Discussion Sample Clauses

Discussion. In our study, we determined cutoffs for four CSF biomarkers for AD (Aβ1-42, Aβ1-40, tTau and pTau) and their ratios measured on the fully automated LUMIPULSE G600II platform to optimize their concordance with 18F-Florbetapir PET. We calibrated Aβ1-42 levels to certified reference material, recently developed to harmonize immunoassays across different platforms, and found that the ratios Xx0-00/Xx0-00, Xx0-00/xXxx and Aβ1-42/pTau had better diagnostic agreement with visual assessment of amyloid scans than single biomarkers. As a marker of amyloid pathology, the Aβ1-42/Aβ1-40 ratio had higher agreement with amyloid PET visual status and showed better correlation with amyloid load quantification compared to Aβ1-42 alone. The agreement between amyloid imaging and AD CSF biomarkers has previously been studied by using other automated immunoassays [10,11,17]. Our results are in line with previous studies showing a good overall agreement between amyloid imaging and AD CSF biomarkers, higher for ratios than for single analytes [10,11]. However, specific cutoff points for CSF biomarkers differ between these studies, and several methodological differences can explain these discrepancies. First, pre-analytical conditions, such as the type of collection and storage tubes, are different between studies, and these factors are known to have a great impact on the absolute values of CSF biomarkers, especially for Aβ1-42 [31,32]. Second, some analytical particularities for each immunoassay and platform used in these studies (specificity of the antibodies, time of incubation) result in diverse CSF biomarker measures. Calibration of all automated platforms to certified reference material, currently underway, will minimize this issue in the future. Likewise, differences in the affinity of PET radiotracers (11C- Pittsburg compound B, 18F-Flutemetamol or 18F-Florbetapir) can lead to disparities in the selection of cutoffs. Third, the definition of the study population can have an impact on the measures of diagnostic accuracy and the determination of cutoffs, and the composition of the populations was not the same across studies. Schindler et al. analyzed data from community-dwelling volunteers [11], whereas Janelidze et al. obtained their results from patients with mild cognitive impairment and subjective cognitive decline from the BioFINDER cohort [17]. Hansson et al. studied CSF of participants from ADNI and BioFINDER cohorts, that included cognitively normal volunteers, patie...
Discussion. Motor vehicle crashes are the leading cause of pregnancy-associated deaths and traumatic fetal mortality (Schiff et al., 1997; Xxxxx & Xxxxxxxxxx, 2002), globally. The objective of this systematic review was to evaluate the association of maternal mortality with seat belt use and motor vehicle crashes in pregnant women. The systematic review suggested three findings. First, in the systematic review, all studies were retrospective and there were no prospective study designs. Second, in the reviewed articles, four (27%) articles (Table 7) had textual excerpts describing both seat belt use and maternal mortality. Lastly, unfortunately, the objective of this study was not achieved. Despite the repeated and rigorous searches using a wide set of screening parameters with the search terms related to maternal mortality and MVC, there was no evidence supporting the association between seat belt use and maternal mortality due to MVC. The first finding was that all the studies identified were retrospective with varying outcomes. Some studies examined fetal outcomes, injury and trauma outcomes, while some considered adverse maternal outcomes. Articles investigating adverse outcomes of motor vehicle crashes usually use a retrospective design, and this finding was supported by other literature (Vladitiu, 2012; Xxxxx et al, 2002; Sirin et al., 2007; Vladitiu et al., 2013a). The research studies in the systematic review may be restricted to retrospective designs due to the challenges of executing prospective studies, including their expense, their length of time, that they are prone to high dropout rates (Xxxxx, 2003), and require larger sample size (Xxxxxxx, 2004). For example, to design a prospective study on maternal mortality and MVC, the study would have to identify and follow a sufficient number of pregnant women during the period of their pregnancy that were involved in MVC and died. The feasibility of capturing a large sample size of pregnant women that would have been involved in MVC, and died during that period of time is limited. For instance, a study was conducted in Sweden using data linkage from 1991 to 2001 (retrospective study design), which accounted for pregnant women in MVC. There were 2,270 pregnant women involved in MVC of which there were 15 maternal mortalities and 40 fetal deaths (Kvarnstrand et al., 2008). This emphasizes the difficulty and complexity of capturing a large sample size. Thus, securing the required sample size for a powered prospecti...
Discussion. The Parties mutually desire that friendly collaboration will continue between them. Accordingly, they will try, and they will cause their respective Group members to try, to resolve in an amicable manner all disagreements and misunderstandings connected with their respective rights and obligations under this Agreement, including any amendments hereto. In furtherance thereof, in the event of any dispute or disagreement (a “Dispute”) between any member of the Remainco Group and any member of the Spinco Group or RMT Partner as to the interpretation of any provision of this Agreement or the performance of obligations hereunder, the Tax departments of the Parties shall negotiate in good faith to resolve the Dispute.
Discussion. For the primary and secondary outcomes, almost no agreement was found between the referring doctors and the patients regarding the patientsʼ main problems. A considerable degree of overlap was found in the tertiary outcomes regarding the medical but not the socioeconomic issues. Choosing only one reviewer ensured consistency and easily comparable results and allowed us to avoid interrater variability. Determining the problems based on short texts only is largely subjective and might be done differently in a similar study. The use of interpreters and the fact that the patientsʼ problems were documented by a staff member are limitations that may potentially mean that important points were omitted or misunderstood. However, the “Problem list” was co-produced and reviewed in cooperation with the patient several times by both a physician and a nurse, making it a unique strength of this study. The frequencies of some problems were very low, especially in the primary outcomes and socioeconomic problems in general. This was partly due to the narrow problem definitions chosen in order to avoid a falsely high degree of agreement. This makes meaningful interpretation of the results in those categories harder. Larger studies or broader categories may provide a greater validity. Disagreement between referrals and patient-reported problems is not limited to this patient group, but establishing a universal solution covering all patients was beyond the scope of this study [18]. This study does not suggest that the patientʼs viewpoint is the right one – merely that it is not in line with the referring doctorʼs viewpoint. The clinic will most likely uncover more problems than described in the referral, which is why the comparison of the referral and the entire MHC notes were only the secondary outcome. However, the referral and the “Problem list” should both be a condensed version of essential problems regarding the patient. The difference between the two indicates that doctors and patients focus on different issues. Co- production of care has shown promising results in terms of aligning the two, but will most likely require rethinking parts of the healthcare system [7]. Perceiving that this is an easy task that will likely yield results rapidly may not be realistic. Nevertheless, the challenges described within the patient group are already an issue and will presumably remain so if no measures are implemented. Testing and validating even small interventions might prove to ...
Discussion. The iHOT-12 and iHOT-33, XXXXX, and HOS are valid measures to assess young adults with hip joint pain. We recom- mend these instruments for use in clinical practice and research.33 34 79 80 For FAI syndrome in particular, iHOT and XXXXX were patient-derived in populations of patients includ- ing those treated for FAI syndrome, and so can be expected to perform well in this group. Both have sound psychometric prop- erties including test-retest reliability, responsiveness, content val- idity, and construct validity. In addition to the hip-specific outcome measures, general quality of life instruments such as the EQ-5D, SF12/36 or PROMIS are recommended.81–83 These instruments may not be necessary for routine clinical decision-making and assessment of FAI syndrome, but they have a role in facilitating economic xxx- lyses and relative comparisons to other conditions and treatments as part of clinical research and health policy development. What future research needs to be conducted? DISCUSSION The delegates at Sports Hip 2016 proposed 118 research ques- tions about the diagnosis and management of FAI syndrome. During the consensus exercise, we identified 23 substantially different questions, which were ranked in order of priority by the panel (see online supplementary file B). The panel grouped the questions into four categories: aetiology, diagnosis, progno- sis and effect of treatment. Regarding aetiology, there was considerable interest in how cam and pincer morphologies develop, whether sporting activity in childhood may influence this, and why some patients develop symptoms and others do not. For diagnosis, we agreed that diagnostic criteria are imprecise and need to be improved, and that the utility of those we have is unclear. We would benefit considerably from better informa- tion on the long-term natural history of FAI syndrome, though the panel recognised that significant resources are needed to perform the necessary long-term prospective studies. Finally, there is an urgent need to compare the effectiveness of xxxxxx- vative, rehabilitation and surgical treatment strategies. Fortunately, several such studies are in progress (see table 2), and results will begin to appear in the next few years.
Discussion. For minor offenses by an employee, management has a responsibility to discuss such matters with the employee. Discussions of this type shall be held in private between the employee and the supervisor. Such discussions are not considered discipline and are not grievable. Following such discussions, there is no prohibition against the supervisor and/or the employee making a personal notation of the date and subject matter for their own personal record(s). However, no notation or other information pertaining to such discussion shall be included in the employee’s personnel folder. While such discussions may not be cited as an element of prior adverse record in any subsequent disciplinary action against an employee, they may be, where relevant and timely, relied upon to establish that employees have been made aware of their obligations and responsibilities.
Discussion. This study was the first to report on such a wide range of urinary trace element concentrations in Kenyan and Tanzanian populations and one of few studies worldwide to report their intra-household correlations In relation to population-based reference values, of the essential elements investigated, only Se showed indications of being low (based on comparisons of Tanzanian (29 µg/L) and Kenyan (24 µg/L) medians that of the CHMS (59 µg/L)) whilst, of those elements broadly considered toxic, Co, Mn, Mo, Ni and U were relatively elevated in some samples. Compared to the limited number of health-based values available, exceedances were observed for As, Co, Mo and Se and deficiencies for both Mo and Se. These exceedances/deficiencies should be interpreted with due caution, but warrant further consideration for research. Moderate-strong intra-household correlations were observed for As (r=0.65), Cs (r=0.67), Xx (r=0.56), Mo (r=0.57), Se (r=0.68) and Tl (r=0.67), with the remainder of elements having correlations below 0.41. These correlations were all a marked improvement on those calculated with urinary concentrations that were not adjusted for urinary SG – reiterating the necessity of hydration adjustments in urinary biomonitoring to improve interpretability (29). Correlations were only marginally improved by matching pairs on gender. Expectedly, the intra-household correlations reported varied greatly by element. For many elements, this may be due to the limitations already discussed. Urinary Cu and Zn both had weak intra-household correlations of 0.01 and 0.35, respectively. Neither element is routinely measured in urine and are both primarily excreted via the faeces (30). The relative strengths of common exposure sources of many elements, and their differences between individuals from the same households, are responsible for variations in strength of correlations. Manganese concentrations were weakly correlated (0.17) and higher in females, whereas the contrary was found for Se, i.e. r=0.68 and higher concentrations in males. Diet is a dominant source of both Mn and Se and higher concentrations are found in specific food items. A dominant source of Se in the Kenyan and Tanzanian diet is likely meat and dairy products, based on food composition studies (31) and findings from neighbouring Burundi (32), whereas Mn is present at highest concentrations in cereals and vegetables (31). Dietary heterogeneity and how it differs between household members may therefore...
Discussion. As hypothesized, using WaterGuard and Sprinkles is associated with reduced prevalence of diarrhea in this study population. This association is especially observed among users of the WaterGuard only. The data also suggest a modest association between Sprinkles use and diarrhea and a similar protective association among users of both Sprinkles and WaterGuard; however, these findings are not statistically significant at the 90% confidence level. Chlorine was found to be a confounder of the relationship between product utilization and diarrhea over the past 24 hours within this population. However, the data showed that the presence of chlorine residual in household drinking water was not protective against diarrhea among the children analyzed. This finding could have been influenced by several factors. First, close to a 19% reduction in sample size occurred in the regression analysis of the final model. In addition, nearly 13% of data on chlorine residual among households was missing due to participants refusing chlorine testing or not having drinking water available for testing. Human error at time of testing for chlorine residual could have also influenced this outcome. Also, discussion with enumerators and NICHE staff members introduced the possibility that reagents used for chlorine testing in the field could have degraded over time due to adverse field conditions such as time spent traveling by enumerators during periods of elevated temperature. Still, the findings of this study do support evidence in the literature that suggests using point-of-use water treatment systems such as WaterGuard can be protective against diarrhea. Similarly, the results of this study in regards to utilization of Sprinkles alone are also coherent with findings in the literature that there is a close link between adequate intake and absorption of essential micronutrients is protective against diarrhea. However, we did not find a statistically significant difference in diarrhea prevalence between individuals using both Sprinkles and WaterGuard and individuals using neither product (0.614, p=0.2567) (Table 12). Given that malnutrition and diarrheal disease are intertwined, it was expected that children exhibiting poor micronutrient intakes (or children not consuming Sprinkles) and also consuming potentially contaminated water would experience higher prevalence of diarrhea than their counterparts who use both products. This was unexpected because many studies have shown diarrhea t...
Discussion. A. Drug screening provides management with a method to assist in the detection of a possible problem so that it may be dealt with in the proper manner.
Discussion. If it is necessary to provide for any matter that is not expressly set forth in this Agreement, the determination shall be made through discussion between the Parties.