indicated that critical micellar concentration (CMC) was positively correlated with Mycobacterium attachment in CA and PA standard assays. Surfactant dipole moment and octanol/water partitioning (LogP) also contributed to detergent activity in the PA system, whereas dipole moment, molecular topology (i.e., connectivity indices), and charge properties influenced activity in the CA system. Influential variables in membrane pretreatment assays included the LogP, topology indices, and charge properties, whereas CMC played a diminished role. Surfactant dipole moment was most influential in CA membrane detachment assays. Increasing system ionic strength by LiBr addition strengthened inhibition of cell attachment to CA membranes by dodecylbenzene sulfonic acid (DBSA) and promoted DBSA adsorption to CA surfaces as indicated by attenuated total reflection Fourier-transform infrared spectrometry. Results indicate that inhibition of bacterial attachment to RO membranes may be maximized by manipulating surfactant molecular structure to optimize surface adsorption behavior.

Bacterial Adhesion↗
PubMed1999

[The perceptions of the adult Spanish population of the factors determinative of health].

OBJECTIVE: To assess which are the most important perceived influential factors on health among the Spanish adult population. This may provide sufficient information to promote primary health care campaigns directed specifically to those that acknowledge that lifestyles are important in spite of not living healthy lifestyles themselves. DESIGN: Observational cross-sectional study. SETTING: Spain (Canary Islands not included). PARTICIPANTS: A representative sample of 1000 Spanish participants over 15 years old selected by a multistage procedure. INTERVENTION: Survey to evaluate the population choosing one of nine known health-related factors (smoking, food, alcohol intake, stress, physical activity, environment, body weight, support from family, genetics) as being one of the two most important factors influencing health through a validated questionnaire. MEASUREMENTS AND RESULTS: The chi-square test for linear trend was used to assess the influence of factors coded on an ordinal scale. The Pearson chi-square test was applied for categorical factors. Smoking was considered the most influential health-related factor by most participants (47.8%). Males, those from lower socioeconomic and educational levels; people living in the south of Spain, and rural regions; those married and individuals who had 3 or more children below 15 years, perceived smoking more often as one of the most important determinants of health. CONCLUSIONS: These data suggest that a large percentage of the Spanish adult population recognizes that life-styles are important determinants of health.

Adolescent↗
PubMed2000

Working women identify influences and obstacles to breast health practices.

PURPOSE/OBJECTIVES: To identify factors contributing to participation in breast screening in working women to drive health education planning and implementation. DESIGN: Survey. SETTING: Automotive plants in southern Canada. SAMPLE: Union and nonunion women working in the plants. METHODS: Survey using "Health Care Practices: A Worksite Survey," modified for Canadian population. MAIN RESEARCH VARIABLES: Age, education, breast health practices, influences on decision to participate in breast screening, and physician gender. FINDINGS: Differences were noted among three age groups (under 30 years, 30-49 years, 50 years or older) in terms of influences and perceived barriers to the different modalities of breast screening. For clinical breast exams, women preferred an expert in breast health, regardless of whether the professional was a physician or a nurse. In all groups, the physician was noted as being very influential; however, perceptions of encouragement from the physician varied across the age groups. Perceptions of barriers to breast screening differed among the age groups and between women with male physicians and those with female physicians. Coworkers were identified as being a strong influence in the older group, whereas friends and family were identified as being more influential in the younger groups. CONCLUSIONS: Health promotion and education strategies may need to be stratified for different age groups. IMPLICATIONS FOR NURSING PRACTICE: Breast health education may need to be seen as an ongoing educational process, with the target groups being both the women and the primary healthcare professionals. The worksite has strong potential as a setting for health promotion activities.

Adolescent↗
PubMed2000

Benner and the critics: promoting scholarly dialogue.

The research and theorizing of Patricia Benner and colleagues have been very influential in nursing around the world. In recent years, however, her work has been challenged on both methodological and philosophical grounds, primarily from critical-hermeneutic and postmodernist perspectives. Critics have identified concerns about Benner's work, including sample limitations, decontextualized exemplars, the exclusion of social and political concerns, the problematic issues of experience and interpretation, and the unacknowledged position of the researcher. This article attempts to synthesize those critiques, and offers a comprehensive framework for constructive dialogue. Disciplinary maturity and scholarly integrity require critical reevaluation of influential texts and research programs.

Education, Nursing↗
PubMed2001

[An empirical research for demand of influenza vaccination].

PURPOSE: This article examines the demand for influenza vaccination in Japan. METHODS: Original date were obtained from a survey conducted by the authors. Two approaches, usual demand analysis and conjoint analysis, were employed. The second approach, conjoint analysis, uses people's statements on how they would respond to different hypothetical situations. In this research, we ask people whether they wish to be vaccinated given different circumstances such as costs of vaccination, degree of convenience, and outbreak news. RESULTS: In the demand analysis, the vaccination rate during the 1999-2000 season was found to have increased by 0.8 percentage points compared to that of the previous season. The rate increased by 1.0 to 3.5 percentage points among the group of people who experienced influenza in the previous season. The vaccination rate also increased by 31-47 percentage points for those who were vaccinated in the previous season. A 10 percentage increase in household income decreased the demand for vaccination by 2 percentage points. Although household income was significant in only with the largest sample, this result may indicate that the time or opportunity cost for vaccination decreases the vaccination demand. In the conjoint analysis, the financial cost was significantly negative. When the cost was reduced from the current level of 6,000 yen to free of charge, the vaccination rate would increase by 43.5 percentage points. Were vaccination available at night or during holidays,! or at school or work, the rate would increase by 11 percentage points, or 16 percentage points, respectively. Most of all, news of influenza prevalence was very influential in increasing the desire for vaccination by 33 percentage points. Vaccination experience and last year's influenza experience were both significantly positive, increasing the rate by 22 and 8 percentage points, respectively. CONCLUSIONS: In the demand analysis, influenza experience and history of vaccination during the 1999-2000 season were found to be influential regarding the decision for vaccination. From the conjoint analysis, providing vaccination of night or during holidays, as well as at work or at schools would increase the demand. News of influenza outbreaks were also found to increase the vaccination demand. Higher income, however, was found to have a negative influence, suggesting that opportunity costs may be an important factor for some individuals. Habit formation effects through a history of vaccination plays quite an important role in vaccination demand.

Adult↗
PubMed2001

Effects of case removal in prognostic models.

Constructing and updating prognostic models that learn from training cases is a time-consuming task. The more compact, and yet informative, the training sets are, the faster one can build and properly evaluate such models. We have compared different regression diagnostic methods for selection and removal of training cases in prognostic models. Univariate determinations were performed using classical regression diagnostic statistics. Multivariate determinations were performed using (1) a sequential "backward" selection of cases, and (2) a non-sequential genetic algorithm. The genetic algorithm produced final models that kept few cases and retained predictive capability. A genetic algorithm approach to case selection may be better suited for guiding removal of cases in training sets than a univariate or a sequential multivariate approach, possibly because of its ability to detect sets of cases that are influential en bloc but may not be sufficiently influential when considered in isolation.

Algorithms↗
PubMed1995

[Social medicine and social engineering].

In a rather complicated process starting at the middle of the 19th century and ending hundred years later social medicine was established as a science. Different theories on the social origin of the diseases and even different perspectives on the role of medicine in society did influence and shape the new discipline. The tradition from Rudolf Virchow and Alfred Grotjahn emphasizing the importance of the social causes of the diseases and the tradition from social hygiene with its stress on the hereditarian background of many diseases was mixed together in the early history of social medicine. Many of those trying to establish the new discipline thought that it could be used in order to prevent the spreading of diseases in society and also hinder the development of social maladjustments of different kinds, as for instance criminality and vagrancy. The political framework of social medicine was very much related to what in the Swedish debate later on was to be called social engineering. Both within the tradition of social liberalism and the social democratic party the ideals of a rational society governed by experts was very influential in the period between the two world wars. Some of the advocates for social medicine did even try to formulate a political programme with the new science as a base. The most influential of those was the forensic pspychiatrist Olof Kinberg (1873-1960). In a series of books and articles during the first half of the 19th century Kinberg developed a theory of a society governed by doctors educated within this new branch of science. He thought that almost every kind of social problem could be handled by these experts. Social maladjustment, criminality and even car accidents could be reduced to a minimum if only the new knowledge of the biological and medical causes of human behavior was allowed to influence the social and political organization of the society. Especially during the 1930s some politicians and also social scientists thought that politics in the future had to be some kind of applied science. In order to govern a complicated society it was necessary to use the knowledge developed within the sciences dealing with the relation between man and society. After the second world war this way of thinking was a little bit obsolete, but it did influence many of those working within the public sphere as administrators and experts.

History, 19th Century↗
PubMed2001

Healthcare benefits of very-low-dose combination treatment used in the management of hypertension.

There are several classes of effective pharmacological agents available for the treatment of hypertension. However, rates of successful blood pressure control remain low among treated patients, while antihypertensive medication represents a large and increasing proportion of healthcare expenditure in many countries. Several influential pharmacoeconomic analyses have confirmed the cost-effectiveness of conventional antihypertensive treatments, usually involving monotherapy using diuretics or beta-blockers, compared with alternative strategies. Recent research has shown that a considerable proportion of the total cost of antihypertensive treatment in general practice is attributable to factors such as inadequate blood pressure control, poor compliance with treatment, discontinuation of treatment, and switching between treatments. These factors are generally less influential in well-supervised clinical trials, and have not been fully incorporated into most economic studies. Some novel strategies, particularly the use of low-dose combinations of antihypertensive agents as first-line therapy, may offer advantages in terms of efficacy, reduced side effects, and improved compliance with treatment; these advantages would be predicted to result in improved cost-effectiveness. There is therefore a need for comprehensive pharmacoeconomic analyses of novel strategies, taking these additional factors into account. Until such studies are available, the wider use of low-dose combination treatments and other novel strategies should not be held back on the basis of findings of earlier economic studies that have not included all relevant considerations.

Antihypertensive Agents↗
PubMed2002

The unexpected influence of physician attributes on clinical decisions: results of an experiment.

UNLABELLED: This experiment was designed to determine: (1) whether patient attributes (specifically a patient's age, gender, race, and socioeconomic status) independently influence clinical decision-making; and (2) whether physician characteristics alone (such as their gender, age, race, and medical specialty), or in combination with patient attributes, influence medical decision-making. METHODS: An experiment was conducted in which 16 (= 2(4)) videotapes portraying patient-physician encounters for two medical conditions (polymyalgia rheumatica (PMR) and depression) were randomly assigned to physicians for viewing. Each video presented a combination of four patient attributes (65 years or 80 years of age; male or female; black or white; blue or white collar occupation). Steps were taken to enhance external validity. One hundred twenty-eight eligible physicians were sampled from the northeastern United States, with numbers balanced across 16 (= 2(4)) strata generated from the following characteristics (male or female; < 15 or > or = 15 years since graduation; black or white; internists or family practitioners). The outcomes studied were: 1) the most likely diagnosis; 2) level of certainty adhering to that diagnosis; and 3) the number of tests that would be ordered. RESULTS: Patient attributes (namely age, race, gender, and socioeconomic status) had no influence on the three outcomes studied (the most likely diagnosis, the level of certainty, and test ordering behavior). This was consistent across the two medical conditions portrayed (PMR and depression). In contrast, characteristics of physicians (namely their medical specialty, race, and age) interactively influenced medical decision-making. CONCLUSION: Epidemiologically important patient attributes (which Bayesian decision theorists hold should be influential) had no effect on medical decision-making for the two conditions, while clinically extraneous physician characteristics (which should not be influential) had a statistically significant effect. The validity of idealized theoretical approaches to medical decision making and the usefulness of further observational approaches are discussed.

Age Factors↗
PubMed2002

A comparative analysis of methods to represent uncertainty in estimating the cost of constructing wastewater treatment plants.

Prediction of construction cost of wastewater treatment facilities could be influential for the economic feasibility of various levels of water pollution control programs. However, construction cost estimation is difficult to precisely evaluate in an uncertain environment and measured quantities are always burdened with different types of cost structures. Therefore, an understanding of the previous development of wastewater treatment plants and of the related construction cost structures of those facilities becomes essential for dealing with an effective regional water pollution control program. But deviations between the observed values and the estimated values are supposed to be due to measurement errors only in the conventional regression models. The inherent uncertainties of the underlying cost structure, where the human estimation is influential, are rarely explored. This paper is designed to recast a well-known problem of construction cost estimation for both domestic and industrial wastewater treatment plants via a comparative framework. Comparisons were made for three technologies of regression analyses, including the conventional least squares regression method, the fuzzy linear regression method, and the newly derived fuzzy goal regression method. The case study, incorporating a complete database with 48 domestic wastewater treatment plants and 29 industrial wastewater treatment plants being collected in Taiwan, implements such a cost estimation procedure in an uncertain environment. Given that the fuzzy structure in regression estimation may account for the inherent human complexity in cost estimation, the fuzzy goal regression method does exhibit more robust results in terms of some criteria. Moderate economy of scale exists in constructing both the domestic and industrial wastewater treatment plants. Findings indicate that the optimal size of a domestic wastewater treatment plant is approximately equivalent to 15,000 m3/day (CMD) and higher in Taiwan. Yet the optimal size of an industrial wastewater treatment plant could fall in between 6000 CMD and 20,000 CMD.

Costs and Cost Analysis↗