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Background The diagnosis and treatment of partial-thickness rotator cuff tears remain controversial, and only a few studies have carried out clinical evaluation and comparison based on different types of tears. The aim of this study was to compare the clinical outcomes of arthroscopic cuff repairs using the suture bridge technique in patients with articular partial-thickness rotator cuff tears (APRCTs) vs. those with bursal partial-thickness rotator cuff tears (BPRCTs). Methods We retrospectively evaluated 29 patients with APRCTs and 22 patients with BPRCTs who underwent arthroscopic cuff repair using the suture bridge technique with a minimum 2-year follow-up. Clinical outcomes were evaluated preoperatively and postoperatively using the visual analog scale score, Japanese Orthopaedic Association (JOA) score, Constant score (CS), active range of motion (ROM) of shoulder flexion and abduction, improvement rate for each score, and retear rate. Results The APRCT group had more women, fewer cases of subacromial decompression, and more patients whose condition changed intraoperatively and transitioned into a complete tear. Preoperatively, the JOA score, CS, ROM of shoulder flexion, ROM of shoulder abduction, and external shoulder rotation strength were lower in the APRCT group. Postoperatively, all scores improved significantly in both groups, and the JOA score, CS, and external shoulder rotation strength remained significantly lower in the APRCT group. Improvement and retear rates were not significantly different between the groups. Conclusions The suture bridge technique significantly improved the clinical outcomes of patients with APRCTs and BPRCTs. Preoperative and postoperative functional parameters were worse in APRCT patients.

The objective of this systematic review and meta-analysis was to evaluate the efficacy and the effectiveness, as well as the safety and tolerability, of urethral bulking agents (UBAs) in women with mixed or stress urinary incontinence. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were used to identify relevant articles. In total, 3510 records were found. A total of 42 full texts were evaluated but only 21 (48.8 %) were selected for the qualitative and quantitative analysis. The pooled improvement rate in studies with a follow-up of ≤1 and >1 year was 46.0 % (95 % CI: 37.0 %-57.0 %; I2: 88.9 %) and 57.0 % (95 % CI: 39.0 %-74.0 %; I2: 89.6 %), respectively. The outcome 'cure/dryness' ranged from 9.1 % to 56.7 %. The pooled cure rate was 26.0 % (95 % CI: 21.0 %-32.0 %; I2: 89.9 %) and 21.0 % (95 % CI: 16.0 %-27.0 %; I2: 34.2 %) in females with a follow-up of ≤1 and >1 year, respectively. The treatment success rate ranged from 32.7 % to 93.3 % in 12 studies; it was objectively assessed with different tools (e.g., the Stamey scale in 5 studies). The pooled objective treatment success rate was 7.0 % (95 % CI: 59.0.0 %-75.0 %; I2: 82.4 %) and 46.0 % (95 % CI: 37.0 %-55.0 %; I2: 55.3 %) in women with a follow-up of ≤12 and >12 months, respectively. The percentage of adverse events was 0.4 % (vaginal infection, irritation, lichen sclerosus, worsening urinary incontinence). However, the use of UBAs as the first-line therapy should be demonstrated in more comparative studies (randomized studies MUSs vs. UBAs). UBAs should be considered a first-line surgical therapy only for women with SUI and mixed UI with high anaesthesia risk, elderly patients, or patients reluctant to undergo surgery. Thus, UBAs should not be offered as first-line therapy for those women desiring a "one-time" durable solution for primary or recurrent SUI.

Purpose To describe the safety and effectiveness of using autologous serum-based eye drops for the treatment of severe dry eye and persistent corneal epithelial defect. Methods Literature searches of the PubMed and Cochrane Library databases were conducted most recently in March 2019. The searches identified 281 citations, which were reviewed in abstract form. Of these, 48 were selected for a full-text review, and 13 met the inclusion criteria and were assigned a quality-of-evidence rating by the panel methodologist. Eight of these studies were rated level II and 5 were rated level III; there were no level I studies. Results This analysis included 10 studies of the use of autologous serum-based eye drops for severe dry eye disease and 4 studies of persistent epithelial defect. Several studies showed good effectiveness, with some improvement in symptoms, signs, or both. Eight of the studies reported improved symptoms for severe dry eye disease, and all noted improvement in at least 1 clinical sign. For persistent epithelial defects, all of the studies showed improvement, with 3 of the 4 demonstrating an improvement rate of more than 90%. Adverse events were rare. Conclusions Although autologous serum-based tears may be effective in the treatment of severe dry eye and persistent epithelial defect, conclusions are limited owing to the absence of controlled trials.

Introduction To assess the efficacy and safety of gastric peroral endoscopic myotomy for the treatment of gastroparesis. Methods PubMed, Embase, Cochrane Library and Web of Science databases were searched from their earliest records to May 2018. The evaluation of clinical efficacy and safety was based on gastric emptying scintigraphy normalization, the improvement in clinical symptoms and adverse event rate. R 3.5.0 software was used to calculate the pooled estimate rates by meta-analysis. The improvement rate of the Gastroparesis Cardinal Symptom Index score was analyzed at different follow-up times. Results Fourteen studies with a total of 276 patients were included in this systematic review. The pooled gastric emptying scintigraphy normalization rate was 61.3% (95% CI, 51.5–70.8%) and clinical symptom improvement rate was 88.2% (95% CI, 83.6–93.1%). Intra-operative complications were found in about 3.2% (95% CI, 0.1–4.2%) of all included patients, and postoperative adverse events in 2.1% (95% CI, 0.3–4.8%). The mean Gastroparesis Cardinal Symptom Index score improvement rate was about 90.2% at one month follow-up, 83.3% at three months, 70.3% at six months, 52.4% at twelve months and 57.1% at eighteen months. Discussion Our systematic review demonstrates that gastric peroral endoscopic myotomy is a safe and effective treatment for gastroparesis. Though the short-term outcomes are promising, prospective, randomized, controlled studies with large sample size and long-term follow-up are required to further confirm these results.

Collaborative robots (cobots) are intended to physically interact with humans in a shared workspace. While cobots research proliferated in the recent decade, only scant attention was given to the strategic consideration of deploying them. The obvious strategic consideration is related to economic cost-benefits trade-off. However, the economic decision is tightly tied to the technology improvement rate, as cobots lifetime expectancy strongly depend on the technological developments. In this regard, the difference between different types of cobots may be dramatic. Another strategic issue is the sociological effects including the reaction of the operators and unions to cobot deployment. This paper reviews the related literature and proposes a model to analyze the underlying factors and facilitate the decision making process of: where and when to deploy which cobots.

In this paper, we study the pricing problems of the European quanto options in which the underlying foreign asset is in imperfectly liquid markets. First, we assume that the dynamics of the underlying foreign asset price are affected by market liquidity and propose a liquidity-adjusted quanto model. This allows for the effects of market liquidity on European quanto option pricing. And then we derive the analytical pricing formulas for four different types of European quanto options. Finally, we empirically investigate the pricing performance of our proposed model with a European quanto construction involving the SSE 50 ETF, as the underlying asset, and the CNY/HKD exchange rate. Empirical results demonstrate that the pricing accuracy of the proposed model is markedly superior to that of the Black-Scholes quanto model. In other words, allowing for liquidity risk in the framework of European quanto option pricing can make markedly improvements in fitting the real market data. Particularly, the improvement rate is high for medium-term and out-of-the-money options. Moreover, these results are robust for different liquidity measures.

Patients with chronic intractable dizziness (henceforth referred to as “intractable dizziness”) have a high risk of developing frailty complications. This warrants investigation of a combined treatment for intractable dizziness and frailty. Ninjin'yoeito (NYT), a traditional Japanese medicine (Kampo medicine), is reportedly effective in treating frailty and sarcopenia. Herein, we report on the results of a retrospective study that involved the combined application of NYT and dizziness rehabilitation therapy (henceforth referred to as “dizziness rehabilitation”). Of the 31 patients with intractable dizziness, 14 developed frailty, indicating a complication rate of 45.2%. This in turn was approximately 4 times higher than the previously reported rates. Eleven patients became non-frail after 6 months of the combined treatment, and their improvement rate was 78.6%. The aforementioned combination therapy not only improved dizziness but also improved frailty. Following 6 months of combined treatment, patients in the frailty group exhibited improvement in the Dizziness Handicap Inventory score, frailty symptoms, Kihon checklist score, and visual analog scale score (fatigue), and approached the pre-treatment values of those in the non-frailty group. Together, our results highlight the need to combine the treatment for intractable dizziness and frailty.

Phenolic resin dispersed particle gel (PDPG) was successfully prepared from bulk gel by a mechanical shearing method. The effects of bulk gel strength, shearing time, shearing rate, and bulk gel-water ratio on the PDPG particles were systematically analyzed. The morphological results showed that the PDPG particles have a round shape with nano-size to micron-size distribution. The shearing rate is one of the most critical factors in the preparation, while the shearing time and bulk gel strength are secondary factors in preparing the PDPG particles. In addition, the bulk gel-water mixing ratio has a slight impact on the prepared PDPG particles. The PDPG particles had a good shearing resistance and expansion capacity which enhances their application performance in oilfields. Sand pack flowing experiments indicated that PDPG particles can easily enter the in-depth formations and effectively plug high permeability channels. The higher the formation permeability ratio of sand packs, the better the profile improvement rate. By retention or adsorption in large permeability zones, trapping and bridging across pore throats or large channels, the prepared PDPG particles can effectively improve the formation profile and divert the following water into low permeability zones, and then the oil is enhanced. The injection of PDPG particles was first successfully applied to Changqing Oilfield in China which provided a reference to control water production in other similar low permeability mature oilfields.

Background Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method—problem- and simulator-based learning (PSBL)—in LP residency training to develop overall skills of neurology residents. Methods We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Results Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Conclusions Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP.

Background Vulvar lichen sclerosus is a chronic and incurable disease that causes various unpleasant symptoms and serious consequences. Objective The purpose of the study was to assess the effectiveness of photodynamic therapy in the treatment of vulvar lichen sclerosus. Methods Participants in the study included 102 female patients aged 19–85 suffer from vulvar lichen sclerosus. The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form. The affected areas were irradiated with a halogenic lamp PhotoDyn 501 (590–760 nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks. Result PDT has brought about a good therapeutic effect (complete or partial clinical remission), with 87.25% improvement rate in patients suffering from lichen sclerosus. The greatest vulvoscopic response was observed in the reduction of subepithelial ecchymoses and teleangiectasia (78.95%), and the reduction of erosions and fissures (70.97%). A partial remission of lichenification with hyperkeratosis was observed in 51.61% of cases. The least response was observed in the atrophic lesions reduction (improvement in 37.36% of cases). Conclusion Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated. Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.

This paper presents the comprehensive investigations for the total lifetime CO 2 -equivalent emissions for food transport refrigeration system under various influencing factors. The new R404A alternative refrigerant—R452A, is investigated to provide an improved environmental performance. With a lower global warming potential (GWP = 1945), which is around half GWP of the currently existing R404A, R452A can make a 5–15% emission reduction for the food transport refrigeration system. In the R452A system, reducing the ambient temperature from 90 °F (32 °C) to 60 °F (15.5 °C) can produce up to 60% emission reduction for the fresh product case while 39% reduction for the frozen. Decreasing the annual leak rate from 25% to 10% can give a 13% emission reduction for the R452A fresh product case while 4% reduction for the frozen. Increasing the food product refrigerating temperature (evaporating temperature) set-point from −10 °F (−23 °C) to 50 °F (10 °C) can lead to more than 80% emission reduction. In addition, a 15% annual insulation degrade rate can provide a 13% emission reduction for the fresh and 14% for the frozen. Moreover, the Cycle Sentry running mode can result in a 14–21% emission saving than the Continuous. Furthermore, the sunny/cloudy conditions, system efficiency improvement rate, and alternative transport refrigeration technologies other than the conventional hydrofluorocarbon (HFC) based vapour compression refrigeration systems, are also investigated to explore the possibility to minimize environmental impacts.

Objective Recovery of hand motor function after surgical treatment in myelopathy patients is commonly observed. Accurate evaluation of postoperative hand function contributes to assessing the efficacy of surgical treatment. However, no objective and effective evaluation method has been widely accepted in clinical practice. Therefore, the study aimed to explore the value of Myelopathy-hand Functional Evaluation System (MFES) in assessing the postoperative hand function for myelopathy patients. Material and method MFES mainly consist of a pair of wise-gloves and a computer with software. One hundred and thirty myelopathy patients were included and all of them received optimal surgery treatment. The Japanese Orthopaedic Association (JOA) scores were marked at preoperative and at 6 months after surgery. All patients were asked to perform the 10-s grip and release test, and the hand movements were simulated and converted into waveforms by MFES. The waveform parameters were measured and analyzed. Results The JOA scores and the number of grip-and-release (G–R) cycles significantly increased after surgery. Correspondingly, the waveforms of ulnar three fingers were significantly higher and narrower, along with the significantly declined average time per cycle in postoperative. The a/b ratio (Wave height/wave width) of five fingers were significantly higher in postoperative than that in preoperative. Based on the improvement rate of a/b, the excellent and good rate of surgical outcomes was 62.30 %, which was significantly higher than that (47.69 %) based on the improvement rate of JOA scores (P = 0.019). Conclusion MFES is an effective assessment tool in evaluating the postoperative hand function for myelopathy patients.

Objective To evaluate the state of psychology and quality of life of patients effected by acne and also the efficacy and safety of photodynamic therapy with topical 5-aminolevulinic acid (ALA-PDT) for moderate to severe acne patients. Methods In the questionnaire part, a pre-designed form was filled out. The questionnaire was comprised of 2 sections related to acne including sociodemographic and disease information as well as Cardiff Acne Disability Index (CADI) and Self-Rating Anxiety Scale (SAS). In the trial part, the ALA-PDT was applied to moderate to severe acne patients. Fresh 5% ALA solution was topically applied to face or face & neck. After 1 h’s incubation, a LED device was illuminated. A power density of 60−100 mW/cm2 was delivered for 20 min. All the patients finished 3–4 sessions of ALA-PDT at 7–10 days intervals. Non-invasive detections were taken for skin moisture, oil, and VISIA indexes. Adverse events were recorded during and after the treatment. Results A total of 247 acne patients finished questionnaires. Over 97 % patients were assessed as mild to severe impacts in CADI questionnaire and 37.6 % patients had various degrees of anxiety in SAS questionnaire. The higher the BMI was, the higher the CADI points were (G = 0.278, p = 0.005). The severity of acne was correlated with psychology and quality of life (CADI: G = 0.367, p = 0.000; SAS: G = 0.285, p = 0.003). A total of 116 patients with moderate or severe acne accepted ALA-PDT and completed at least 3 sessions (PDT3) or even PDT4. After 1 session of treatment (AT1) and AT2, the efficiencies of all patients were 5.2 % and 29.3 %. For patients with PDT3, the efficiencies at follow-up at 1st month after last session (FU1), FU2 and FU3 were 59.4 %, 66.7 % and 78.3 %, respectively. For patients with PDT4, the efficiencies at AT3 and FU1–3 were 51.3 %, 63.6 %, 76.5 % and 85.7 %, respectively. The efficacies of PDT4 patients showed an increasing trend from FU1 to FU3 (G = 0.480, p = 0.004). Acne lesions of mild to severe were correlated with the treatment efficacies (FU1: G = 0.354, p = 0.000; FU2: G = 0.474, p = 0.000; FU3: G = 0.397, p = 0.000). Nearly 15 % patients were followed up for 12 months and among them 52.9 % patients were able to maintain ≥90 % improvement rate. There were no statistically significant differences before and after treatment (p > 0.05) according to the skin moisture content, oil content, ultraviolet ray spots, brown spots, red areas, and purple textures measured. The adverse reactions of ALA-PDT, including local burning sensation, mild pain sensation, mild edema erythema, reactive acne, pigmentation, etc., were temporary and tolerable. Conclusion In our study, 97.2 % patients were rated as impact in CADI questionnaire and 37.6 % patients had anxiety in SAS questionnaire. It is necessary to control weight and disease progression. The efficiencies of ALA-PDT for moderate and severe acne were 59.4%–85.7% at follow-ups of 1st, 2nd or 3rd month after last session. The adverse reactions of ALA-PDT were temporary and tolerable.

International audience; Thanks to the opportunities offered by additive manufacturing (AM) processes, design rules are evolving to lead to lighter and stiffer parts with really more complex shapes than those obtained by conventional processes. Worldwide, new tools of assistance to the design are developed, gathered under the naming “Design for Additive Manufacturing” (DfAM). However, most of the DfAM methods suggested in the literature remain focused on only one component and are not considering the product as a system of components. Moreover, optimizations are mainly limited on reducing the mass or the number of parts, and more rarely on adding some functions.In this article, a new approach is presented to realize a multifunctional optimization of a mechanical system (MS). A methodology is first proposed in order to improve a product by using the AM opportunity. Then, to quantify the improvements of an optimized system, a new design indicator appointed “functional improvement rate” is defined. Finally, a case study, applied to a compressed-air Wobbler engine, is presented to demonstrate the relevance of the methodology and the functional improvement rate. The design adapted to traditional manufacturing is compared to a part-by-part optimized design and a multifunctional optimized design, both adapted to additive manufacturing.

Implementing PEM can promote organization's improvement of achievement level (AL).Organization's opinion on importance level (IL) is different with the PEM criteria.The improvement rate of AL is in partial positive correlation with IL.The improvement of process helps to improve the financial results. Performance excellence model (PEM) has become an important management pattern for many years in the world. In 2004, China issued two national standards of PEM. But at present, most researches on PEM are based on the static data on some certain time, in this way there lacks systematic research on its dynamic changes features, including the improvement of PEM implementation, the impacts of process improvement towards results improvement, etc. Hence this article conducts a research on the improvements of items' achievement levels of PEM implementation, the relationship between the improvements and items' importance levels, and the impacts of process improvements towards financial results. Through the researches on the Government Quality Award (GQA) recipients in Shandong province and Anhui province, it is found that those recipients have gained improvements with different levels in terms of item's achievement after PEM implementation and the achievement level is in positive correlation with its importance. Besides, under the control of achievement level before PEM import, the improvement rate of achievement is also in positive correlation with its importance. Moreover, the improvement of process helps to improve the financial results and each 1% increase in the process's improvement rate of achievement level per year on average will lead to a 0.605% increase in the annual improvement rate of financial results. Organization's opinion on importance level is different with the PEM criteria. And the point value gap among process categories should be narrowed down.

Objective To observe the hemostatic effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula on simvastatin-induced zebrafish hemorrhage model compared with that of the Heat-clearing and Blood-cooling Formula. Methods AB strain wild type zebrafish were treated with 0.5 μM simvastatin for 24 hours to establish the zebrafish hemorrhage model. Under strictly blind experimental conditions, the zebrafish were then treated with experimental agents in different concentration within the maximum non-lethal dose. The intervention effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula was comprehensively assessed by examining the main observational parameters such as the bleeding reduction rate and hemostatic rate while referring to the additional parameters such as blood flow, improvement rate of blood flow, velocity of movement, improvement rate of motion under spleen-qi deficiency. Results Hemostatic effect: The bleeding rate and hemostatic rate in the zebrafish were respectively, 30%, 15%, 45%, 40% and 60%, 80%, 40%, 47% when equal concentration of 500 μg/mL, 1000 μg/mL were used. This showed that the experimental herbs B1 was superior to B2 in decreasing the bleeding rate and improving hemostatic effect in the zebrafish. Improvement of blood flow: With equal concentration, the experimental herb B1 was superior to B2 in increasing the blood flow and improvement rate of blood flow in hemorrhagic zebrafish. Promotion of the improvement of motion: With equal concentration of 500 μg/mL and 1000 μg/mL, the experimental herb B1 was superior to B2 in promoting the velocity of motion in the zebrafish and promoting the improvement rate of motion. Conclusion The manifestations of simvastatin-induced zebrafish hemorrhage are basically similar to that of failure of the spleen to control blood in human beings. The Spleen-invigorating, Qi-replenishing and Blood-arresting Formula has good hemostatic effect on simvastatin-induced hemorrhage in the zebrafish. It also boasts the functions of improving blood flow and velocity of motion in the hemorrhagic zebrafish. Such a conclusion provides the experimental basis for the treatment of the syndrome of failure of the spleen to control blood by this formula.

Lack of timely drying after harvesting resulted in grain losses of approximately 30 million tons in China. Considering the small-scale production mode in rural China, we investigate a new fixed bed drying method that features swing temperature and alternating airflow. Heating and tempering processes are linked and combined in both time and space. The ratio range of the normal flow heating time to the reverse flow heating time with the best wheat drying uniformity under the conditions of the total heating time 78 min is from 0.733 to 0.902. The wheat drying uniformity with tempering is higher by 2.55%, with an improvement rate of 58.7%, compared with that without tempering. With the same heat supply, extending the time and changing the air velocity at the tempering stage exert minimal influence on wheat drying uniformity. Increasing the temperature at the tempering stage effectively improves the wheat drying uniformity with deep-bed and the blower power consumption reduces, but the heat efficiency decreases. Moreover, the wheat drying uniformity improves with increasing air velocity in both drying and tempering processes. According to the drying capacity and economic analysis, the STAA is better than fluidized bed.

Background In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. Methods The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. Findings 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P, Highlights • This report establishes that an e-learning system on the Internet can improve the diagnostic ability of endoscopists. • Countless endoscopists worldwide can access the system to learn how to make an endoscopic diagnosis of early gastric cancer. • The e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs. This is the first report to demonstrate how an e-learning system based on the Internet can improve the diagnostic ability of gastrointestinal endoscopists worldwide. There is no limit to the number of endoscopists who can access the system and benefit from this opportunity to learn how to make an endoscopic diagnosis of early gastric cancer. This e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs such as the large intestine and the esophagus, as well as the stomach. It may contribute to human welfare and health by reducing the mortality from gastrointestinal cancer.

Objective The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics. Methods Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed. Results Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention. Conclusion This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs.

In this study, the crashworthiness behavior of the tapered multi-cell tubes is theoretically and numerically investigated. The side wall tapering and the cross section dividing into the cells are used in order to improve the energy absorption of the thin walled structure. In order to estimate the non-constant mean crush load of the tapered multi-cell tubes, incorporating the theoretical relations on the energy absorption of the simple multi-cell and tapered single-cell tubes, in conjunction with numerical results, would lead to the development of the analytical formula. The analytical formula is based on the mean crush load calculation of the equivalent segmented simple multi-cell tubes. In order to prepare a realistic finite element model, the elastic–plastic-damage material assumption is introduced into the numerical simulation. The numerical predictions of the mean crush load are consisted with experimental data in literature. The results reveal that the increase of the taper angle, the wall thickness and the number of cells in the cross section would enrich the crashworthiness capacity of the structure. The results indicate that the crashworthiness improvement rate of the structure with number of cells in the cross section is decreased in such a way that the variation of the energy absorption efficiency in the thin walled structure with the 8×8, 9×9 and 10×10 cells in the cross section would be negligible. The transition wall thickness in which the crashworthiness of the tapered multi-cell structure transits from thin to thick walled behavior are determined.

The purpose of this paper is to develop a new method to improve the service life of asphalt pavement adding the geocell as reinforcement for asphalt mixture. A series of splitting fatigue tests were conducted and a viscoelastic damage model with clear physical meaning was used to evaluate the influence of geocell on the macroscopic performance of asphalt mixture. The test results show that the fatigue life of reinforced specimens is significantly improved compared to unreinforced specimens under the same loading conditions. Moreover, the improvement rate of fatigue life is not related to stress ratio, but related to loading temperature. When the loading temperatures are 5 °C, 15 °C and 25 °C, the improvement rates are approximately 60%, 110% and 230%, respectively. In addition, based on the viscoelastic damage model, it can be seen that the elastic modulus E v of the model increases with increasing stress ratio and decreases with increasing loading temperature, the model’s viscosity coefficients η e and η v both decrease with increasing stress ratio and loading temperature. The presence of geocell reduces the model’s elastic modulus E v and increases the viscosity coefficients η e and η v .

The acquisition of high-level motor skills beyond a “plateau” is important in sports training and rehabilitation. We aimed to investigate whether motor skills close to a plateau state can be improved further by performing motor imagery (MI) training while observing movements with difficulty levels optimized for individual motor skills. The subjects were divided randomly into four groups (n = 10 per group): the control group and three groups of MI combined with action observation (MI + AO) training with varying difficulty levels. The task was to rotate the two cork balls 20 times counterclockwise using the left hand. The subjects performed 30 and 10 successful trials of this task before and after MI + AO training, respectively. In the three training groups, MI training was performed while observing videos showing ball rotation movements adjusted to the same level, a moderately higher level, or a remarkably higher level of difficulty than that achieved by the individual subjects. The improvement rate of the ball rotation time after MI + AO training was significantly higher in the moderate-difficulty than in the control group and remarkably higher level of difficulty group. The other two MI + AO training groups did not differ significantly compared with the control group. The vividness of the MI during MI + AO training was significantly greater in the moderate-difficulty vs. the remarkably-high-difficulty group. These results suggest that performing MI training while observing movement at a level that is moderately higher than an individual's ability can promote improvements in motor skills (close to a plateau state) in rehabilitation and sports training. The vividness of MI may be an important index for determining the difficulty level of the movement to be observed during MI + AO training.

Objective Flow diversion is a popular technique used to treat ordinary small, as well as complex internal carotid artery (ICA) aneurysms. We describe aneurysm occlusion rates, complications and patient outcomes in patients with ICA aneurysms treated with flow diverter stents. Patients and methods We identified all consecutive patients with ICA aneurysms that were treated with flow diverter stents between 2014 and 2019 at our institution. We divided the aneurysms into two anatomic subgroups (cavernous and supraclinoid segments). All the imaging studies and medical records were reviewed for relevant features in relation to aneurysms, complications and patient outcomes. Results A total of 62 patients with 76 ICA aneurysms (72 unruptured; 4 ruptured) were treated with 70 flow diversion procedures, including six re-treatments. Complete aneurysm occlusion was achieved in 61 % of patients at 6-month follow-up (cavernous 69 %, supraclinoid 58 %), and in 69 % at the latest follow-up (mean of 18 months). Postprocedural intracranial ischemia or hemorrhage was seen in 24 % of patients, including two aneurysm ruptures after flow diversion, and related major long-term functional decline or mortality was seen in 6% of patients. Preprocedural dysfunction of extraocular muscles or vision disturbance improved moderately at best (40–60 %). At the latest follow-up, 54 patients (87 %) were functionally independent (mRS ≤2). Conclusion Flow diversion for cavernous and supraclinoid ICA aneurysms demonstrated acceptable results, but complex aneurysm features cause uncertainty in predicting aneurysm occlusion probability. Patients should be informed of the non-negligible rate of complications, and of only moderate improvement rate of cranial nerve dysfunctions.

Objectives To evaluate the effect and cost of Xiyanping injection (herb-derived compound, andrographolide sulfonate) on the treatment of community acquired pneumonia among adults using real world data in China. Methods Data about patients diagnosed with community acquired pneumonia identified with ICD-10 diagnosis code dated between 2013 and 2014 was extracted from the Hospital Information System Database of 2 hospitals in Jiangxi Province. Patients were divided into 4 groups according to the age and causative agent: young patients (15-64 years) with viral pneumonia (group 1) or bacterial pneumonia (group 2), and elderly patients (over 65 years) with viral pneumonia (group 3) or bacterial pneumonia (group 4). Cure rate, improvement rate, uncured rate, death rate, average hospitalization days and total hospitalization costs were compared between patients treated with Xiyanping injection and those treated with conventional treatment. Results 114 patients treated with Xiyanping injection (60, 21, 18 and 15 patients in group 1-4, respectively) and 3,107 patients with conventional treatment (893, 376, 1,322 and 516 patients in group 1-4, respectively) were included. After prosperity score matching, no significant differences in the cure rate, improvement rate, uncured rate, and death rate when comparing patients treated with Xiyanping injection and those treated with conventional treatment. Patients treated with Xiyanping injection had significantly shorter hospital stay for Group 1 patients (5.142±2.54 vs. 6.98±3.86 days), Group 2 patients (5.00±2.61 vs. 7.92±3.75 days) and Group 4 patients (5.58±2.97 vs. 9.25±3.19 days). The total cost of hospitalization was lower for patients treated with Xiyanping injection than those treated with conventional treatment in Group 1, 2 and 4 although there were no significant statistics differences. Conclusions Comparing with conventional treatment, Xiyanping injection provided the same clinical outcome but with shorter hospital stay resulting in reduced hospitalization cost for adults with community acquired pneumonia in China.

Purpose To evaluate the fluoroscopic guided injection, local injection, conservative treatment and surgery in managing coccygodynia. Methods Fifty chronic coccygodynia patients were evaluated. All patients complained of pain while sitting and had tenderness localized to the coccyx. All patients were offered conservative management initially, then they were assigned into four groups: 5 patients underwent coccygectomy, 22 patients had fluoroscopic guided injection, 11 patients had local injection, and 12 patients were treated only conservatively. Patients’ satisfaction with treatment was assessed by a visual analog scale (VAS). The follow-up period ranged from 7 to 32 months (mean 17.3 months). Results The initial conservative therapy had the lowest improvement rate (7/50, 14%). All patients subjected to coccygectomy or fluoroscopic guided injections improved and were satisfied. Nine patients of the local injection group (9/11, 82%) improved and 2 patients (18%) were stationary. Fourteen of the 16 patients with hypermobility (88%) required fluoroscopic guided injection, while 60% (12/20) of patients with normal mobility were treated conservatively. All patients with spicule required surgery. Conclusions Fluoroscopic guided injection and surgery have the highest efficacy and satisfaction rates in managing chronic coccygodynia. Hypermobility and spicules are predictors of failure of conservative therapy.

This paper assesses the global emission reduction target of halving CO2 emissions by 2050. First, future GDPs with specific uncertainty ranges were developed. The Kaya identity and the developed GDP outlook indicate that halving global CO2 emissions by 2050, which corresponds to almost 450 ppm-CO2eq. stabilization, requires an improvement approximately four times as large as the historical CO2 intensity improvement rate on average up to 2050, if GDP loss should remain within a few percent of potential baseline GDP. In addition, the global energy-related CO2 emission reductions were assessed by using an energy systems model. Marginal abatement cost of CO2 is over 470 $/tCO2 for halving global CO2 emissions by 2050 relative to 2005 even under the lower GDP scenario and technology improvements. Great challenges will have to be met for achieving the 450 ppm-CO2eq. Realistic alternative emission reduction scenarios should be explored in two ways; 1) more innovative technological development than any present imaginable development, and/or drastic social innovations are needed for cheaper carbon costs, e.g., within a few tens of US$ per tonne of CO2, and 2) more modest emission reduction targets, e.g., 550 ppm-CO2eq., and adaptation measures are considered. Keywords: Emission reduction target, GDP, Kaya identity

Objective To evaluate the therapeutic effect and safety of time-oriented points opening of Linggui Bafa for Bell's palsy and provide a new idea for the clinical treatment of this problem. Methods Fifty-four cases included in the study were randomized into two groups, and the treatment group was treated with the routine acupuncture combined with time-oriented points opening of Linggui Bafa. The control group was treated with the routine acupuncture only, Hegu ( LI 4), Kūnlun ( BL 60), Jiachē ( ST 6), Dicāng ( ST 4), Xiaguān ( ST 7), Cuanzhu ( BL 2), Yangbai ( GB 14), and Quanliao ( SI 18) were selected as the main points. The manipulation and time of retaining needles were as same as the treatment group. Both groups were treated once a day, 5 days made one session and 4 sessions were required in all. Modified Portmann's scale, Horse-Brackmann grading scale (H-B), FDIP and FDIS were used to assess the therapeutic effect after the treatment. Results The curative and improvement rate in the treatment group was 80.8% (22/26), and that in the control group was 66.7% (16/24), with the statistically significant difference ( P P Conclusion The method of time-oriented points opening of Linggui Bafa for Bell's palsy is better than the routine acupuncture for Bell's palsy.

We investigate the modelling of mortality improvement rates and the feasibility of projecting mortality improvement rates (as opposed to projecting mortality rates), using parametric predictor structures that are amenable to simple time series forecasting. This leads to our proposing a parallel dual approach to the direct parametric modelling and projecting of mortality rates. Comparisons of simulated life expectancy predictions (by the cohort method) using the England and Wales population mortality experiences for males and females under a variety of controlled data trimming exercises are presented in detail and comparisons are also made between the parallel modelling approaches.

The purpose of this study was to determine the effectiveness of video modeling (VM) interventions on the social and communication skills of children with autism spectrum disorders (ASD). Twenty-six single-case design studies involving a total of 59 participants were included in this meta-analysis. We measured intervention effects by computing the improvement rate difference (IRD). The overall mean IRD was 0.53, suggesting that VM interventions had a 53% improvement rate from baseline to intervention phrases on enhancing social and communication skills for these children.

The main breeding objective for the Swedish Warmblood horse (SWB) is to produce competitive horses in show jumping or dressage. The aims of this study were to investigate the genetic trends of SWB and the factors affecting the genetic progress. The realised genetic trend was studied separately for stallions and mares using the relative breeding values (RBVs) from the official genetic evaluation in 2009. RBVs were estimated using a multi-trait animal model with results from competitions and two young horse performance tests. The genetic progress increased substantially from the mid 1980s in both show jumping and dressage. The improvement rate was almost twice as high for show jumping as for dressage, 0.056 genetic standard deviation units per year compared with 0.032. The trend of broodmares followed the trend of the un-selected mares; thus the achieved progress was solely due to stallion selection. The stronger stallion selection was a result of the improved stallion performance test introduced in late 1970s, import of high quality stallions, and the BLUP evaluation based on the progenies results at young horse performance test introduced in 1986. For stallions born until 1984 the selection intensity was close to zero, thereafter the selection intensities corresponded to selection of the 5% best stallions in show jumping and the 28% best stallions in dressage. Accuracy at selection was 0.60 in show jumping for both stallions and broodmares, and 0.41 and 0.48 in dressage for stallions and broodmares, respectively. The generation interval was 11.1 years for stallions and 10.3 years for broodmares. In the future the breeding programme should focus on more efficient use of RBVs for selection of both stallions and broodmares at both young age and when progenies of stallions have been tested. Because of the strongly increased genetic level in the population, high quality stallions can be selected within the SWB population to a higher extent than previously.

Individuals with autism spectrum disorders (ASD) who cannot speak at all or not intelligibly are frequently taught to use aided augmentative and alternative communication (AAC). The majority of the research on the use of AAC with individuals with ASD has been single-case research studies. This investigation involved a meta-analysis of the single-case research on the use of aided AAC with individuals with autism spectrum disorders (ASD), investigating the differential impacts of AAC by participant characteristics. An effect size measure, the Improvement Rate Difference (IRD) was used to analyze 24 single-case studies. Two research questions were investigated concerning (a) the impact of AAC interventions on individuals diagnosed with subcategories of ASD and co-morbid conditions, and (b) the effects of AAC interventions on individuals in different age groups. Results indicated that participants with ASD and no additional diagnoses had better outcomes than others and that participants with ASD and developmental disabilities outperformed participants with ASD and multiple disabilities. Further, preschool-aged participants had better outcomes than elementary-aged and secondary-aged participants. Participants in all diagnostic categories and age ranges had moderate or better effects.

To study the effect of low molecular weight heparin (LMWH) in the treatment of severe acute pancreatitis (SAP). Methods: A total of 265 SAP patients were randomly divided into two groups: firstly, the conventional treatment group (C group, n = 130; and secondly the conventional treatment plus the LMWH treatment group (LT group, n = 135). The clinical parameters, laboratory parameters and computed tomography (CT) score of pancreatic necrosis (CTSPN) in the two groups were compared. Results: On admission, all the clinical parameters, laboratory parameters and CTSPN in the two groups were not significantly different (p > 0.05). However, after treatment, in LT group, the clinical presentation improvement rate and laboratory parameters improvement were significantly higher than those in C group (p < 0.05–0.01), and the acute physiology and chronic health evaluation (APACHE) II score, complication rate, mortality and mean hospital stay in LT group were obviously lower than those in C group (p < 0.05–0.01). The CT score in LT group was much lower than that in C group (p < 0.05). Two weeks after treatment FBI decreased obviously in C group, but not in LT group, and no haemorrhagic complications occurred. Conclusions: LMWH can enhance the effect of conventional treatment for SAP, and can markedly decrease the mortality of SAP. LMWH is a simple, safe, economic and effective method for treatment of SAP. It is can be used in every hospital.

Objective To compare different treatment protocols for sudden deafness(SD), for the purpose of identifying an appropriate approach to SD. Methods A total of 104 patients with diagnosis of sudden hearing loss treated from Jan 2006 to December 2008 were included in this study, of which 31 received the typical pharmaceutical treatment(group I), 40 received the typical pharmaceutical treatment plus polarized liquid(Group II) and 33 received the hyperbaric oxygen in addition to the treatment included in Group II (Group III). Results The total improvement rate(67.74%, 62.50% and 75.76% for Groups I, II and III respectively) was not statistically different between the three groups (P>0.05). Conclusion The three treatment protocols are similar when judged by the treatment outcomes in SD, neither being superior to the others. The two important factors that appear to influence treatment outcomes are the audiogram pattern and duration of hearing loss before seeking treatment. Patients with upsloping or peak–type audiograms and treated within 7 days from the onset have better prognosis than others.

In reviewing our experience with reoperation of RLDH, our aim was mainly to determine whether patients fared worse than after primary surgery. We found no uniform answers to this question in the literature.The data of 95 patients (29 women and 66 men) who underwent reoperation for RLDH at the same level and side were analyzed retrospectively. Forty-two patients underwent the first operation in our clinic (recurrence rate, 2.6% of 1586 cases). Gadolinium-enhanced MRI was performed in all patients. Main clinical data of patients, pain-free interval, operation time, surgical complications, duration of hospital stay, and clinical improvement rate were recorded.The mean pain-free interval was 55 months (range, 3-120 months). Levels of recurrent herniation were L4 through L5 and L5 through S1 (65% and 35% of cases, respectively). Revision surgery lasted longer on average than the previous diskectomy (P.01) and was complicated by dural tear in 4 cases (4.2% vs 0.9% during primary diskectomy, P.05). There were no significant differences between revision and previous surgery in terms of hospital stay. However, rates of excellent/good outcomes were significantly less for RLDH (89% vs 95%, P.05); and the percentage of poor results was higher (2% vs 0.5%, P.05). Age, sex, smoking, profession, trauma, level and degree of herniation, and pain-free interval were not correlated with clinical outcome.Conventional microsurgery for RLDH showed lightly but significantly worse results than those of primary microdiskectomy. Patients contemplating reoperation should be informed of this fact and of the risk of dural tear and prolonged operation time.

The antero-medial microsurgical disc or osteophyte removal without formal interbody fusion is a surgical alternative in the treatment of cervical discs causing radicular compression or cervical myelopathy. In the past 20 years 379 patients underwent anterior surgery, including 240 microdiscectomies without graft and 139 Cloward's dowel procedures. The long-term results of both procedures are compared in patients suffering from radicular compression, dominant myelopathy and radiculo-myelopathy. We found no statistically significant differences between the two methods treating three different conditions. The improvement rate in patients with soft and sequestrated discs is generally better compared to those with hard discs and spondylotic changes. Functional stability of the cervical spine is present in 92% of cases treated without interbody fusion immediately after surgery. A complete osseous fusion after a period of 6–12 months was found in 90% of Cloward procedures and in 81% of discectomy without graft. No definite correlation was found between the clinical improvement and the radiological results. According to our experience the Cloward's fusion procedure has no long-term advantages over discectomy without graft except in cases of severe myelopathy caused by multilevel ventral compression due to osteophytes. No permanent postoperative complication was encountered. Most of the treated patients returned to their previous activities.

Many of the critical technologies in knowledge economy are undergoing an exponential rate of rapid improvement. The best known roadmap to guide exponential trend of improvement has been provided by Moore’s law.This paper will update the validity of Moore’s law by applying it to microprocessor technology. Using Moore’s law as the benchmark, then, we will examine how well the historical trends of performance improvement in speed for mobile cellular, genome sequencing, and microprocessor technologies have followed Moore’s law. We will also test whether the improvement rate have begun to slow down in recent years. Our finding indicates that Moore’s law remains valid over the last 40 years. However, improvement rate of speed measure varies for each technology.Another finding is that more recent improvement rate during the last 10 years again vary between different technologies. For example, a significant acceleration in the improvement rate for genome sequencing technology has occurred, while a marked slowdown has taken place to microprocessor’s clock speed.All of these variations, however, do not alter the fact that exponential trend indicated by Moore’s law remains valid to guide overall improvement of speed expected of these technologies.

Phototherapy was administered to 24 depressed patients with seasonal affective disorder (SAD), of which 62%, 24%, and 14%, respectively, showed improvements of greater than or equal to 50%, 25-50%, and less than 25% based on the Hamilton rating scale for depression for SAD (HAMSAD). No patients showed aggravation or side effects. Although the improvement rate in HAMSAD correlated significantly with the pretreatment severity of atypical symptoms of depression, it did not correlate with that of typical symptoms. This suggests that phototherapy is a useful treatment in SAD and that responsiveness to phototherapy in SAD can possibly be predicted by the atypical depressive symptoms before treatment.

evaluated before treatment and at 3-months follow-up using a visual analog scale scoring system (VAS). Results: Average VAS scores before treatment and at the 3-month follow-up were 3.8 and 1.4 in the unilateral-pain group, and 4.9 and 2.9 in the center-pain group, respectively. Both groups reported a significant reduction in pain. At the 3-month follow-up, the mean improvement rate of VAS was 77% in the unilateral-pain group and 33.5% in the center-pain group. The improvement rate of VAS in the unilateral-pain group was significantly decreased compared with the centerpain group (p< 0.05). Conclusion(s): This study showed that, overall, physical therapy reduced pain in patients with CLBP. In addition, the unilateral-pain CLBP patients showed significantly more improvement in pain reduction than center-pain patients. Therefore, the results of this study suggest that CLBPpatients with unilateral low back painmay benefit more from physical therapy than those with center low back pain. In conclusion, this study reveals that the response to physical therapy for CLBP varies according to pain location. Future clinical trials using differential physical therapy should be performed to investigate the effect of physical therapy on CLBP patients with centered and unilateral pain. Implications: A better understanding of the differential effects of physical therapy on CLBP patients based on pain locationmight lead to better treatments of this common problem.

OBJECTIVES : Management of recurrent stress urinary incontinence (SUI) after synthetic mid-urethral sling placement is a challenging clinical dilemma. This case series describes a safe, minimally invasive treatment option for recurrent SUI after failure of the primary mid-urethral sling procedure. METHODS : Twenty women with recurrent SUI after previous synthetic mid-urethral sling placement underwent plication of the sling with 2-0 polyester suture under intravenous sedation with an intra-operative cough stress test between December 2004 and December 2008. A retrospective chart review was performed to obtain pertinent preoperative and postoperative data. RESULTS : Nine of the patients had prior retropubic synthetic mid-urethral slings. The other 11 women had transobturator mid-urethral slings, 10 of whom had slings via the outside-in approach and 1 had a single-incision mini-sling placed. The mean patient age was 59.8 years (range 38-83 years). Sling plication was performed at a median of 159.5 days after initial sling placement (range 26-2090 days). Overall 85% of patients had subjective improvement in SUI after sling plication with a median follow-up of 54.5 days (range 29-972 days). Those patients with prior retropubic slings had a 100% improvement rate compared to 72% improvement with prior obturator slings (P = 0.22). The subjective cure rate was 65%, 88% for the retropubic slings and 45% for the transobturator slings (P = 0.07). There were no complications. CONCLUSIONS : Midline plication of previously placed synthetic mid-urethral slings is a safe and effective method of treating recurrent SUI.

A modification of the classic Marshall-Marchetti-Krantz (MMK) operation which includes suspending the urethrovesical junction to the pubis by the vaginal approach is presented. This offers the advantages of a shorter operating time, the lack of an abdominal incision, and the concomitant repair of other pelvic anatomic defects through the vagina, with a cure rate at least equal to, if not better than, that associated with the abdominal route. The study group of 25 patients had less morbidity, a 1-day decrease in hospital stay, and 1 1 / 2 fewer days of catheter drainage compared to a matched control group of MMK operations done abdominally in this preliminary report. A 96% cure and improvement rate of the symptoms of stress incontinence was shown at the 6-week postoperative visit. This compares to a 92% rate in the control series of abdominal MMKs. The permanency of the procedure will have to be evaluated critically as more cases are added and sufficient time elapses to see if these good initial results hold up.

A report of 44 patients with chronic painful TM j subluxation and dislocation, non-amenable to conservative treatment, who underwent bilateral eminectomies is presented. A complete success rate of 82% and a tolerated improvement rate of 93% were obtained.

The CO2 laser treatment system ‘Melase 1000’ has been developed for the treatment of Tinea pedis and the efficacy of the treatment using the system and its optimum irradiation condition are studied. The present system enables us to make the healing time of Tinea pedis treatment far shorter than conventional pharmaceuticals. This is in spite of using heat levels low enough for patients not to feel discomfort. Features offered by the system are a safe-and-easy operation and a stable laser power for a prolonged use. The efficacy of the present therapy is excellent; only two treatments a week for three weeks, i.e. six consecutive treatments, attained an improvement rate of 71.8% in the skin findings and a ‘usefulness’ of 66.2% determined from cases rated as ‘useful’ or ‘better’. The optimum laser irradiation condition for a single treatment found in this experiment is a light fluence of about 3 J/cm2 and four laser pulses with a time interval between pulses of 1 s for a typical horny layer thinner than 0.5 mm.

We reanalyzed outcome data from a series of studies investigating the efficacy of exposure-based treatments for agoraphobia. Applying statistical criteria developed by Jacobson, Follette, and Revenstorf (1984) to determine clinically significant change whenever possible, the reanalysis of 11 data sets yielded an average improvement rate across all data sets of 58%. The percentages of clinets who actually recovered in response to exposure-based treatments was considerably lower: Only 27% of the clients ended therapy with little or no residual agoraphobic behavior. Generally, the treatment gains that were made were maintained over the course of various follow-up periods. Discussion focused on methodological issues such as criteria for good outcome measures and the pros and cons of standardized versus a priori measures of clinical significance, clinical issues involving the implications of these findings, and suggestions in the literature for how to increase treatment efficacy.