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PubMed2003

Establishment success and extinction risk in autocorrelated environments.

We consider establishment success (and extinction risk of small populations) in fluctuating environments, by means of an inhomogeneous branching process model. In this model it is assumed that individuals reproduce asexually during discrete reproduction periods. Within each period individuals reproduce independently and have random numbers of offspring. Expected numbers of offspring vary over reproduction periods due to random environmental changes. Previous simulation results indicated that there is a positive autocorrelation between the establishment probabilities of invaders in successive reproduction periods when environmental states are independently distributed. This result was never formally proved. In this paper we prove that this is indeed true, regardless of the form of the distribution of environmental states or the offspring distribution (under a monotonicity condition, which holds for biologically realistic models). Furthermore, we prove that it is also true for positively autocorrelated environmental states. We show by a counterexample that in environments with a strong negative autocorrelation establishment probabilities can be negatively autocorrelated. This was further examined through simulations. Our results imply that in independent, positively autocorrelated and weakly negatively autocorrelated environments the probability of success of invasion in different independently varying sites is the highest, followed by sequential invasion. For environments with a strong negative autocorrelation, sequential invasion has the highest probability of success. Effects of autocorrelation were further examined with simulations. From the results it appears that the expected length of 'runs of bad luck' is the most crucial factor for establishment success.

Algorithms↗

PubMed2003

Life span variations in 128 successive generations of D. melanogaster. I. Evidence that the phenomenon exists and analysis of the variations mode.

Survival of Drosophila melanogaster was estimated in 128 successive generations for 5 years. The resultant 116 samples (58 for females and 58 for males) containing series of individual values of life span (LS; 50-90 values in each series) were analyzed. Each of 58 pairs of samples belonged to a definite generation in a continuous succession where every next generation was an offspring of the preceding one. In total, 10180 Drosophila flies (5100 females and 5080 males) were studied. The mean life span (MLS) was found to be considerably heterogeneous in the series of generations: in many pairs of consecutive generations, MLSs significantly differed within two errors of the mean (P<0.05), and the minimum and maximum MLSs in the series differed from each other almost twofold. The use of the nonparametric Kruskal-Wallis test made it possible to conclusively demonstrate highly significant (P<0.001) differences between LS distributions and their medians in the series of successive generations of D. melanogaster. Highly significant (P<0.0001) positive correlations (from 0.61 to 0.91) between the parameters characterizing the minimum (t(10)), mean, and maximum (t(90)) LSs were found. This indicates considerable consistency of the LS variations in successive generations of the same population, with the proportions of individuals with low and high LSs remaining about the same irrespective of the MLS. It was demonstrated with the use of mathematical simulation that the MLS changes in successive generations may be regarded as an oscillatory process and described as a sum of several (three to five) harmonic components. The calculated determination coefficients were high (93.51 and 88.93% for females and males, respectively). This indicates that the mathematical model used for simulation adequately described the observed variations in MLS. The results are discussed in terms of population gerontology and the problem of geroprotector effectiveness.

Aging↗

PubMed1998

Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience.

BACKGROUND: We have used epidural spinal cord stimulation (SCS) for pain control for the past 15 years. An analysis of our series of 235 patients has clarified the value of specific prognostic parameters in the prediction of successful SCS. METHODS: Patients were followed up for periods ranging from 6 months to 15 years with a mean follow-up of 66 months. The mean age of the 150 men and 85 women in the study was 51.4 years. Indications for SCS included failed back syndrome (114 patients), peripheral vascular disease (39 patients), peripheral neuropathy (30 patients), multiple sclerosis (13 patients), reflex sympathetic dystrophy (13 patients), and other etiologies of chronic intractable pain (26 patients). RESULTS: One hundred and eighty-nine patients received permanent devices; 111 (59%) of these patients continue to receive satisfactory pain relief. Pain attributable to failed back syndrome, reflex sympathetic dystrophy, peripheral vascular disease of lower limbs, multiple sclerosis, and peripheral neuropathy responded favorably to spinal cord stimulation. In contrast, paraplegic pain, cauda equina syndrome, stump pain, phantom limb pain, and primary bone and joint disease pain did not respond as well. Cases of cauda equina injury had promising initial pain relief, but gradually declined after a few years. After long-term follow-up, 47 of the 111 successfully implanted patients were gainfully employed, compared with 22 patients before implantation. The successful patients reported improvements in daily living as well as a decrease in analgesic usage. Multipolar stimulation systems were significantly more reliable (p < 0.001) than unipolar systems. Complications included hardware malfunction, electrode displacement, infection, and tolerance. CONCLUSION: Aside from etiologies of pain syndromes as a prognostic factor, we have identified other parameters of success. In patients who have undergone previous surgical procedures, the shorter the duration of time to implantation, the greater the rate of success (p < 0.001). The diagnosis of failed back syndrome must be considered a confounding factor in our analysis. Those patients whose pain did not follow a surgical procedure had better responses to SCS than patients who had multiple surgical procedures prior to their first implant. The advent of multipolar systems has significantly improved clinical reliability over unipolar systems. Age, sex, and laterality of pain did not prove to be of significance.

Adult↗

PubMed2003

Minimal time to successful intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: To determine the minimal time to successful intercourse after taking sildenafil citrate for erectile dysfunction (ED). METHODS: Male patients with ED (mean age 60 years; mean ED duration 7.0 years) who were successfully treated with sildenafil (100 mg) for 2 months or longer were randomized to sildenafil (n = 115) or placebo (n = 113) for 4 weeks of double-blind treatment. Using a stopwatch, patients recorded the time needed to obtain an erection hard enough for sexual intercourse after taking the study drug at least 2 hours after eating. RESULTS: Within 14 and 20 minutes of sildenafil dosing, 35% and 51% of sildenafil-treated patients, respectively, versus 22% and 30% of placebo-treated patients, respectively, had an erection that led to successful intercourse (P <0.05 for both). The median time to erection leading to successful intercourse after sildenafil dosing was 36 minutes compared with 141 minutes for placebo. CONCLUSIONS: In this study, slightly more than one half of a population of prior sildenafil responders achieved an erection that led to successful sexual intercourse within 20 minutes of sildenafil administration, suggesting that the onset of action of sildenafil can be less than 30 minutes in men with ED.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2002

Success of balloon catheter dilatation as a primary or secondary procedure for congenital nasolacrimal duct obstruction.

PURPOSE: To determine the efficacy of lacrimal balloon catheter dilatation in treating congenital nasolacrimal duct obstruction (CNLDO) as a primary procedure in children more than 18 months of age and in children who have failed lacrimal probing or silicone intubation. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Fifty-nine patients, ranging in age from 15 months to 9 years (mean, 35.6 months), with 73 lacrimal systems diagnosed with CNLDO who underwent nasolacrimal balloon catheter dilatation. Thirty-four lacrimal systems (46.5%) had no previous procedures, whereas 39 lacrimal systems (53.5%) had failed probing, silicone intubation, or both. INTERVENTION: Balloon catheter dilatation was performed following standard protocol, with a simplified regimen in most patients. MAIN OUTCOME MEASURES: Clinical patency of the nasolacrimal duct after balloon dilatation was the main outcome measure and was defined as complete resolution of signs and symptoms (crusting, discharge, and increased tear meniscus). Age, inferior turbinate infracture, and Downe's syndrome as related to the main outcome measure were also analyzed. RESULTS: Overall, 56 of the 73 lacrimal systems (76.7%) had complete resolution of symptoms. Twenty-seven of all 34 primary balloon catheter dilatations (79.4%) remained clinically patent, whereas 29 of all 39 secondary balloon catheter dilatations (74.4%) remained clinically patent after surgery (P = 0.8165). Thirty-nine of 47 lacrimal systems (82.9%) in children older than 24 months remained clinically patent, whereas 17 of 26 lacrimal systems (65.4%) in children younger than 24 months remained clinically patent (P = 0.1573). The mean age of patients with successful outcomes was 37 months, whereas the mean age of patients with failed balloon catheter dilatations was 32 months (P = 0.3924). In the secondary procedure group, analysis showed that the mean age of success (32 months) was greater than the mean age of failure (18 months; P = 0.0491). Within the secondary group, 16 of 17 lacrimal systems (94.1%) older than 24 months were successful, whereas 13 of 22 lacrimal systems (59.1%) younger than 24 months were successful (P = 0.0344). CONCLUSIONS: Balloon catheter dilatation is an effective treatment for congenital nasolacrimal duct obstruction. In particular, balloon catheter dilatation in older children who failed previous probing is highly successful.

Catheterization↗

PubMed1994

Late re-opening of macular holes after initially successful treatment with vitreous surgery.

BACKGROUND: In more than 50% of eyes with idiopathic, full-thickness macular holes, vitrectomy results in clinical closure of the hole and improvement in visual acuity. Other than cataract formation, late complications of the procedure have not been reported. METHODS: Over a 4-year period, 167 eyes underwent successful vitreous surgery for idiopathic macular holes documented by clinical closure of the hole and an improvement in visual acuity of at least two Snellen lines. The authors retrospectively studied eight of these eyes. All initially had successful surgery; however, they subsequently had spontaneous late re-opening of the macular hole with acute diminution in vision. RESULTS: Late re-opening developed in these eyes between 2 and 22 months after initial surgery. The mean time for re-opening was 12.5 months. Three of eight eyes underwent a second vitrectomy, which was successful in improving visual acuity in two eyes. Another patient manifested the growth of an epiretinal membrane that apparently sealed the re-opened macular hole and improved vision. CONCLUSION: Late re-opening can complicate initially successful macular hole surgery and may occur in at least 4.8% (8 of 167) of initially successful operations. Re-opening has been documented as late as 22 months after initial surgery. Repeat vitrectomy with gas injection may result in reclosure of the hole and improvement in vision.

Aged↗

PubMed1997

Success of multiple endosseous dental implant designs to second-stage surgery across study sites.

A multicenter clinical study of dental implants is being conducted by the Dental Implant Clinical Research Group to investigate the influence of implant design, application, and site on clinical performance and crestal bone. This article reports on the percentage of success up to implant uncovering for different implant designs and the distribution of failures across study sites. Data from 2,847 implants placed at 32 study sites were analyzed. Percentages of success up to implant uncovering were calculated for study implants overall, by implant design, by implant design within study strata, and according to individual study sites and quartile groupings of sites based on success. Comparisons were made, with chi-square and exact tests employed where appropriate. Differences were found between the different implant designs for the study overall, and between implant designs within the different study strata. Although some implant designs were found to have generally high success across study sites, some study sites designated as having surgeons with less experience tended to have higher failure levels, and one implant design failed at higher rates in a subset of study sites. The percentage and distribution of implant failures varied across study sites and by implant design. These differences appeared to be in part related to the level of experience of the surgeons. Further investigation should focus on identification of factors that contribute to higher success in implant placement with different implant designs.

Adult↗

PubMed2003

Predicting defibrillation success by 'genetic' programming in patients with out-of-hospital cardiac arrest.

BACKGROUND: In some patients with ventricular fibrillation (VF) there may be a better chance of successful defibrillation after a period of chest compression and ventilation before the defibrillation attempt. It is therefore important to know whether a defibrillation attempt will be successful. The predictive power of a model developed by 'genetic' programming (GP) to predict defibrillation success was studied. METHODS AND RESULTS: 203 defibrillations were administered in 47 patients with out-of-hospital cardiac arrest due to a cardiac cause. Maximal amplitude, a total energy of power spectral density, and the Hurst exponent of the VF electrocardiogram (ECG) signal were included in the model developed by GP. Positive and negative likelihood ratios of the model for testing data were 35.5 and 0.00, respectively. Using a model developed by GP on the complete database, 120 of the 124 unsuccessful defibrillations would have been avoided, whereas all of the 79 successful defibrillations would have been administered. CONCLUSION: The VF ECG contains information predictive of defibrillation success. The model developed by GP, including data from the time-domain, frequency-domain and nonlinear dynamics, could reduce the incidence of unsuccessful defibrillations.

Aged↗

PubMed2003

A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest.

BACKGROUND: Evidence suggests that biphasic waveforms are more effective than monophasic waveforms for defibrillation in out-of-hospital cardiac arrest (OHCA), yet their performance has only been compared in un-blinded studies. METHODS AND RESULTS: We compared the success of biphasic truncated exponential (BTE) and monophasic damped sine (MDS) shocks for defibrillation in OHCA in a prospective, randomised, double blind clinical trial. First responders were equipped with MDS and BTE automated external defibrillators (AEDs) in a random fashion. Patients in ventricular fibrillation (VF) received BTE or MDS first shocks of 200 J. The ECG was recorded for subsequent analysis continuously. The success of the first shock as a primary endpoint was removal of VF and required a return of an organized rhythm for at least two QRS complexes, with an interval of <5 s, within 1 min after the first shock. The secondary endpoint was termination of VF at 5 s. VF was the initial recorded rhythm in 120 patients in OHCA, 51 patients received BTE and 69 received MDS shocks. The success rate of 200 J first shocks was significantly higher for BTE than for MDS shocks, 35/51 (69%) and 31/69 (45%), P=0.01. In a logistic regression model the odds ratio of success for a BTE shock was 4.01 (95% CI 1.01-10.0), adjusted for baseline cardiopulmonary resuscitation, VF-amplitude and time between collapse and first shock. No difference was found with respect to the secondary endpoint, termination of VF at 5 s (RR 1.07 95% CI: 0.99-1.11) and with respect to survival to hospital discharge (RR 0.73 95% CI: 0.31-1.70). CONCLUSION: BTE-waveform AEDs provide significantly higher rates of successful defibrillation with return of an organized rhythm in OHCA than MDS waveform AEDs.

Adult↗

PubMedDate not supplied

Measurement of myocardial contractility following successful resuscitation: quantitated left ventricular systolic function utilising non-invasive wall stress analysis.

After successful resuscitation from cardiac arrest, prolonged contractile failure has been demonstrated in animal experiments. No systematic evaluation of myocardial contractility following successful resuscitation after human cardiac arrest exists. The aim of this study was to assess left ventricular contractility following human cardiac arrest with successful resuscitation. In 20 adult patients after cardiac arrest and in four control patients, the relation between meridional wall stress (MWS) and rate-corrected mean velocity of circumferential fibre shortening (Vcf(c)), a load independent and rate corrected index of left ventricular contractility was measured within 4 h after return of spontaneous circulation and after 24 h by means of transoesophageal echocardiography. As the normal values of Vcf(c) depend on MWS, a normal deviate (z) was calculated. A normal z-score is defined as 0+/-2, < -2 indicates reduced contractility, > + 2 increased contractility. Data are presented as median and the interquartile range (IQR). For the comparison of related samples the Wilcoxon sign test was used. In most patients after cardiac arrest contractility was severely impaired within 4 h after successful resuscitation [z - 7.0 (IQR - 8.9 - (-2.5))]. Contractility did not significantly improve within the observational period [z after 24 h - 3.7 (IQR - 7.9 - (-1.8))] (P = 0.3). The four control patients had normal left ventricular contractility on arrival (z 0.0, range - 0.9-0.8) and after 24 h (z 0.7, range - 1.5-2.7). In conclusion non-invasive wall stress analysis can be applied to quantitate systolic left ventricular function, which was severely compromised in most patients within the first 24 h after successful resuscitation. Whether depression of left ventricular function is caused by cardiac arrest itself or by the underlying disease remains speculative.

Adult↗

PubMed1991

Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: effect on in-hospital mortality and left ventricular function.

To determine the effect of treatment of recurrent ischemia after reperfusion for acute myocardial infarction on in-hospital mortality and left ventricular function recovery and to identify patients at highest risk of serious consequences in the event of recurrent ischemia in this setting, 405 consecutively treated patients were studied retrospectively. All patients received intravenous thrombolytic therapy within 6 h of ST segment elevation-documented infarction and had angiographic confirmation of their reperfusion status performed within 120 min of treatment. Three hundred three patients had successful reperfusion with or without rescue angioplasty and had no recurrent ischemia (group 1), 74 patients had initially successful reperfusion but subsequent recurrent ischemia (group 2) and 28 patients had failed reperfusion (group 3). The in-hospital mortality in groups 1 to 3 was 2.0%, 14.9% and 32.1%, respectively (p less than 0.001) and the change from baseline to prehospital discharge left ventricular ejection fraction was 1.2 +/- 9.3%, -0.8 +/- 8.7% and -4.3 +/- 5.3%, respectively (p = NS). Within the recurrent ischemia group (group 2), multiple regression analysis found absence of cardiogenic shock at presentation (p = 0.002) and successful treatment initiated within 90 min of recurrent ischemia (p = 0.045) to be the only variables independently correlated with in-hospital survival. Later successful reperfusion was not associated with improved hospital survival. The timing and success of treatment did not affect recovery of global or regional left ventricular function in the patients with paired angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1998

Reopening after successful coil occlusion for patent ductus arteriosus.

OBJECTIVES: This study was performed to determine the frequency of patent ductus arteriosus (PDA) reopening and the factors that may predict reopening after successful coil occlusion. BACKGROUND: Transcatheter coil occlusion is a widely used and accepted method to close a PDA. After documented successful coil occlusion, we found PDAs that reopened. We hypothesized that specific factors are involved in those that reopened. METHODS: All patients who underwent percutaneous transarterial PDA coil occlusion were studied. Successful coil occlusion was documented. PDA reopening was determined when Doppler-echocardiography (DE) performed after the procedure was negative for PDA flow but at follow-up demonstrated PDA shunting. Patients with a reopened PDA were compared with all other patients in evaluating independent variables. RESULTS: Coil occlusion for PDA was attempted in 22 patients. Clinical success was achieved in 20 patients (91%), and DE was negative for PDA shunting in 19 patients (90%). At follow-up, five patients demonstrated reopening. The PDA minimal diameter was 1.4 +/- 0.5 mm (mean +/- SD) for the reopened group and 1.2 +/- 0.7 mm for the other patients. The PDA length was 2.9 +/- 1.9 mm for the reopened group and 7.1 +/- 3.2 mm for all other patients. All those with type B PDA were in the reopened group. When independent variables were compared between groups, only PDA length and type B PDA predicted reopening (p < 0.05). CONCLUSIONS: PDA reopening may occur after successful coil occlusion. Short PDA length and type B PDA are associated with reopening. The data suggest that in such anatomy, alternative strategies to the current coil occlusion technique should be considered.

Adolescent↗

PubMed1999

Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention.

OBJECTIVES: The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention. BACKGROUND: The ideal dose and duration of heparin infusion after successful coronary intervention is unknown. METHODS: Patients were randomized to one of three heparin strategies after coronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patients) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any further heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome. RESULTS: After successful coronary intervention, 414 patients were randomized. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overall incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all three groups. CONCLUSIONS: Heparin infusion after successful coronary intervention is associated with more minor bleeding and vascular injury, prolonged length of stay and increased cost. In-hospital and one-month ischemic events rarely occur after successful intervention, irrespective of heparin use. Routine postprocedure heparin is not recommended, even in patients who present with unstable ischemic syndromes.

Angioplasty, Balloon, Coronary↗

PubMed1998

Can intrarenal duplex waveform analysis predict successful renal artery revascularization?

PURPOSE: No currently available noninvasive test can preoperatively predict a successful outcome to renal revascularization. Resistance measurements from the renal parenchyma obtained with duplex sonography reflect the magnitude of intraparenchymal disease, and patients with extensive intrarenal disease may respond less favorably to revascularization. To address this question, we reviewed our (primarily) operative experience in patients undergoing renal artery revascularization, and compared the blood pressure (BP) and renal function response with resistance measurements obtained from the kidney both before and after revascularization. METHODS: During a 56-month period, 31 consecutive renal artery revascularizations (25 surgical and 6 percutaneous angioplasties) were performed in 23 patients (21 atherosclerotic, 2 fibromuscular dysplasia). Duplex sonography was performed in each patient before and after revascularization, and parenchymal diastolic/systolic (d/s) ratios were calculated. BP and renal function response to intervention were compared with measurements of intrarenal flow patterns before and after revascularization. RESULTS: Mean parenchymal peak systolic velocity was significantly higher after repair in all patients (pre-repair: 19.5 +/- 1.3, postrepair: 27.2 +/- 1.7; P < .0001). Despite this, there were no statistical differences between preoperative and postoperative parenchymal d/s ratios. A favorable (cured or improved) BP response was seen in 81% (17 of 21) of revascularizations performed for hypertension. Among these successes, parenchymal d/s ratios were in the normal range (ie, > or = 0.30) both before and after repair (mean prerepair: 0.34 +/- 0.03, mean postrepair: 0.31 +/- 0.03; not significant). In 4 patients in which BP failed to improve after intervention, the d/s ratio was abnormal before surgery (< 0.3), and remained so after revascularization (mean preoperative d/s ratio: 0.18 +/- 0.04, mean postoperative d/s ratio: 0.11 +/- 0.04; P = .003). Mean preoperative parenchymal d/s ratios were significantly higher in all patients with a successful BP response when compared with failures (P = .048). Similarly, among patients with single artery repairs, mean preoperative d/s ratios approached significance in successes vs. failures (success: 0.40 +/- 0.03, failure: 0.21 +/- 0.03; P = .054). A decrease in serum creatinine greater than or equal to 20% was seen in 8 of 18 patients (44%) with ischemic nephropathy. These patients also had normal d/s ratios preoperatively (mean 0.39 +/- 0.04), whereas the 10 patients who failed to improve had significantly lower ratios (mean 0.24 +/- 0.03; P = .041). Kidney length did not correlate with d/s ratio. CONCLUSION: Although we do not believe that duplex sonographic measurement of intrarenal flow patterns alone is an accurate means of assessing main renal artery occlusive disease, the resistive indices seem to reflect the magnitude of intraparenchymal disease, and thus may provide important prognostic information for patients undergoing surgical revascularization. Our data suggest that a preoperative d/s ratio below 0.3 correlates with clinical failure relative to BP and renal function responses.

Aged↗

PubMed2005

[Logistical regression of success factors in the former internship examination for medical students].

INTRODUCTION: The French competitive internship examination for medical students was replaced in 2004 by a national-ranking exam. The profile of students successful at the internship exam, although more or less stereotypical, was never methodically analyzed. AIMS: To determine the factors that influenced success in the internship exam. METHODS: Records of 242 students from four successive entering classes (1989-1992) at the Saint-Etienne Faculty of Medicine underwent logistical regression analysis. Factors studied were: gender; occupation of the head of household; details about their General Certificate of Education test (age attest, core subject, overall grade); repeating any first-cycle medical studies (PCEM1); PCEM1 grade; number of certificates resat at the end-of-year make-up session or the following year during second-cycle medical studies (DCEM), known as "debts"; and the ranking obtained in the five faculty certificate tests deemed representative of the overall competitive test and on the clinical and therapeutic summary certificate (CSCT). RESULTS: The 95 students (59%) who did not take the internship exam differed from those who did. The former typically: (1) were older when they began studying medicine (p = 0.003); (2) had passed the General Certificate of Education with the lowest or next lowest pass levels (p = 0.023); (3) re-did their PCEM1 studies (p = 0.001); (4) were ranked in the lower two-thirds of their PCEM1 class (p = 0.001); (5) had more PCEM1 certificates to resit during DCEM (p = 0.007); (6) were ranked in the lower two-thirds of their class for the certificates (including the CSCT) (p < 0.001). Of the 147 students who did take the internship exam, 102 (69%) passed. Logistical regression identified three predictive factors in their success: (1) took the General Certificate of Education at an average or younger than average age (adjusted odds ratio (OR) 7.79, confidence interval (CI) 95% [1.59-38.13]); (2) had at most one "debt" (adjusted OR 16.51 [1.88-144.78); (3) ranked in the top third of their class for certificates (including the CSCT) (adjusted OR 7.84 [2.42-25.41]). CONCLUSION: Our study objectively confirmed that consistent work and effective learning strategies, acquired early during education and applied throughout medical studies, strongly promoted success in the previous internship exam. It is likely--but should be verified--that medical students who choose this strategy of constant effort will also do best on the new national-ranking examination.

Educational Measurement↗

PubMed2003

Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines.

This study was undertaken to examine the success rate and the length of orthodontic treatment of impacted maxillary canines in adult patients. A sample of 19 adults (mean age, 28.8 +/- 8.6 years; range, 20-47 years), who had been treated for a total of 23 impacted maxillary canines, was compared with a younger control group (mean age, 13.7 +/- 1.3 years; range, 12-16 years). The control subjects were chosen for a similar degree of impaction difficulty by carefully matching the positions of the impacted canines in the 3 planes of space. The success rate among the adults was 69.5% compared with 100% among the younger controls. The lower success rate was due to 5 canines that had failed to erupt and 2 canines that had been partially extruded but could not be aligned in the arch. The duration of treating the overall malocclusion of the adults and young subjects did not materially differ. However, the adults showed significant increases in the duration and number of treatment visits required for resolving the canine impaction, in both the simpler and the more difficult cases. When further divided by age, all the failed canines were found in the older (over 30) adult subgroup. It was concluded that the prognosis for successful orthodontic resolution of an impacted canine in an adult is lower than that in a younger patient and that the prognosis worsens with age. Furthermore, when such treatment is undertaken, its successful completion should be expected to take considerably longer.

Adolescent↗

PubMed2001

Successful aging among people with HIV/AIDS.

With advances made in the treatment of people with HIV/AIDS, there is an increasing number of persons who are reaching old age. This is a heterogeneous group. Yet, all of these diverse patients share in common the challenge of aging successfully despite their condition. There is little room in most gerontological conceptualizations for consideration of success for older persons unfortunate enough to live with chronic and particularly life-threatening illnesses in late life. Ideals of successful aging certainly leave little room for older adults with HIV/AIDS, a highly stigmatized, life-threatening, and disabling condition. In this article, we briefly review a new model of successful aging that we have developed, and show how it can be meaningfully applied to expectations of successful aging even among disabled and chronically ill populations of older adults such as persons with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Outcome of temporal lobectomy: expectations and the prediction of perceived success.

PURPOSE: This study examined the independent contributions of medical and psychosocial factors to perceived surgical success. We aimed to develop a multidimensional model predictive of perceived surgical outcome. METHODS: Fifty anterior temporal lobectomy (ATL) patients were prospectively assessed, using a formally coded, semistructured clinical interview. This has been routinely administered pre- and post-operatively as part of a larger, nationwide study of Australian ATL patients. The interview covers a broad range of epileptological, psychiatric, neuropsychological and psychosocial issues. Variables from these domains were examined in relation to the patient's perception of surgical success at the 6-month post-operative review. RESULTS: Variables that correlated with success were analysed using principal components analysis and multiple regression. A predictive model of perceived surgical success emerged, which highlighted the multidimensionality of outcome. Independent effects were observed for both medical and psychosocial factors. These included the patients' pre-operative expectations of surgery, their post-operative seizure outcome, and affective state. The findings also highlighted the importance of discarding sick role behaviours associated with chronic epilepsy, after surgery. CONCLUSIONS: Traditional outcome measures (seizure frequency, post-operative affect) are significant in the patient's evaluation of surgical success. These traditional measures, however, do not account for the process of psychosocial adjustment surrounding seizure surgery. This process involves two major components: (1) positive anticipation of change prior to surgery, and (2) learning to discard roles associated with chronic epilepsy after surgery.

Adult↗