Página 1 dos resultados de 15713 itens digitais encontrados em 0.104 segundos

## An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies

El Dib, Regina; Nascimento Junior, Paulo; Kapoor, Anil
Fonte: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia Publicador: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Tipo: Artigo de Revista Científica Formato: 870-876
ENG
Relevância na Pesquisa
45.93%
PURPOSE: Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS: We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS: As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention´s effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS: Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient´s wishes and circumstances in the absence of high-quality primary studies. It´s not a replacement for the gold standard randomized clinical trial...

## Signal transduction profile of chemical sensitisers in dendritic cells: an endpoint to be included in a cell-based in vitro alternative approach to hazard identification?

Neves, BM; Gonçalo, Margarida; Figueiredo, A; Duarte, CB; Lopes, MC; Cruz, MT
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.84%
The development of non-animal testing methods for the assessment of skin sensitisation potential is an urgent challenge within the framework of existing and forthcoming legislation. Efforts have been made to replace current animal tests, but so far no alternative methods have been developed. It is widely recognised that alternatives to animal testing cannot be accomplished with a single approach, but rather will require the integration of results obtained from different in vitro and in silico assays. The argument subjacent to the development of in vitro dendritic cell (DC)-based assays is that sensitiser-induced changes in the DC phenotype can be differentiated from those induced by irritants. This assumption is derived from the unique capacity of DC to convert environmental signals encountered at the skin into a receptor expression pattern (MHC class II molecules, co-stimulatory molecules, chemokine receptors) and a soluble mediator release profile that will stimulate T lymphocytes. Since signal transduction cascades precede changes in surface marker expression and cytokine/chemokine secretion, these phenotypic modifications are a consequence of a signal transduction profile that is specifically triggered by sensitisers and not by irritants. A limited number of studies have addressed this subject and the present review attempts to summarise and highlight all of the signalling pathways modulated by skin sensitisers and irritants. Furthermore...

## An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies

El Dib,Regina; Nascimento Junior,Paulo; Kapoor,Anil
Fonte: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia Publicador: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Tipo: Artigo de Revista Científica Formato: text/html
Relevância na Pesquisa
45.93%
PURPOSE: Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS: We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS: As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention´s effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS: Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient´s wishes and circumstances in the absence of high-quality primary studies. It´s not a replacement for the gold standard randomized clinical trial...

## An Alternative Approach to Atopic Dermatitis: Part I—Case-Series Presentation

Kobayashi, Hiromi; Takahashi, Kuniaki; Mizuno, Nobuyuki; Kutsuna, Haruo; Ishii, Masamitsu
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.84%
Atopic dermatitis (AD) is a complex disease of obscure pathogenesis. A substantial portion of AD patients treated with conventional therapy become intractable after several cycles of recurrence. Over the last 20 years we have developed an alternative approach to treat many of these patients by diet and Kampo herbal medicine. However, as our approach is highly individualized and the Kampo formulae sometimes complicated, it is not easy to provide evidence to establish usefulness of this approach. In this Review, to demonstrate the effectiveness of the method of individualized Kampo therapy, results are presented for a series of patients who had failed with conventional therapy but were treated afterwards in our institution. Based on these data, we contend that there exist a definite subgroup of AD patients in whom conventional therapy fails, but the ‘Diet and Kampo’ approach succeeds, to heal. Therefore, this approach should be considered seriously as a second-line treatment for AD patients. In the Discussion, we review the evidential status of the current conventional strategies for AD treatment in general, and then specifically discuss the possibility of integrating Kampo regimens into it, taking our case-series presented here as evidential basis. We emphasize that Kampo therapy for AD is more ‘art’ than technology...

## An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Ren, Xinhua S; Qian, Shirley; Kazis, Lewis E
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.81%
Prior studies have demonstrated the importance of treatment persistence with anti-psychotic agents in sustaining control of schizophrenic symptoms. However, the conventional approach in measuring treatment persistence tended to use only the first prescription episode even though some patients received multiple prescriptions (or multiple treatment episodes) of the same medication within one year following the initiation of the index drug. In this study, we used data from the Veterans Health Administration in the United States to assess the extent to which patients received multiple prescriptions. The study found that about a quarter of the patients had two or more treatment episodes and that levels of treatment persistence tended to vary across treatment episodes. Based on these results, we offered an alternative approach in which we calculated treatment persistence with typical and atypical antipsychotic agents separately for patients with one, two, or three treatment episodes. Considering that patients with different number of treatment episodes might differ in disease profiles, this treatment episode-specific approach offered a fair comparison of the levels of treatment persistence across patients with different number of treatment episodes. Future research needs to extend the analyses beyond two antipsychotic classes to individual antipsychotic agents. A more comprehensive assessment using appropriate analytic methods should help physicians make prescription choices that will ultimately improve the care of patients with schizophrenia.

## Application service providers: an alternative approach to PACS implementation

Reiner, B; Siegel, E
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.81%
Several impediments have delayed the adoption of filmless imaging by the majority of radiology practitioners. These factors include concerns for technology obsolescence, limited available capital, and lack of existing information technology (IT) infrastructure and experienced personnel. Application service providers (ASPs) have begun to emerge as an alternative approach to the more traditional acquisition of picture archiving and communication (PAC) systems. This approach offers the prospective PACS customer the opportunity to outsource hardware, software, and IT services to a vendor on a fee-per-use basis. The ideal candidates for such an approach would be small to medium-sized hospitals with limited existing IT infrastructure. Using the ASP model, prospective PACS customers can purchase services unique to their needs and upgrade or expand these as needed. As ASP vendors increase their customer base, there is the potential for customers to achieve unique economies of scale not available through traditional financing means. This report discusses the economic and operational issues associated with ASPs, as well as potential limitations and future implications of this phenomenon.

## Identification of Differentially Evolved Genes: An Alternative Approach to Detection of Accelerated Molecular Evolution from Genome-Wide Comparative Data

Kim, Kyu-Won; Burt, David W.; Kim, Heebal; Cho, Seoae
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.79%
One of the most important measures for detecting molecular adaptations between species/lineages at the gene level is the comparison of relative fixation rates of synonymous (dS) and non-synonymous (dN) mutations. This study shows that the branch model is sensitive to tree topology and proposes an alternative approach, devogs, which does not require phylogenetic topology for analysis. We compared devogs with a branch model method using virtual data and a varying ω ratio, in which parameters were obtained from real data. The positive predictive value, sensitivity, and specificity of the branch model were affected by the phylogenic tree topology. Devogs showed greater positive predictive value, whereas the branch model method had greater sensitivity. In a working example using devogs, a group of human RNA polymerase II-related genes, which are important in mediating alternative splicing, were significantly accelerated compared to four other mammals.

## An alternative approach to the teaching of EFL to secondary students of a public school in Patos - PB; Uma abordagem alternativa para ensino de língua inglesa para alunos de ensino médio em uma escola pública em Patos - PB

Lima Filho, Jarbas Medeiros de
Fonte: Universidade Federal de Alagoas; BR; Linguística; Literatura Brasileira; Programa de Pós-Graduação em Letras e Linguística; UFAL Publicador: Universidade Federal de Alagoas; BR; Linguística; Literatura Brasileira; Programa de Pós-Graduação em Letras e Linguística; UFAL
Tipo: Dissertação Formato: application/pdf
ENG
Relevância na Pesquisa
55.95%

## A Polycentric Approach for Coping with Climate Change

Ostrom, Elinor
Fonte: Banco Mundial Publicador: Banco Mundial
Relevância na Pesquisa
45.87%
This paper proposes an alternative approach to addressing the complex problems of climate change caused by greenhouse gas emissions. The author, who won the 2009 Nobel Prize in Economic Sciences, argues that single policies adopted only at a global scale are unlikely to generate sufficient trust among citizens and firms so that collective action can take place in a comprehensive and transparent manner that will effectively reduce global warming. Furthermore, simply recommending a single governmental unit to solve global collective action problems is inherently weak because of free-rider problems. For example, the Carbon Development Mechanism (CDM) can be gamed in ways that hike up prices of natural resources and in some cases can lead to further natural resource exploitation. Some flaws are also noticeable in the Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD) program. Both the CDM and REDD are vulnerable to the free-rider problem. As an alternative, the paper proposes a polycentric approach at various levels with active oversight of local...

## Cross-Sectional Analyses of Climate Change Impacts

Mendelsohn, Robert; Dinar, Ariel; Basist, Alan; Kurukulasuriya, Pradeep; Ihsan Ajwad, Mohamed; Kogan, Felix; Williams, Claude
Fonte: World Bank, Washington, D.C. Publicador: World Bank, Washington, D.C.
EN_US
Relevância na Pesquisa
45.81%
The authors explore the use of cross-sectional analysis to measure the impacts of climate change on agriculture. The impact literature, using experiments on crops in laboratory settings combined with simulation models, suggests that agriculture will be strongly affected by climate change. The extent of these effects varies by country and region. Therefore, local experiments are needed for policy purposes, which becomes expensive and difficult to implement for most developing countries. The cross-sectional technique, as an alternative approach, examines farm performance across a broad range of climates. By seeing how farm performance changes with climate, one can estimate long-run impacts. The advantage of this approach is that it fully captures adaptation as each farmer adapts to the climate they have lived in. The technique measures the full net cost of climate change, including the costs as well as the benefits of adaptation. However, the technique is not concern-free. The four chapters in this paper examine important potential concerns of the cross-sectional method and how they could be addressed...

## An approach to compatible new buildings in historic urban environments : case study in the Arabian Gulf region

Khalaf, Roha W.
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
EN
Relevância na Pesquisa
55.92%
Cette thèse contribue à l'état actuel des connaissances sur la compatibilité des nouveaux bâtiments avec les environnements urbains historiques. Elle suit un mode de présentation classique: Introduction, Revue de Littérature, Méthodologie, Résultats, Discussion et Conclusion. Le problème étudié est le manque d'orientation pour intégrer les processus de développement et de sauvegarde dans les contextes établis. La littérature récente révèle que les règles de préservation, aussi appelées normes et lignes directrices, ne peuvent pas garantir une relation compatible entre une intervention et son milieu. La pensée contemporaine dans le domaine de la conservation et de la gestion du patrimoine invite donc l’exploration d'autres moyens pour lier la nouvelle architecture à l'ancienne. Ainsi, le présent projet de recherche explore une approche alternative aux règles de préservation en vue d’atteindre le but de nouveaux bâtiments compatibles et d’améliorer la prise de décision fondée sur les valeurs. Pour produire des résultats spécifiques et convaincants, un cas a été sélectionné. Celui-ci est une ville dans la région du Golfe Arabe : la Ville de Koweït. Le résultat principal est le développement d’une approche...

## Para uma concetualização alternativa de accountability em educação; To an alternative approach of accountability on education; Pour une autre conceptualisation de l'accountability

Afonso, Almerindo Janela
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.79%
Nas últimas duas ou três décadas, a problemática da accountabilty tem sido enclausurada nas lógicas do pensamento único, neoconservador e neoliberal. Torna-se, por isso, necessário lembrar que há outras alternativas. Neste sentido, este texto adota uma abordagem crítica e revisita brevemente o conceito de accountability (ou seja, a interação entre avaliação, prestação de contas e responsabilização), no sentido de chamar a atenção para configurações que sejam mais democráticas e progressistas. Por referência a esta mesma problemática, pontuam-se também algumas tendências em curso em Portugal e outros países europeus.; In the last two or three decades, the issue of accountability has been enclosed in the logic of the neoconservative and neoliberal single thought. It is therefore necessary to show that there are others alternatives. In this regard, this paper adopts a critical approach and briefly revisits the concept of accountability (that is, the interaction between evaluation, answerability and enforcement) in order to draw attention to the need for models that could be more democratic. By reference to this same question, the author indicates some trends underway in Portugal and other European countries.; Dans les deux ou trois dernières décennies...

## Alternative approach to the regularization of odd dimensional AdS gravity

Mora, Pablo
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.79%
In this paper I present an action principle for odd dimensional AdS gravity which consists of introducing another manifold with the same boundary and a very specific boundary term. This new action allows and alternative approach to the regularization of the theory, yielding a finite euclidean action and finite conserved charges. The choice of the boundary term is justified on the grounds that an enhanced 'almost off-shell' local AdS/Conformal symmetry arises for that very special choice. One may say that the boundary term is dictated by a guiding symmetry principle. Two sets of boundary conditions are considered, which yield regularization procedures analogous to (but different from) the standard 'background substraction' and 'counterterms' regularization methods. The Noether charges are constructed in general. As an application it is shown that for Schwarszchild-AdS black holes the charge associated to the time-like Killing vector is finite and is indeed the mass. The Euclidean action for Schwarzschild-AdS black holes is computed, and it turns out to be finite, and to yield the right thermodynamics. The previous paragraph may be interpreted in the sense that the boundary term dictated by the symmetry principle is the one that correctly regularizes the action.; Comment: References added...

## On QCD analysis of stucture function $F_2^{\gamma}$ in alternative approach

Hejbal, Jiri
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.88%
The alternative approach to QCD analysis of the photon structure function $F_2^{\gamma}$ is presented. It differs from the conventional one by the presence of the terms which in conventional approach appear in higher orders. We show that this difference concerns also the photonic parton distribution functions. In the alternative approach, the complete LO analysis of $F_2^{\gamma}$ can be performed as all required quantities are known. At the NLO, however, one of the coefficient function is so far not available and thus only the photonic parton distribution function can be computed and compared to those of standard approach. We discuss the numerical difference of these approaches at the LO and the NLO approximation and show that in case of $F_2^{\gamma}$ this difference is non-negligible and may play an important role in the analysis on photon data of the future experiments.; Comment: 25 pages

## Equilibrium of a Brownian particle in an inhomogeneous medium: An alternative approach

Biswas, Avik; Bhattacharyay, A.
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.79%
We look at the equilibrium of a Brownian particle in an inhomogeneous space following the alternative approach proposed in ref.[1]. We consider a coordinate dependent damping that makes the stochastic dynamics the one with multiplicative noise. Here we show that the mapping to an additive noise gives the equilibrium distribution of the generalized Langevin dynamics of a particle with mass. The procedure does not need inclusion of any ad hoc current cancelling term in the Langevin dynamics. The result shows a modified Maxwell-Boltzmann distribution with a damping dependent amplitude.; Comment: 15 pages and 2 figures, errors of previous versions are corrected and a full derivation of alternative equilibrium distribution is given in this version

## Alternative approach to precision narrow-angle astrometry for Antarctic long baseline interferometry

Kok, Y.; Ireland, M. J.; Rizzuto, A. C.; Tuthill, P. G.; Robertson, J. G.; Warrington, B. A.; Tango, W. J.
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.81%
The conventional approach to high-precision narrow-angle astrometry using a long baseline interferometer is to directly measure the fringe packet separation of a target and a nearby reference star. This is done by means of a technique known as phase-referencing which requires a network of dual beam combiners and laser metrology systems. Using an alternative approach that does not rely on phase-referencing, the narrow-angle astrometry of several closed binary stars (with separation less than 2$"$), as described in this paper, was carried out by observing the fringe packet crossing event of the binary systems. Such an event occurs twice every sidereal day when the line joining the two stars of the binary is is perpendicular to the projected baseline of the interferometer. Observation of these events is well suited for an interferometer in Antarctica. Proof of concept observations were carried out at the Sydney University Stellar Interferometer (SUSI) with targets selected according to its geographical location. Narrow-angle astrometry using this indirect approach has achieved sub-100 micro-arcsecond precision.; Comment: SPIE Astronomical Telescopes and Instrumentation conference, June 2014, Paper ID 9146-103, 17 pages, 13 figures

## An Alternative Approach To Measuring Reverberation Lags in Active Galactic Nuclei

Zu, Ying; Kochanek, C. S.; Peterson, Bradley. M.
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.81%
Motivated by recent progress in the statistical modeling of quasar variability, we develop a new approach to measuring emission-line reverberation lags to estimate the size of broad-line regions (BLRs) in active galactic nuclei. Assuming that all emission-line light curves are scaled, smoothed, and displaced versions of the continuum, this alternative approach fits the light curves directly using a damped random walk model and aligns them to recover the time lag and its statistical confidence limits. We introduce the mathematical formalism of this approach and demonstrate its ability to cope with some of the problems for traditional methods, such as irregular sampling, correlated errors, and seasonal gaps. We redetermine the lags for 87 emission lines in 31 quasars and reassess the BLR size--luminosity relationship using 60 H-beta lags. We confirm the general results from the traditional cross-correlation methods, with a few exceptions. Our method, however, also supports a broad range of extensions. In particular, it can simultaneously fit multiple lines and continuum light curves which improves the lag estimate for the lines and provides estimates of the error correlations between them. Determining these correlations is of particular importance for interpreting emission-line velocity--delay maps. We can also include parameters for luminosity-dependent lags or line responses. We use this to detect the scaling of the BLR size with continuum luminosity in NGC 5548.; Comment: match to the version accepted to ApJ. New code release available at http://www.astronomy.ohio-state.edu/~yingzu/spear.html

## Foundations of an Alternative Approach to Reification in RDF

Hartig, Olaf; Thompson, Bryan
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
45.88%
This document defines extensions of the RDF data model and of the SPARQL query language that capture an alternative approach to represent statement-level metadata. While this alternative approach is backwards compatible with RDF reification as defined by the RDF standard, the approach aims to address usability and data management shortcomings of RDF reification. One of the great advantages of the proposed approach is that it clarifies a means to (i) understand sparse matrices, the property graph model, hypergraphs, and other data structures with an emphasis on link attributes, (ii) map such data onto RDF, and (iii) query such data using SPARQL. Further, the proposal greatly expands both the freedom that database designers enjoy when creating physical indexing schemes and query plans for graph data annotated with link attributes and the interoperability of those database solutions.; Comment: 14 pages

## An alternative approach to fundamental general physics concepts

Kamoua Kolani, Bantipo
Tipo: Dissertação de Mestrado Formato: application/pdf; application/pdf