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PubMed2000

A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003.

PURPOSE: The optimal fractionation schedule for radiotherapy of head and neck cancer has been controversial. The objective of this randomized trial was to test the efficacy of hyperfractionation and two types of accelerated fractionation individually against standard fractionation. METHODS AND MATERIALS: Patients with locally advanced head and neck cancer were randomly assigned to receive radiotherapy delivered with: 1) standard fractionation at 2 Gy/fraction/day, 5 days/week, to 70 Gy/35 fractions/7 weeks; 2) hyperfractionation at 1. 2 Gy/fraction, twice daily, 5 days/week to 81.6 Gy/68 fractions/7 weeks; 3) accelerated fractionation with split at 1.6 Gy/fraction, twice daily, 5 days/week, to 67.2 Gy/42 fractions/6 weeks including a 2-week rest after 38.4 Gy; or 4) accelerated fractionation with concomitant boost at 1.8 Gy/fraction/day, 5 days/week and 1.5 Gy/fraction/day to a boost field as a second daily treatment for the last 12 treatment days to 72 Gy/42 fractions/6 weeks. Of the 1113 patients entered, 1073 patients were analyzable for outcome. The median follow-up was 23 months for all analyzable patients and 41.2 months for patients alive. RESULTS: Patients treated with hyperfractionation and accelerated fractionation with concomitant boost had significantly better local-regional control (p = 0.045 and p = 0.050 respectively) than those treated with standard fractionation. There was also a trend toward improved disease-free survival (p = 0.067 and p = 0.054 respectively) although the difference in overall survival was not significant. Patients treated with accelerated fractionation with split had similar outcome to those treated with standard fractionation. All three altered fractionation groups had significantly greater acute side effects compared to standard fractionation. However, there was no significant increase of late effects. CONCLUSIONS: Hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally advanced head and neck cancer. Acute but not late effects are also increased.

Adult↗
PubMed2001

A fetal growth standard derived from multiple modalities.

OBJECTIVE: To create a fetal weight growth standard from published data on ultrasound-dated pregnancies. METHODS: A fetal growth standard was calculated from published birth weight data, sonographic weight standards, and one MRI study. The birth weights from the East Midlands Obstetric Database were modified by an incremental function to compensate for the lower weights of preterm infants. Published sonographic and MRI standards, and the modified birth weight curve were transformed to yield fractional growth curves that express fetal size as a proportion of the expected term weight. These three curves were then averaged, and the standard deviation was taken as 12% of the median. Curves for Europeans and Chinese were then generated. RESULTS: The average curve for fetal weight is a virtually linear function of gestational age, with a weekly weight gain of 5.2% of the expected term birth weight. CONCLUSIONS: Ultrasound-derived fetal growth curves are subject to bias inherent in weight estimation formulae. A standard derived from multiple modalities is likely to be a more robust estimate of normal fetal growth.

Birth Weight↗
PubMed2003

Similarity and difference among standard medical care, palliative sedation therapy, and euthanasia: a multidimensional scaling analysis on physicians' and the general population's opinions.

There is a strong controversy about the differences among standard medical care, palliative sedation therapy, and euthanasia in recent medical literature. To investigate the similarities and differences among these medical treatments, a secondary analysis of two previous surveys was performed. In those surveys, Japanese physicians and the general population were asked to identify their treatment recommendations or preferences for intolerable and refractory distress in the terminal stage. The options were standard medical care without intentional sedation, mild sedation, intermittent deep sedation, continuous deep sedation, and physician-assisted suicide (PAS)/euthanasia. Multidimensional scaling analysis mapped their responses. The physician responses were clustered into 3 groups: 1) standard medical care, 2) palliative sedation therapy including mild, intermittent deep, continuous deep sedation, and 3) PAS/euthanasia. The general population's responses were classified into 3 subgroups: 1) standard medical care, 2) mild and intermittent deep sedation, and 3) a group including continuous deep sedation and PAS/euthanasia. Physicians placed continuous deep sedation closer to mild and intermittent sedation, while the general population mapped it closer to PAS/euthanasia. In conclusion, physicians and general population can generally differentiate the three approaches--standard medical care, palliative sedation therapy, and PAS/euthanasia. We recommend that mild and intermittent deep sedation should be differentiated from standard medical care, and that continuous deep sedation should be dealt with separately from other types of sedation. Clear definitions of palliative sedation therapy will contribute to quality discussion.

Attitude of Health Personnel↗
PubMed1997

Standardizing constants for ultrasonic biometry, keratometry, and intraocular lens power calculations.

PURPOSE: To provide a method and values that facilitate standardization of constants for ultrasonic biometry, keratometry, and intraocular lens (IOL) power calculations. SETTING: University of Texas Medical School, Houston, Texas, USA. METHODS: Keratometry and ultrasonic biometry provide the two measured input variables for the six variable vergence equations used to calculate the appropriate IOL power for a specific patient with a cataract. A review of the literature reflecting the past 156 years of research and development reveals the appropriate index of refraction to be used with the keratometer for net optical corneal power, the location of the principal planes of the cornea, the nominal value for retinal thickness, and the appropriate velocities for ultrasonic measurement of the axial length. The relationship of the thick IOL to the thin IOL is derived along with the physical location of the thick lens. Two methods are described that provide the best IOL constant to be used by a manufacturer to minimize the prediction error for a surgeon using the lens for the first time. The formulas for phakic IOLs and secondary piggyback IOLs are also derived and applied to methods described above for standard IOLs. RESULTS: Using a standardized net index of refraction of 4/3 for the cornea eliminates a variability of 0.56 diopter (D) in the predicted refraction. Using a standardized 1532 m/s velocity for axial length measurements and adding a value of 0.28 mm reduces the tolerance of axial length measurements to +/-0.03 mm for any length eye. The physical location of the thick IOL's secondary principal plane must be anterior to the thin lens equivalent by approximately the separation of the principal planes of the thick lens. For biconvex poly(methyl methacrylate) IOLs, the separation in the principal planes is approximately 0.10 mm. Using these relationships, the physical position of the thick lens within the eye can be used to confirm the lens constant for any IOL style. CONCLUSIONS: Standardizing the constants for keratometry, ultrasonic biometry, and IOL power calculations can significantly improve the predictability of refractive outcomes. Back-calculating and physically measuring the position of the lens within the eye can provide surgeons with an initial lens constant known to have a standard error of the mean of +/-0.05 mm (+/-0.10 D). Other parameters such as the cardinal points of a lens, the shape factor, the lens-haptic plane, and the center lens thickness would allow further refinement of IOL power calculations.

Adult↗
PubMedDate not supplied

Ultrasound beam orientation during standard two-dimensional imaging: assessment by three-dimensional echocardiography.

Standard two-dimensional echocardiographic image planes are defined by anatomic landmarks and assumptions regarding their orientation when these landmarks are visualized. However, variations of anatomy and technique may invalidate these assumptions and thus limit reproducibility and accuracy of cardiac dimensions recorded from these views. To overcome this problem, we have developed a three-dimensional echocardiograph consisting of a real-time scanner, three-dimensional spatial locater, and personal computer. This system displays the line of intersection of a real-time image and an orthogonal reference image and may be used to assess actual image orientation during standardized two-dimensional imaging when the line-of-intersection display is not observed by the operator. Three hundred forty standard images were assessed from 85 examinations by 11 echocardiographers. Twenty-four percent of the unguided standard images were optimally positioned within +/- 5 mm and +/- 15 degrees of the standard. Of the optimal images, two thirds were parasternal long-axis views. A subsequent study with three-dimensional echocardiography and line-of-intersection guidance of image positioning showed 80% of the guided images to be optimally positioned, a threefold improvement (p < 0.001). Two-dimensional echocardiography does not achieve reasonably consistent optimal positioning of standard imaging views, suggesting that measurements taken from these views are likely to be suboptimal. Three-dimensional echocardiography that uses line-of-intersection guidance improves image positioning threefold and should therefore improve the accuracy and reproducibility of quantitative echocardiographic measurements derived from these images.

Adolescent↗
PubMed2000

An alternative to standard drinks as a measure of alcohol consumption.

Despite the field's longstanding concern with underreporting of alcohol consumption, traditional survey questions encourage error because respondents often must calculate their number of drinks based on standard drink sizes that often do not match their own drinking style. This study considered how often respondents' self-defined drink sizes matched a 'standard' drink size based on approximately 12 g of ethanol for six different beverages. We also studied whether respondents could accurately judge the size of their drinks. Subjects were recruited and interviewed at urban prenatal clinics, health clinics, and via snowball referrals and community outreach in Los Angeles and the San Francisco Bay Area. Because of the urgency of accurate measurement of consumption during pregnancy, urban pregnant women from the groups most at risk for Fetal Alcohol Syndrome, Native Americans (n = 102) and African Americans (185), were targeted. A small comparison group of urban pregnant white women (n = 34) was included. One-hour in-person interviews were conducted. Self-defined drink sizes were determined for each beverage consumed, using models and photographs of vessels. Frequent drinkers and the majority of women who reported drinking higher alcohol content beverages reported drinking larger-than-standard drink sizes. The median size of a malt liquor drink among the daily drinkers was almost three times as large as the standard, their fortified wine drinks were four times the standard, and their spirits drinks were six times the standard size. The majority of drinkers of each beverage were unable to accurately judge the size of their drinks, underestimating the number of fluid ounces by about 30%. Although the vessels methodology used here must be refined and tested further on other populations (e.g., men, nonpregnant women, and all ethnic groups), results suggest that determination of risk levels should be based on survey data that takes into consideration the beverage mix and the actual size of respondents' alcohol drinks.

Adult↗
PubMedDate not supplied

Self-efficacy, standards, and abstinence violation: a comparison between newly sober and long-term sober alcoholics.

Recent theory and empirical data suggest that self-efficacy plays an important role in resistance to relapse for substance abusers. Another key in the relapse process, according to Marlatt and Gordon (1985), is the abstinence violation effect, which comprises self-attribution for failure and affective reaction to violation of self-imposed standards. The combination of unrealistically high standards and low self-efficacy for following those standards may potentiate the risk for relapse. A 25-item questionnaire designed to assess self-efficacy and standards was administered to alcoholics newly admitted to an inpatient treatment program and alcoholics who had been sober for at least 1 year. The groups did not differ with regard to having high standards, but the successfully abstinent alcoholics had significantly higher self-efficacy expectations than the newly sober alcoholics. These results suggest that treatment programs may need to include interventions which decrease unrealistic standards as well as those designed to increase self-efficacy expectations.

Adult↗
PubMed1997

Dose to the contralateral breast: a comparison of two techniques using the enhanced dynamic wedge versus a standard wedge.

The dose to the contralateral breast has been associated with an increased risk of developing a second breast malignancy. Varying techniques have been devised and described in the literature to minimize this dose. Metal beam modifiers such as standard wedges are used to improve the dose distribution in the treated breast, but unfortunately introduce an increased scatter dose outside the treatment field, in particular to the contralateral breast. The enhanced dynamic wedge is a means of remote wedging created by independently moving one collimator jaw through the treatment field during dose delivery. This study is an analysis of differing doses to the contralateral breast using two common clinical set-up techniques with the enhanced dynamic wedge versus the standard metal wedge. A tissue equivalent block (solid water), modeled to represent a typical breast outline, was designed as an insert in a Rando phantom to simulate a standard patient being treated for breast conservation. Tissue equivalent material was then used to complete the natural contour of the breast and to reproduce appropriate build-up and internal scatter. Thermoluminescent dosimeter (TLD) rods were placed at predetermined distances from the geometric beam's edge to measure the dose to the contralateral breast. A total of 35 locations were used with five TLDs in each location to verify the accuracy of the measured dose. The radiation techniques used were an isocentric set-up with co-planar, non divergent posterior borders and an isocentric set-up with a half beam block technique utilizing the asymmetric collimator jaw. Each technique used compensating wedges to optimize the dose distribution. A comparison of the dose to the contralateral breast was then made with the enhanced dynamic wedge vs. the standard metal wedge. The measurements revealed a significant reduction in the contralateral breast dose with the enhanced dynamic wedge compared to the standard metal wedge in both set-up techniques. The dose was measured at varying distances from the geometric field edge, ranging from 2 to 8 cm. The average dose with the enhanced dynamic wedge was 2.7-2.8%. The average dose with the standard wedge was 4.0-4.7%. Thermoluminescent dosimeter measurements suggest an increase in both scattered electrons and photons with metal wedges. The enhanced dynamic wedge is a practical clinical advance which improves the dose distribution in patients undergoing breast conservation while at the same time minimizing dose to the contralateral breast, thereby reducing the potential carcinogenic effects.

Breast↗
PubMed1998

RETRACTED: Pain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen.

OBJECTIVE: To compare standard nurse-based pain therapy with a patient-controlled analgesia (PCA) regimen. DESIGN: Prospective, randomized study. SETTING: Single-institutional, clinical investigation in an urban, university-affiliated hospital. PARTICIPANTS: Sixty patients undergoing elective first-time cardiac surgery were included. INTERVENTIONS: In 30 patients, a standard analgesic regimen was used, and in 30 patients, a PCA regimen was used. The perioperative and postoperative management was similar for all patients. MEASUREMENTS AND MAIN RESULTS: Degree of sedation, satisfaction, and pain (by visual analog scale [VAS]) was assessed within the first 3 postoperative days. Vital capacity (VC) and forced expiratory volume in 1 second (FEV1) were measured using a portable spirometry system. Cortisol and troponin T (TnT) plasma levels were also measured. The expectation of pain was similar in both groups, and the postoperative pain score was significantly lower in the PCA than in the standard group throughout the study period. Significantly more piritramid was used in the PCA (total, 75.6 +/- 33.4 mg) than in the standard group (total, 20.1 +/- 31.9 mg). VC and FEV1 were significantly lower in the standard group compared with the PCA patients. Cortisol and TnT plasma levels were similar in both groups. Frequency of side effects were similar for both groups. CONCLUSION: Because of the beneficial effects with regard to degree of pain and satisfaction, pain management using PCA systems can be recommended for cardiac surgery patients. It appears to be superior to standard nurse-based pain therapy.

Analgesia, Patient-Controlled↗
PubMed2003

2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques.

RATIONALE AND OBJECTIVES: Investigators in this study compared standard-dose and low-dose inspiratory and expiratory computed tomographic (CT) images with regard to their usefulness for measuring the tracheal lumen in patients with or without tracheobronchomalacia (TBM). MATERIALS AND METHODS; Hospital records were reviewed to identify 10 consecutive patients with bronchoscopically proved TBM and 10 control subjects without TBM who underwent paired volumetric inspiratory and dynamic expiratory examinations with multisection CT. A low-dose (40-80 mA) technique was used for dynamic expiratory CT in 14 (70%) of the 20 subjects, and a standard dose (240-280 mA) was used in the remaining six (30%). All images were reviewed in a randomized, blinded fashion by two observers, who measured the tracheal lumen to determine the presence of TBM by consensus. The degree of confidence in measuring the tracheal lumen was graded on a four-point scale from 0(no confidence) to 3 (highest level of confidence), also by consensus of the two observers. Statistical analysis for differences in confidence level was performed with the Mann-Whitney U test. The image noise level was assessed by measuring the standard deviation of the presternal soft tissue, and statistical analysis for differences in noise level was performed with the t test. RESULTS: The level of confidence in tracheal lumen measurement was high, regardless of respiratory phase and dose (inspiratory mean, 2.9; median, 3; range, 2-3; expiratory low-dose mean, 2.6; median, 3; range, 2-3; expiratory standard-dose mean, 2.8; median, 3; range, 2-3). There was no significant difference in confidence level between standard- and low-dose techniques (P = .53). Excessive central airway collapse (expiratory reduction in cross-sectional diameter, > 50%) was seen in all 10 patients with TBM and in none of the control subjects. CONCLUSION: The acquisition of paired inspiratory and dynamic expiratory images with multisection helical CT is a promising method for diagnosing TBM. The low-dose technique performs as well as the standard-dose technique for the dynamic expiratory phase, with a similar degree of confidence for measuring the tracheal lumen.

Awards and Prizes↗
PubMed1998

SCP-ECG and Vital Signs Information Representation--two examples of successful transcontinental cooperation in medical informatics standardization.

During the past 2-3 decades, development work on Medical Devices focused on improving their functionality (device control, signal analysis, pattern recognition and classification). At present, the dominant user requirement is information integration. This requires interconnectivity and interoperability of devices and device systems. Today, due to all major manufacturers operating globally, this requirement can only be met if standards with global relevance are developed. The first standard discussed is the Standard Communications Protocol for Computerized Electrocardiography (SCP ECG). The rapid finalization of the standards document itself was possible due to some of the experts being involved on basic problems for greater than 10 years. Their knowledge and long standing cooperation contributed significantly to a fast consensus finding process as well as quick implementation. The second standard discussed in this paper deals with Vital Signs Information Representation. Before starting to write the document, an International inventory workshop was held to document the state of the technology and of user requirements. This common base of problem understanding makes consensus finding less difficult. Continuous cooperation between the IEEE P1073 group and the CEN/TC251 WG5 project team also ensures early harmonization of the related standards. Finally, early implementation projects in Europe and the US allow verification and modifications based on feed-back from practical experience.

Electrocardiography↗
PubMedDate not supplied

Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome.

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) procedures have a known incidence of subsidence. The individual risk of subsidence for specific lumbar levels in ALIF procedures has not been determined. PURPOSE: To evaluate the incidence of subsidence with two ALIF constructs. A paired Bagby and Kuslich (BAK) standard cage construct is compared with a paired BAK Proximity construct (Sulzer Spine-Tech, Minneapolis, MN). Study purpose is to evaluate lumbar intervertebral disc subsidence including the subsidence incidence for each disc level and with single- and two-level constructs. Also evaluated is the site of maximal subsidence within each end plate, risk with increased reaming depth, fusion incidence and clinical outcome. STUDY DESIGN: A consecutive series of 70 fused levels fused with paired standard BAK cages is compared with a subsequent series of 70 fused levels using paired Proximity BAK cages. PATIENT SAMPLE: The study population is derived from a consecutive series of ALIF procedures completed by a single surgeon. In 1998 the construct was changed from dual-standard to dual-Proximity cages. In the year 2000 there were 52 patients with a 2-year follow-up. These were matched to the previous 52 patients with dual-standard construct. OUTCOME MEASURES: Clinical outcome was determined using pre- and postoperative Oswestry questionnaires. Postoperative questionnaires were completed at the yearly follow-up. Radiographic outcome was determined by fusion status and evaluation of subsidence. Also evaluated was reaming depth and cage size for each fused level. METHODS: A total of 52 patients with ALIF procedures using paired BAK standard cages (the SS group) were studied with a group of 52 patients using paired BAK Proximity cages (the PP group). The study population was derived from an ongoing prospective study of consecutive ALIF fusion procedures completed by a single surgeon. Disc height measurements were used to determine subsidence. Reaming depth, fusion status and the site of maximal subsidence were all recorded. Clinical outcome was determined with a pre- and postoperative Oswestry functional questionnaire. RESULTS: Subsidence greater than 2 mm was noted in 5 of the 70 SS fused levels and in 9 of the 70 fused PP levels. Subsidence was always at the L4-L5 level in the SS subsided levels. Subsidence was in two-level fusions in all but one of the SS constructs. Subsidence was at the L4-L5 level in eight of the nine subsided PP levels. Subsidence was associated with increased reaming depth and the use of larger cage sizes. Subsidence was usually in the posterior and superior end plate. The clinical outcome was not affected by subsidence. Subsidence incidence was not associated with the age, sex or weight of the patient. CONCLUSIONS: There is a statistically significant increased incidence of subsidence at the L4-L5 level as opposed to other fused lumbar levels in ALIF fusions with BAK cage constructs. There is an increased incidence of subsidence with the PP constructs. Subsidence also is associated with increased reaming depth and with larger cage sizes. The lowest risk for subsidence was with single-level dual-standard cage constructs.

Adult↗
PubMed2004

Kinetics and the on-site application of standards in a solid-phase microextraction fiber.

The kinetics of the desorption of analytes from a SPME fiber into an agitated sample matrix was studied, and a theoretical model was proposed to describe the dynamic desorption process, based on the steady-state diffusion of analytes in the extraction phase and in the boundary layer. It was found that the desorption of analytes from a SPME fiber into an agitated sampling matrix is isotropic to the absorption of the analytes onto the SPME fiber from the sample matrix under the same agitation conditions, and this allows for the calibration of absorption using desorption. The calibration was accomplished by exposing a SPME fiber, preloaded with a standard, to an agitated sample matrix, during which desorption of the standard and absorption of analytes occurred simultaneously. When the standard was the isotopically labeled analogue of the target analyte, the information from the desorption process, i.e., time constant a, could be directly used for estimating the concentration of the target analyte. When the standard varied from the target analyte, the mass-transfer coefficient of the analyte could be extrapolated from that of the standard. These predictions agree well with experimental results. This approach facilitates the full integration of sampling, sample preparation, and sample introduction, especially for on-site or in vivo investigations, where the addition of standards to the sample matrix, or control of the velocity of the sample matrix, is very difficult.

Journal Article↗
PubMed2004

Brief survey of EPA standard-setting and health assessment.

The Environmental Protection Agency (EPA) promulgates standards for air pollutants and drinking water contaminants, as part of its mandate to protect public health and welfare. The Agency also assesses the health risks associated with hundreds of chemical substances, often developing quantitative toxicity and cancer potency benchmarks. This article compares EPA standards and benchmark values to those of other countries and other agencies. This includes the national ambient air quality standards (NAAQS), the national primary drinking water regulations (NPDWR), and benchmark values from the Integrated Risk Information System (IRIS). Results show that the NAAQS are generally comparable to or less strict than the air quality standards of other countries and international organizations. The NPDWR tend to be less strict than the water quality standards of other countries for inorganic chemicals, and they are more strict about as often as they are less strict for organic chemicals. Reference values for toxicity and cancer potency derived in EPA health assessments posted in the IRIS database are less stringentthan those of other agencies about as often as they are more stringent, and they are often identical. Revisions to these values more often than not made them less stringent. These results suggest that EPA's standards and quantitative health assessments are not out of line with those of other agencies and other countries.

Carcinogenicity Tests↗
PubMed2004

Quantitative determination of allicin in garlic: supercritical fluid extraction and standard addition of alliin.

A quantitative method is described for the determination of allicin (2-propene-1-sulfinothioic acid S-2-propenyl ester) in garlic, using standard additions of alliin (l-(+)-S-allylcysteine sulfoxide) in conjunction with supercritical fluid extraction (SFE) and high performance liquid chromatography analysis with UV-vis absorbance detection. Optimum CO(2)-SFE conditions provided 96% recovery for allicin with precision of 3% (RSD) for repeat samples. The incorporation of an internal standard (allyl phenyl sulfone) in the SFE step resulted in a modest improvement in recovery (99%) and precision (2% RSD). Standard additions of alliin were converted to allicin in situ by endogenous alliinase (l-(+)-S-alk(en)ylcysteine sulfoxide lyase, EC 4.4.1.4). Complete conversion of the spiked alliin to allicin was achieved by making additions after homogenization-induced conversion of the naturally occurring cysteine sulfoxides to thiosulfinates had taken place, thus eliminating the likelihood of competing reactions. Concentration values for allicin determined in samples of fresh garlic (Allium sativum L. and Allium ampeloprasum) and commercially available garlic powders (Allium sativum L.) by standard addition of alliin were found in all cases to be in statistical agreement (95% confidence interval) with values determined using a secondary allicin standard (concentration determined using published extinction coefficients). This method provides a convenient alternative for assessing the amount of allicin present in fresh and powdered garlic, as alliin is a far more stable and commercially prevalent compound than allicin and is thus more amenable for use as a standard for routine analysis.

Carbon-Sulfur Lyases↗
PubMed1994

Shifting standards and stereotype-based judgments.

Four studies tested a model of stereotype-based shifts in judgment standards developed by M. Biernat, M. Manis, and T. E. Nelson (1991). The model suggests that subjective judgments of target persons from different social groups may fail to reveal the stereotyped expectations of judges, because they invite the use of different evaluative standards; more "objective" or common rule indicators reduce such standard shifts. The stereotypes that men are more competent than women, women are more verbally able than men, Whites are more verbally able than Blacks, and Blacks are more athletic than Whites were successfully used to demonstrate the shifting standards phenomenon. Several individual-difference measures were also effective in predicting differential susceptibility to standard shifts, and direct evidence was provided that differing comparison standards account for substantial differences in target ratings.

Adolescent↗
PubMed2003

What friends are for! The use of routine standards in social comparison.

Social comparisons are frequently used for self-evaluation. As a consequence, judges have to be efficient in each comparison step. Standard selection, however, is traditionally seen as an elaborate process in which judges deliberately select similar standards. We propose that often judges do not engage in such deliberate selection processes. Instead, they use routine standards--standards that have frequently been used for self-evaluation. Consistent with this assumption, Studies 1-3 demonstrate that student participants activate knowledge about their best friend--a likely routine standard--during self-evaluation. In Study 1, lexical decisions for the best friend's name are facilitated after self-evaluation. In Study 2, participants judge their best friend faster after evaluating themselves on the same dimension. In Study 3, this is even the case if the best friend is dissimilar and consequently undiagnostic. Finally, in Study 4, self-evaluations are primarily influenced by comparison information about an experimentally created routine standard.

Adult↗
PubMed1998

Consensus standards for the process of cancer care: a modified expert panel method applied to head and neck cancer. South and West Expert Tumour Panel for Head and Neck Cancer.

There are many pressures to improve the standard of care delivered to cancer patients, including the reforms subsequent to the Calman-Hine report. The establishment of standards is a prerequisite for audit, benchmarking and certification of cancer centres and units. Randomized trials of head and neck cancer are uncommon, and other forms of evidence often conflicting. In the south and west of England, a multidisciplinary expert panel consensus method has been applied to the development of standards. A panel representative of specialties involved in the process of care at all three levels, plus social medicine and lay members, was constructed. A model for the process of care was developed consisting of activity areas. For each activity, a near exhaustive list of tasks and standards was established. A three-iteration method with statistical group response was then used to refine the standards. The same method was also applied to the production of a minimum data set for registration, recording and audit. The resulting standards will be regularly reviewed. We have developed a model of the care process, and an expert panel methodology that is applicable to a wide range of problems in clinical oncology.

Head and Neck Neoplasms↗