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PubMed2003

Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital.

OBJECTIVE: The purpose of this study was to determine our institutional success rate with single-dose intramuscular methotrexate therapy for the treatment of ectopic pregnancy and to identify predictors of treatment outcome. STUDY DESIGN: This was a retrospective review of consecutive patients who were treated with methotrexate from January 2000 until April 2002. Successful treatment was defined as the resolution of the ectopic pregnancy without surgical intervention. RESULTS: Our overall success rate was 85% (69/81 patients). The median pretreatment serum beta-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure (793 vs 3804 mIU/mL, P <.002). The presence of a yolk sac that was visualized on vaginal ultrasonography was the only significant predictor of treatment failure (adjusted odds ratio, 19.3; P <.002). CONCLUSION: Our institutional success rate (85%) with methotrexate for treatment of tubal ectopic pregnancy is comparable with other published results. However, a finding unique to this study was that visualization of a yolk sac was a risk factor for failure.

Abortifacient Agents, Nonsteroidal↗

PubMed2000

Defining characteristics of financially successful orthodontists.

Financially successful personality profiles in most of the business world have been reported to be the choleric (powerful) and the melancholy (perfect) types. In 1996, Hughes proposed that the same relationship possibly exists in the profession of orthodontics. The purpose of this study was to explore whether a dominant personality profile exists for the most financially successful orthodontists. A questionnaire was used to gather information regarding the financial sophistication and the dominant personality profile of each participating orthodontist. One hundred twenty-six of the 300 surveys distributed to orthodontists were returned for a response rate of 42%. For every question, the null hypothesis of independence was tested with the chi-square test. The null hypothesis of independence was rejected for a P value of less than.05. The results revealed that no correlation exists between the financial sophistication of orthodontists and their personality profiles. However, over two thirds of the orthodontists had the choleric (powerful) and the melancholy (perfect) as dominant personality types. Interestingly, the questionnaire shed much light on factors that do contribute to financial success in orthodontics. Although statistical differences are lacking in these data, certain traits about successful practitioners could be identified. These orthodontists (1) allow their practices to grow if it will increase the net income, (2) view control of overhead as a key principle, (3) emphasize the competence of staff in determining the success of practice, and (4) believe in marketing. Implementation of these simple and common sense principles in some orthodontic practices might affect the business significantly.

Chi-Square Distribution↗

PubMed1984

Percutaneous transluminal dilatation of peripheral arteries: an analysis of factors predicting early success.

Four hundred ninety-five patients undergoing peripheral arterial percutaneous transluminal dilatation (TLD) with the Gruntzig balloon catheter were studied prospectively to determine which factors could be used to predict a successful result from the procedure. Ten variables were recorded before the TLD. The procedure was considered a success at follow-up if both the clinical grade and the objective vascular laboratory results improved. The results of a logistic discriminant function analysis showed that three variables were associated with success of a TLD at 3 months: the site of the TLD, the severity of the lesion (i.e., stenosis or occlusion), and the runoff. With these results, logistic regression analysis was used to estimate the chances of a successful result for all combinations of these significant variables. It is concluded that the early result of a TLD is determined by the site of the TLD, the severity of the lesion, and the runoff. A table of the estimated chances of success for any combination of these variables has been constructed and accurately describes our patient population.

Aged↗

PubMed1990

The Syme amputation: success in elderly diabetic patients with palpable ankle pulses.

The Syme amputation is an old operation that has been used during this century primarily as a means of treating traumatic injuries to the forefoot in military patients. In 1984 we made a deliberate attempt to perform the operation in a highly selective group of dysvascular patients with forefoot necrosis who happened to have a palpable posterior tibial pulse. We reviewed the charts of 26 patients who underwent a one-stage (3 patients) or two-stage (23 patients) Syme amputation. The mean age was 60 years, (range 32 to 74 years). There were 17 insulin-dependent diabetic patients, and 3 diet-controlled diabetic patients. Twenty-two patients (85%) had a palpable posterior tibial pulse before surgery. Fourteen patients (54%) underwent a preliminary Ray (4) or transmetatarsal (10) amputation to rid the forefoot of an active infection. Overall, 20 patients (77%) had successful Syme amputations. Nineteen of 22 patients (85%) with a palpable posterior tibial pulse had a successful amputation in contrast to one out of four patients (25%) who did not have a palpable pulse before surgery (p = 0.04). The mean follow-up of all patients was 23 months. The durability of the operation was demonstrated in finding that only one patient in 20 initially successful Syme amputations required revision to the below-knee level. The two-stage Syme amputation can be a very gratifying operation with success rates approaching 85%, even if offered to elderly diabetic patients. The single most important feature for success is to limit the operation to those patients with a palpable posterior tibial pulse before operation.

Amputation, Surgical↗

PubMed2001

A 1-year follow-up quality of life study after hemodynamically successful or unsuccessful surgical revascularization of lower limb ischemia.

PURPOSE: The impact of hemodynamically successful or unsuccessful bypass grafting or angioplasty on patients' quality of life was assessed throughout the first year postsurgery. METHODS: A total of 146 patients, 97 patients who underwent successful revascularization and 49 patients who underwent unsuccessful revascularization, were assessed for quality of life with the Nottingham Health Profile. RESULTS: Hemodynamically successful revascularization resulted in an immediate and lasting impact on the patients' quality of life. Despite hemodynamic failure, patients had improvements in pain, emotional reactions, sleep, and family relationships at the 1-year follow-up assessment. A successful revascularization in patients with claudication demonstrated the most marked quality of life benefits, including all health dimensions that were not normal at baseline. Patients with critical ischemia had improved quality of life for pain, sleep, and physical mobility. High ankle pressure, in the claudicant group, and a high sense of coherence were significantly associated with high quality of life. CONCLUSION: The treatment of lower limb ischemia resulted in an immediate and relatively lasting improvement in patients' quality of life. Patients who underwent hemodynamically successful bypass grafting procedures or angioplasty demonstrated higher quality of life benefits than patients who underwent a failed bypass grafting procedure. Quality of life was further determined by means of the patients' sense of coherence.

Aged↗

PubMed2004

A one-headed class V myosin molecule develops multiple large (approximately 32-nm) steps successively.

Class V myosin (myosin-V) was first found as a processive motor that moves along an actin filament with large ( approximately 36-nm) successive steps and plays an important role in cargo transport in cells. Subsequently, several other myosins have also been found to move processively. Because myosin-V has two heads with ATP- and actin-binding sites, the mechanism of successive movement has been generally explained based on the two-headed structure. However, the fundamental problem of whether the two-headed structure is essential for the successive movement has not been solved. Here, we measure motility of engineered myosin-V having only one head by optical trapping nanometry. The results show that a single one-headed myosin-V undergoes multiple successive large (approximately 32-nm) steps, suggesting that a novel mechanism is operating for successive myosin movement.

Actin Cytoskeleton↗

PubMed1989

Familiar neighbors enhance breeding success in birds.

We tested the hypothesis that long-term familiarity with neighbors is advantageous by determining whether male red-winged blackbirds (Agelaius phoeniceus) breeding adjacent to familiar neighbors have better reproductive success than other males. Using data gathered during a 10-yr study of breeding success, we found that males with familiar neighbors fledged, on average, significantly more offspring annually than males without familiar neighbors. We also found that the same males, breeding in different years on the same territories, had significantly larger harems in the years they had familiar neighbors. Improved reproductive success was due to the males' abilities to attract more females to nest in their territories. Alternative hypotheses to explain the positive relationship between familiar neighbors and breeding success were not supported by our data. Relatively high reproductive success for breeders with long-term neighbors may provide a basis for the evolution of cooperative behavior in this and other species.

Animals↗

PubMed1978

Fear of success-fact or artifact?

Each of 240 high school juniors and seniors wrote stories in response to one of four variations of the story cues used by Matina Horner to measure what has been called "fear of success." These cues described either Ann or John achieving success in medical school in a situation in which either all of the protagonist's classmates were men or there were equal numbers of men and women. Six different consequences of the success were assessed. Results indicated that male and female students perceived the depicted success in similar ways and that when the "deviance" aspect of Ann being alone in a class of men was removed, negative outcomes of success were lessened. The common interpretation of these stories as the writers' projections of their own personalities is challenged.

Achievement↗

PubMed1999

Achievement goals, beliefs about the causes of success and reported emotion in post-16 physical education.

The main aim of this study was to examine whether goal orientations of male and female adolescents involved in an optional post-16 physical education (PE) programme were related in a conceptually consistent manner with their beliefs about the causes of success in PE. We also determined relationships between these achievement goal-belief dimensions and reported enjoyment and boredom within PE classes. Participants (n = 171) in a sixth-form college PE programme completed an inventory assessing their task and ego goal orientations, beliefs about the determinants of success in PE, and emotion in PE activities at college. Separate factor analyses of goal orientations and beliefs for male and female students revealed two goal-belief dimensions. The first dimension showed ego orientation was linked to the view that ability and deceptive tactics lead to success. The second dimension suggested task orientation was associated with the belief that success is the result of hard work and effort. This task goal-belief factor was found to be more strongly correlated with enjoyment in PE among female students than among males. For boys, the task goal-belief factor was correlated significantly and negatively with boredom in PE, but this was not the case for girls. No significant relationships emerged between the ego goal-belief factor and reported emotion in PE among the male and female participants. Facilitating task involvement and beliefs about causes of success that are fundamentally under personal control may, therefore, promote positive affective experiences in sixth-form PE, especially among female students.

Achievement↗

PubMed2006

Ethnic disparity in the success of vaginal birth after cesarean delivery.

OBJECTIVE: To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). STUDY DESIGN: A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g. RESULTS: Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women. CONCLUSION: African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.

Adult↗

PubMed2004

Application of strict radiologic criteria to define success in laparoscopic pyeloplasty.

PURPOSE: To review our experience and utilize rigorous radiologic criteria to establish success in laparoscopic pyeloplasty. PATIENTS AND METHODS: The hospital records of consecutive adult patients who underwent laparoscopic pyeloplasty for ureteropelvic junction (UPJ) obstruction during a 5-year period at our institution were reviewed. We identified 47 candidates for study inclusion. With one open conversion secondary to excessive fibrosis and one patient requiring repeat laparoscopic pyeloplasty for recurrence, 46 patients with 47 renal units were included for analysis. Thirteen renal units had prior surgery for UPJ obstruction. Preoperative and postoperative symptomatology were compared to determine subjective outcome. Mercaptoacetyltriglycine (MAG3) nuclear renography was performed preoperatively and postoperatively to assess differential renal function (DRF) and obstruction, defined as a T1/2 -20 minutes, and evaluate objective success. There were 34 dismembered and 13 Y-V pyeloplasties. RESULTS: The mean operative time was 341.6 minutes (range 200-717 minutes). The mean preoperative T1/2 was 48.4 minutes (range 14 minutes-xc), with a mean DRF of 39.8% (range 22%-60%). The mean postoperative T1/2 was 9.32 minutes (range 2-27 minutes), and the mean DRF was 39.5% (range 7%-57%). The average length of hospital stay was 2.25 days (range 1-3 days). At a mean follow-up of 19.93 months (range 2-55 months), the subjective success rate was 95.7%, and the objective success rate was 93.6%. CONCLUSION: Even when using strict radiologic criteria to define success, laparoscopic pyeloplasty is found to be similar to open surgery in its efficacy for the correction of adult UPJ obstruction.

Adolescent↗

PubMed2000

Therapeutic success of latanoprost 0.005% compared to brimonidine 0.2% in patients with open-angle glaucoma or ocular hypertension.

The purpose of this study was to evaluate the success rate ofmonotherapy with latanoprost 0.005% once daily versus brimonidine 0.2% twice daily in patients with open-angle glaucoma or ocular hypertension. Patients who were prescribed latanoprost or brimonidine as monotherapy were included in this study, and their consecutive charts were retrospectively reviewed. The primary efficacy variable was success of therapy, defined as a reduction in intraocular pressure > or =3 mm Hg without an adverse event leading to discontinuation over a potential of six months of therapy. We included 157 patients in this study. In the latanoprost group, 64 of 92 (70%) were considered successes; 26 of 65 (40%) were successful with brimonidine (P < 0.001). Nine failed brimonidine therapy, and one latanoprost, because of an adverse event, and the rest failed because of inadequate intraocular pressure response. The change from baseline in intraocular pressure was significantly greater with latanoprost (mean +/- S.D., 21.6 +/- 5.1 to 17.1 +/- 3.3 mm Hg) than brimonidine (23.7 +/- 5.6 to 21.9 +/- 5.7 mm Hg) (P = 0.001). Overall, 52 (80%) brimonidine- and 41 (45%) latanoprost-treated patients required additional visit(s) to adjust therapy to further lower intraocular pressure or to assess an adverse event (P < 0.001). In conclusion, latanoprost more likely provides a successful response to therapy than brimonidine when used as monotherapy in primary open-angle glaucoma or ocular hypertensive patients.

Adrenergic alpha-Agonists↗

PubMed2001

Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study.

BACKGROUND: In quality improvement activities such as audit, some general practices succeed in improving care and some do not. With audit of care likely to be one of the major tools in clinical governance, it would be helpful to establish what features of primary health care teams are associated with successful audit in general practice. OBJECTIVE: The aim of the present study was to identify those features of primary health care teams that were associated with successful quality improvement during systematic audit of diabetes care. METHOD: Semi-structured tape-recorded interviews were carried out with lead GPs and practice nurses in 18 general practices in Leicestershire that had the opportunity to improve their care and had completed two data collections in a multipractice audit of diabetes care. The interviewees were asked to describe their practice's approach to audit and the transcripts were coded for common features and judged for strength of feeling by blinded independent raters. Features common to practices that had, and those that had not, managed to improve diabetes care were identified. RESULTS: Six features were identified reliably in the transcripts by blinded independent raters. Four were significantly associated with the successful improvement of care. Success was more likely in teams in which: the GP or nurse felt personally involved in the audit; they perceived their teamwork as good; they had recognized the need for systematic plans to address obstacles to quality improvement; and their teams had a positive attitude to continued monitoring of care. A positive attitude to audit and a personal interest in the disease were not associated with improvement in care. CONCLUSIONS: Success in improving diabetes care is associated with certain organizational features of primary health care teams. Experimental studies are required to determine whether the development of teamwork enables practice teams to identify and overcome systematically the obstacles to improved quality of patient care that face them.

Diabetes Mellitus↗

PubMed1985

Adaptation at specific loci. IV. Differential mating success among glycolytic allozyme genotypes of Colias butterflies.

Male mating success as a function of genotype is an important fitness component. It can be studied in wild populations, in species for which a given group of progeny has exactly one father, by determining genotypes of wildcaught mothers and of sufficient numbers of their progeny. Here, we study male mating success as a function of allozyme genotype at two glycolytic loci in Colias butterflies, in which sperm precedence is complete, so that the most recent male to mate fathers all of a female's subsequent progeny.--For the phosphoglucose isomerase, PGI, polymorphism, we predict mating advantage and disadvantage of male genotypes based on evaluation of their biochemical functional differences in the context of thermal-physiological-ecological constraints on the insects' flight activity. As predicted, we find major, significant advantage in mating success for kinetically favored genotypes, compared to the genotype distribution of males active with the sampled females in the wild. These effects are repeatable among samples and on different semispecies' genetic backgrounds.--Initial study of the phosphoglucomutase, PGM, polymorphism in the same samples reveals heterozygote advantage in male-mating success, compared to males active with the females sampled. This contrasts with a lack of correspondence between PGI and PGM genotypes in other fitness index or component differences.--Epistatic interactions in mating success between the two loci are absent.--There is no evidence for segregation distortion associated with the alleles of either primary locus studied, nor is there significant assortative mating.--These results extend our understanding of the specific variation studied and suggest that even loci closely related in function may have distinctive experience of evolutionary forces. Implications of the specificity of the effects seen are briefly discussed.

Adaptation, Physiological↗

PubMed1979

Attribution for success and failure as a function of perceived age.

Based on an attributional model of achievement-related behavior, it was predicted that success on the part of a young person and failure on the part of an old person, being expected outcomes, would be attributed to stable causes, whereas success on the part of an old person and failure on the part of a young person, being unexpected outcomes, would be attributed to unstable causes. Using a between-subjects experimental design, subjects were asked to estimate the probability that a young vs an old stimulus person would succeed in college and to judge the causes for his success or failure. Although there occurred no differences as a function of age in expectancy of success or attributions for success, failure on the part of the old stimulus person was attributed more to the stable causes of lack of ability and task difficulty, while failure on the part of the young stimulus person was attributed more to the unstable cause of lack of effort. The results were discussed in terms of those conditions under which negative stereotypes concerning the competency of the elderly will be considered appropriate and thereby exert an influence on evaluations.

Achievement↗

PubMed1996

Successful aging: predictors and associated activities.

Six-year predictors of successful aging were analyzed for 356 Alameda County Study men and women aged 65-95 years measured prospectively in 1984 and followed to 1990. Successful aging was defined as needing no assistance nor having difficulty on any of 13 activity/mobility measures plus little or no difficulty on five physical performance measures. After adjusting for baseline successful aging, sex, and age, the authors found that 1984 predictors of 1990 successful aging included income above the lowest quintile (odds ratio (OR) = 2.01, 95% confidence interval (CI) 0.99-4.11), > or = 12 years of education (OR = 1.67, 95% CI 0.98-2.84), white ethnicity (OR = 2.12, 95% CI 0.93-4.86), diabetes (OR = 0.10, 95% CI 0.01-0.79), chronic obstructive pulmonary disease (OR = 0.41, 95% CI 0.17-0.97), arthritis (OR = 0.43, 95% CI 0.26-0.71), and hearing problems (OR = 0.48, 95% CI 0.25-0.89). Adjusting for all variables, the authors found that behavioral and psychosocial predictors included the absence of depression (OR = 1.94, 95% CI 1.10-3.42), having close personal contacts (OR = 1.82, 95% CI 1.05-3.18), and often walks for exercise (OR = 1.77, 95% CI 1.00-3.12). Cross-sectional comparisons at follow-up revealed significantly higher community involvement, physical activity, and mental health for those aging successfully.

Activities of Daily Living↗

PubMed1996

Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success.

A retrospective analysis of 260 completed intrauterine insemination (IUI) cycles was used in an attempt to identify significant variables predictive of treatment success. Couples received a maximum of three IUI cycles for the treatment of anovulation, cervical factors or unexplained infertility. Male factor problems were largely excluded by pretreatment screening. The overall pregnancy rate was 19.6% per completed cycle, the miscarriage rate 15.6%, the multiple pregnancy rate 23.5% and the cancellation rate 19%. Logistic regression identified four significant IUI variables [follicle number (P < 0.005), endometrial thickness (P < 0.005), duration of infertility (P < 0.01) and progressive motility (P < 0.05)] which were the most predictive of IUI success. The chance of conceiving when only one follicle was produced was only 7.6%, whereas with two follicles this chance increased to 26%. These variables were incorporated into a statistical model to allow the prediction of the chance of success in subsequent cycles. We conclude that careful patient selection criteria coupled with successful ovarian stimulation is the model for IUI success.

Adult↗

PubMed1995

Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy.

Single-dose methotrexate is an alternative to surgery in treating ectopic pregnancy. Because success rates vary, we sought to identify factors which predict treatment outcome. A total of 44 women with ectopic gestation were treated. The non-laparoscopic diagnosis of ectopic pregnancy was made following history, physical examination, ultrasound, endometrial biopsy and the measurement of serial beta-human chorionic gonadotrophin (HCG) and progesterone concentrations. Methotrexate (50 mg/m2 i.m.) was administered, with a second dose given 1 week later in patients with plateauing or rising beta-HCG concentrations. Of 44 patients, 23 (52.3%) were successfully treated with one dose. An additional 10 women (22.7%) were also successfully managed but required a second dose, giving an overall success rate of 75.0%. In all, 11 women (25.0%) required surgery, four of whom experienced tubal rupture. Receiver operator curves were constructed to optimally select pretreatment beta-HCG and progesterone cut-off concentrations for successful treatment. Using beta-HCG < 1500 IU/l or progesterone < 7.0 ng/ml (22.3 nmol/l) as a cut-off concentration produced a diagnostic test with a sensitivity of 87.5%, a specificity of 90.0%, a positive predictive value of 96.6% and a negative predictive value of 69.2%. Conversely, this model predicts that patients with serum beta-HCG concentrations > or = 1500 IU/l and progesterone concentrations > or = 7.0 ng/ml are at far greater risk of failing single-dose methotrexate therapy.

Adult↗