Many governments and charities adopt Rawlsian difference principle by maximizing the welfare of the least advantaged and giving priority to equality over efficiency. There are two views about which ...domain the principle should be applied to. The first applies it to the final distribution of income. Previous empirical studies have focused on this but found little evidence supporting it. The other view linked the principle with Rawlsian primary goods: Since the cost of losing primary social goods is huge, people will maximize the benefit of the least advantaged behind the veil of ignorance, such that everyone has access to necessary means. According to the latter reading of Rawls, we experimentally imposed a great cost for losing primary goods, and observed a salient majority of subjects obeying this principle, unlike previous studies finding a minority. Moreover, even if we lowered the cost for losing primary goods, more than one-third of the subjects still adopted this principle.
This paper presents a hardware platform for wireless mm-sized bio-implant networks, exploiting adaptive magnetoelectric power transfer and novel schemes for efficient bidirectional multi-access ...communication. The closed-loop power control mitigates power delivery fluctuations caused by distance and alignment change and avoids redundant power of the external transceiver. The system also enables simultaneous power and time-domain modulated downlink data with a 5% peak power transfer efficiency and a 62.3-kbps maximum data rate at 340-kHz carrier frequency; multi-access uplink of all the implants enabled by individually programmed IF with a 40-kbps maximum data rate at 31-MHz carrier frequency; and more than 6-cm distance between the implant and the external TRX.
Purpose:
To investigate the musculus uvulae morphology in vivo in adults with normal velopharyngeal anatomy and to examine sex and race effects on the muscle morphology. We also sought to provide a ...preliminary comparison of musculus uvulae morphology in adults with normal velopharyngeal anatomy to adults with repaired cleft palate.
Methods:
Three-dimensional magnetic resonance imaging data and Amira 5.5 Visualization Modeling software were used to evaluate the musculus uvulae in 70 participants without cleft palate and 6 participants with cleft palate. Muscle length, thickness, width, and volume were compared among participant groups.
Results:
Analysis of covariance analysis did not yield statistically significant differences in musculus uvulae length, thickness, width, or volume by race or sex among participants without cleft palate when the effect of body size was accounted for. Two-sample t test revealed that the musculus uvulae in participants with repaired cleft palate is significantly shorter (P = .008, 13.65 mm vs 16.07 mm) and has less volume (P = .002, 51.08 mm3 vs 97.62 mm3) than participants without cleft palate.
Conclusion:
In adults with normal velopharyngeal anatomy, the musculus uvulae is a cylindrical oblong-shaped muscle lying on the nasal surface of the soft palate, with its greatest bulk located just nasal to the levator veli palatini muscle sling. In participants with repaired cleft palate, the musculus uvulae is substantially reduced in volume. This diminished muscle bulk located just at the point where the palate contacts the posterior pharyngeal wall may contribute to velopharyngeal insufficiency in children with repaired cleft palate.
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CMK, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
For a carefully planned and well-designed Phase 3 confirmatory trial, there is still a potential risk of failing to meet the study objective due to possible differences between Phase 2 ...and Phase 3 studies. As illustrated by the ENGAGE trial, potential sample size increase at an interim analysis can mitigate the risk for an otherwise underpowered study. Many approaches for sample size adjustment (SSA) require certain modifications to the conventional statistical method, such as changing critical values or using a weighted Z-statistic for final hypothesis testing. Without modification, the type I error rate can be inflated, primarily caused by sample size increase for nonpromising interim observation that is close to null or no treatment effect. As illustrated by the TOPICAL trial, increasing sample size for nonpromising interim result could waste limited resource on ineffective treatment. The modifications in these approaches are therefore unnecessary costs of flexibility/interpretability for unnecessary scenarios of sample size increase.
Purpose:
To discuss and illustrate the appropriateness of SSA based on promising interim results, that is, conditional power being greater than 50% (or CDL approach), in a carefully planned and well-designed Phase 3 confirmatory trial.
Methods:
Two clinical trials are used to illustrate the clinical setting for the CDL approach and appropriateness of its application. Operating characteristics are assessed and compared to other methods using numeric computation. Hypothetical trials based on real clinical data are used to illustrate the approach.
Results:
The CDL approach for SSA leads to a small increase in expected sample size resulting in a small power gain versus the fixed design. This indicates that adding SSA will not on average substantially affect the budget at the portfolio level. However, when the interim result is promising, the CDL approach can dramatically increase the conditional power therefore mitigating the risk of an otherwise underpowered study.
Limitations:
Implementation challenges of the SSA methods are not in the scope of this paper. SSA is not intended to replace careful design of a confirmatory trial; instead, it can mitigate the risk for a well-designed trial.
Conclusions:
The CDL approach for SSA based on promising interim results, that is, conditional power being greater than 50%, is particularly useful in mitigating the risk for a carefully planned and well-designed Phase 3 confirmatory trial. No modification to the conventional statistical procedure is necessary while the type I error rate is controlled. Such a feature of ''no interference,'' or no change to the conventional statistical procedure with or without sample size adjustment, is important for the interpretation of a confirmatory trial. Similar to the fixed design, carefully planned and well-designed group sequential studies can also benefit from SSA to mitigate the risk of failing to meet the study objective.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Background
Modern low-cost 3D printing technologies offer the promise of access to surgical tools in resource scarce areas, however optimal designs for manufacturing have not yet been established. We ...explore how the optimization of 3D printing parameters when manufacturing polylactic acid filament based Army-Navy retractors vastly increases the strength of retractors, and investigate sources of variability in retractor strength, material cost, printing time, and parameter limitations.
Methods
Standard retractors were printed from various polylactic acid filament spools intra-manufacturer and inter-manufacturer to measure variability in retractor strength. Printing parameters were systematically varied to determine optimum printing parameters. These parameters include retractor width, thickness, infill percentage, infill geometry, perimeter number, and a reinforced joint design. Estimated retractor mass from computer models allows us to estimate material cost.
Results
We found statistically significant differences in retractor strength between spools of the same manufacturer and between manufacturers. We determined the true strength optimized retractor to have 30% infill, 3 perimeters, 0.25 in. thickness, 0.75 in. width, and has “Triangle” infill geometry and reinforced joints, failing at more than 15X the threshold for clinically excessive retraction and costs $1.25 USD.
Conclusions
The optimization of 3D printed Army-Navy retractors greatly improve the efficacy of this instrument and expedite the adoption of 3D printing technology in many diverse fields in medicine not necessarily limited to resource poor settings.
Bacterial colonisation of the respiratory tract is commonly described and usually thought to be of no clinical significance. The aim of this study was to examine the presence and significance of ...bacteria and viruses in the upper respiratory tract of healthcare workers (HCWs), and association with respiratory symptoms.
A prospective cohort study was conducted in China and 223 HCWs were recruited from fever clinics and respiratory, paediatric, emergency/Intensive medication wards. Participants were followed over 4 weeks (7th May 2015 to 4th June 2015) for development of clinical respiratory illness (CRI). Nasopharyngeal swabs were obtained at baseline and at the end of the study. The primary endpoints were laboratory-confirmed bacterial colonisation and viral respiratory infection. Rates of the following infections in symptomatic and asymptomatic participants were compared at the start or end of the study; 1) all bacterial/viral infections, 2) bacterial infection and bacterial-viral co-infections, excluding virus only infections, and 3) only bacterial infections.
Bacterial colonisation was identified in 88% (196/223) of participants at the start or end of the study. Among these participants, 66% (148/223) had only bacterial colonisation while 22% (48/223) had co-infection with a virus. Bacteria were isolated from 170 (76.2%) participants at baseline and 127 (57%) participants at the end of the study. Laboratory confirmed viral infections were identified in 53 (23.8%) participants - 35 (15.7%) at the baseline and 20 (9.0%) at the end of the study. CRI symptoms were recorded in 12 participants (4.5%) and all had a positive bacterium isolation at baseline (n = 11) or end of the study (n = 1). Among asymptomatic participants, 187 (87%) had bacterial colonisation or bacterial/viral co-infection at baseline or end of the study. Viruses were also isolated from 5 (2.4%) asymptomatic cases. Rates of all infection outcomes were higher in symptomatic participants, however differences were not statistically significant.
We isolated high rates of bacteria and viruses in the upper respiratory tract of hospital HCWs, which may reflect greater exposure to respiratory infections in the hospital. Although respiratory infections are mostly symptomatic, the association between bacterial colonization and symptomatic illness is not clear. In the healthcare setting, HCWs may acquire and transmit infection to patients and other HCWs around them. Larger studies are required to explore ongoing occupational risk of respiratory infection in hospitals HCWs.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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