PubMed · 9188958
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J R Miller. 1997. Basic concepts concerning bracket failure research.. https://doi.org/10.1043/0003-3219(1997)067%3C0167%3Acbccbf%3E2.3.co%3B2
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OBJECTIVE: To determine whether the efficacy of interferon beta-1b (IFNbeta-1b) on lesion activity could be shown with annual analysis of MRI. BACKGROUND: Clinical outcomes and MRI burden of disease changes in MS patients in a multicenter double-blind placebo-controlled 5-year trial of IFNbeta-1b have been reported, together with an analysis of 6-weekly MRI activity in a small subgroup during 2 years. MRI activity measurements based on annual scans have not been documented. METHODS: Patients were randomized into three treatment arms: placebo, 1.6 mIU, and 8 mIU IFNbeta-1b self-administered subcutaneously every other day. Active lesions were identified as new, enlarging, or recurrent on proton density and T2-weighted MRI scans. Gadolinium was not used. An annual accumulation activity index was developed as an additional analysis of lesion activity. RESULTS: During the 5 years, both high- and low-dose IFNbeta-1b groups showed a striking reduction in lesion annual accumulation activity on the activity index versus placebo (p = 0.001). Thirty-five percent of the high-dose patients and 29% of the low-dose patients were MRI inactive by this method of analysis, whereas only 16% of placebo patients were inactive (p = 0.001, placebo versus 8 mIU). CONCLUSIONS: This analysis of the annual accumulation of lesion activity shows that the previously reported treatment effect seen on MRI scanning once every 6 weeks in a subcohort of the patients can also be seen on yearly scans. This annual accumulation activity analysis provides an independent MRI confirmation of a treatment and dose effect for IFNbeta-1b.
OBJECTIVE: To assess the feasibility of anonymous shortlisting of applications for medical school and its effect on those with non-European names. DESIGN: Prospective cohort study. SETTING: Leeds school of medicine, United Kingdom. SUBJECTS: 2047 applications for 1998 entry from the United Kingdom and the European Union. INTERVENTION: Deletion of all references to name and nationality from the application form. MAIN OUTCOME MEASURES: Scoring by two admissions tutors at shortlisting. RESULTS: Deleting names was cumbersome as some were repeated up to 15 times. Anonymising application forms was ineffective as one admissions tutor was able to identify nearly 50% of candidates classed as being from an ethnic minority group. Although scores were lower for applicants with non-European names, anonymity did not improve scores. Applicants with non-European names who were identified as such by tutors were significantly less likely to drop marks in one particular non-academic area (the career insight component) than their European counterparts. CONCLUSIONS: There was no evidence of benefit to candidates with non-European names of attempting to blind assessment. Anonymising application forms cannot be recommended.
This paper introduces a space-time continuum model to evaluate the effectiveness of programs that encourage recruitment and retention of health professionals. Based on the shape of a wineglass, the model provides a framework to study the locational histories of a cohort of health professionals, both conceptually and quantitatively. A key component of the model is that it measures geographic dispersion over time from a medical school, residency program, or other shared location. Geographic dispersion can be studied in the model through standard deviational ellipses, standard distance, or average distance circles. The model enables analysis through structuration theory, which is used as a guide for analyzing the interplay between human agency (e.g., individual decisions on practice location) and structure (e.g., medical education). Space-time modeling is linked with structuration theory. Variations in the shape of the wineglass reveal how people may be bound by a general structure, yet through lifetime locational decisions may change that structure over space and time. Using data on University of Nebraska alumni, the authors constructed a pilot demonstration to test and confirm the model's potential usefulness. In the pilot demonstration, standard deviational ellipses represented the range of physician locations during each year, overlaid on maps of the US. The pilot demonstration indicated the model's strength in identifying changing mobility over time, while also pointing to concerns about unevenness in data availability from one year to the next. Further application of the wineglass model could be used toward studying the life histories of health professionals. The impact of community-based training on long- or short-term retention, changes in the mobility of male vs female providers, and the career trajectories of people in different health professions or medical schools are only a few examples of potential future applications of the model.