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Kolisnyk, Lyudmyla, Đorđe Čekrlija, and Bogdan Kalagurka. "Peculiarities of superiority and inferiority complexes of Ukrainians." Mental Health: Global Challenges Journal 4, no. 2 (2020): 38. http://dx.doi.org/10.32437/mhgcj.v4i2.86.
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Introduction: The central concept of the Adlerian theory of personality is the feeling of inferiority, which main function is to activate compensatory processes that make a person want to improve, grow and overcome their perceived weakness (Adler, 1989). The evidence of such processes is the life choices of people in the sphere of education and occupation.
 Purpose: The main purpose of the present work is to highlight the study results of inferiority and superiority complexes peculiarities of Ukrainians, their relation to the education and occupation choices.
 Methodology: The study sample included 449 subjects (282 females, 168 male) between 17 and 85 years old (M=32,96, SD = 13.299). Subjects were recruited from the general population by students who participated in the data collection. Participation in the study was voluntary and anonymous. Inferiority and superiority complexes were assessed using Adlerian inferiority (COMPIN) and superiority (SUCOMP) complex shortened scales (Čekrlija et al., 2017); socio-demographic variables such as gender, age, education and occupation were included.
 Results: Results show that approximately 70% of respondents have an average level of inferiority and superiority complexes. There is no significant correlation between the mentioned complexes and gender, but there is a negative correlation between the inferiority complex and age (r=.187). The younger Ukrainians are the more intensive inferiority complex they have. Occupation correlates negatively with the inferiority complex (r=.-120) and positively with the superiority complex (r=. 119). The more intensive superiority complex is, the higher positions occupy the respondents. Only inferiority complex correlates negatively with a level of education (r=.-160). People with higher education have less intensive inferiority complex.
 Conclusion: In sum, it is peculiar to Ukrainians to overcome inferiority complex with age. The intensity of their inferiority and superiority complexes doesn’t depend on gender. Ukrainians who occupy the high positions have a lower inferiority complex and higher superiority complex. People with low educational level have inferiority complex propensity
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Derin, Sümeyye, and Ekrem Sedat Şahin. "Inferiority and Superiority Complex: Examination in Terms of Gender, Birth Order and Psychological Symptoms." Primenjena psihologija 16, no. 3 (2023): 375–401. http://dx.doi.org/10.19090/pp.v16i3.2463.
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Inferiority and superiority complex are personality structures that point to unhealthy development in Adlerian theory. In this study, the aim was to examine inferiority and superiority complex in terms of socio-demographic characteristics of adult individuals, and to determine the predictive relationships between psychological symptoms and inferiority and superiority complex. A total of 361 (205 females, 156 males) adults between the ages of 18 and 62, reached through the convenient sampling method, participated in the study. Data were collected through the Turkish Version of the Adlerian Inferiority and Superiority Complex Shortened Scales, the Symptom Check List, and the Personal Information Form. In the study, it was found that the main effects of gender and birth order were significant in inferiority complex, while the main effect of birth order was significant in superiority complex. Gender main effect for superiority complex and gender-birth order interaction effect for both complexes were not significant. In addition, it was determined that psychological symptoms were a significant predictor of inferiority complex, but not a significant predictor of superiority complex.
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Derin, Sümeyye, and Ekrem Şahin. "Turkish version of the Adlerian inferiority and superiority complex shortened scales: validity and reliability." Psihologija, no. 00 (2023): 6. http://dx.doi.org/10.2298/psi220522006d.
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The aim of this study was to test the psychometric properties of Adlerian Inferiority and Superiority Complex Shortened Scales in a Turkish sample. Exploratory factor analysis sample consisted of 331 individuals (192 female and 139 men) between the ages of 15 and 65, while confirmatory factor analysis sample consisted of 192 individuals (113 female and 79 men) between the ages of 15 and 64. As a result of exploratory factor analysis, inferiority complex showed a structure of 10 items, while superiority complex showed a structure of 9 items. Confirmatory factor analysis showed that the scales had acceptable fit values in a two-factor structure. Findings related to the internal consistency coefficient, test-retest reliability and concurrent validity showed that Adlerian Inferiority Complex and Superiority Complex Shortened Scales are valid and reliable tools for evaluate the inferiority and superiority complex levels of individuals aged 15 and older in Turkey sample.
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Agnes, Fenny. "The Superiority Complex of Eleanor in Crazy Rich Asians." k@ta kita 10, no. 3 (2022): 617–24. http://dx.doi.org/10.9744/katakita.10.3.617-624.
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Crazy Rich Asians is one of the movies that is adapted from literature. In this thesis I am analyzing this movie because of the depiction of a rich person, Eleanor Young, who has an underlying inferiority. However, she shows that she has a superiority over others to cover inferiority. Therefore, in this thesis I am interested in analyzing the superiority complex that was portrayed by Eleanor in the movie and the impact for other characters. In the analysis I use Alfred Adler’s theory of superiority complex. The findings show that Eleanor's superiority complex is shown through her action and behavior, her speech, and her characteristic traits. Her superiority complex affects other characters, who are Nick and Rachel. As a result, Eleanor does not have a good relationship with Nick and Rachel and she portrays her superiority complex.
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Rokvić, Nikola. "Alexithymia, disgust and the inferiority/superiority complex: An exploratory study." Engrami 42, no. 1 (2020): 32–43. http://dx.doi.org/10.5937/engrami2001032r.
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Stoyanova, Stanislava, and Nikolay Ivantchev. "Self-Esteem and Feelings of Inferiority and Superiority Among Athletes and Non-Athletes." European Journal of Investigation in Health, Psychology and Education 15, no. 2 (2025): 22. https://doi.org/10.3390/ejihpe15020022.
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Self-esteem is a central part of personality, related to self-perceptions and evaluation of oneself compared to other people. Self-esteem could be global self-esteem, concerning the whole personality, or partial self-esteem, concerning the different aspects of personality and performance. Global self-esteem, as well as feelings of inferiority and supremacy, were compared among 197 athletes and 198 non-athletes in Bulgaria based on three self-reported questionnaires—the inferiority complex shortened scale COMPIN-10, the superiority complex shortened scale SUCOMP-10, and the single-item self-esteem scale. It was found that the athletes had significantly higher self-esteem and more strongly expressed feelings of superiority, as well as fewer experienced feelings of inferiority than the non-athletes. This may be due to athletes’ achievements and their recognition by society, as well as the social image imposed by media as rich, successful, and representatives of their country. High self-esteem is necessary for athletes to be confident in their ability to perform well during sports competitions. More years of sport experience correlated with a decrease in inferiority feelings and an increase in self-esteem. There were not any statistically significant differences between the athletes practicing individual sports and the athletes practicing team sports in their inferiority feelings, superiority feelings, or self-esteem.
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Ijiri, Hidenori. "Sino-Japanese Controversy since the the 1972 Diplomatic Normalization." China Quarterly 124 (December 1990): 639–61. http://dx.doi.org/10.1017/s030574100003143x.
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IntroductionSino-Japanese relations appear to have a dual structure which is built into the long history of exchanges and interaction between the two countries. Some phrases such as ichii taisui (“neighbours across the strip of water”) and dobun doshu (“same Chinese characters, same race”) have long been regarded as a symbol of the friendly relationship between the two countries. Such a symbol, however, implies dual and conflicting sentiments of the Japanese and the Chinese, namely the feelings of inferiority and superiority with each other in a hierarchical order of foreign relations in Asia.To be more specific, the Chinese have a superiority complex deriving from their cultural influence in pre-modern history and hatred stemming from Japanese military aggression against China in the modern period, while having an inferiority complex based upon Japan's co-operation in their modernization, and admiration for Japan's advanced economy. On the other hand, the Japanese have an inferiority complex due to their cultural debt to China and the sense of original sin stemming from their past aggression against China, while having a superiority complex based upon their assistance to China's modernization and contempt for China's backwardness.
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Polosin, V. S. "Religious Superiority Complex: A Psychological Perspective." Minbar. Islamic Studies 16, no. 3 (2023): 701–17. http://dx.doi.org/10.31162/2618-9569-2023-16-3-701-717.
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The article discusses the mechanism of formation of the complex of religious superiority, as well as its practical consequences. The source of this complex is an inferiority complex and collective trauma, which is forced out through mental influence – appropriating the achievements of saints and heroes of the past, one's people and country. Collective trauma can cause a desire to transcend external superiority over others at any cost. When searching for a way out of a collective trauma, communities often seek help from ancient archetypal images stored in the sphere of the collective unconscious, which are reconstructed in the collective consciousness with the functions that they had in the past. The irrational way of reconstructing the past allows the elite to manipulate the collective will and direct it in the way they need.In relation to Islam, these processes have been visible since the end of the 19th century, against the background of the struggle of a number of Muslim countries against Western colonialism and attempts to reconstruct the post-Ottoman caliphate. These processes led to the emergence of “Political Islam”, in which religious goals are replaced by earthly ones, namely, by religious and political superiority.
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Carmitha, Inez Catur Windy. "Representation of Inferiority and Superiority in the Drama Script Kereta Kencana by W.S. Rendra." Journal of Society Innovation and Development 4, no. 2 (2023): 173–81. https://doi.org/10.63924/jsid.v4i2.205.
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This article aims to describe the form of inferiority of grandfather and grandmother characters in the drama script Kereta Kencana by W.S. Rendra describe the form of superiority of grandfather and grandmother characters in the drama script Kereta Kencana by W.S. Rendra. The method used is descriptive qualitative. The source of data in the study is the play Kereta Kencana by W.S. Rendra. The data was analyzed using the individual psychology approach of Alfred Adler's theory. The results of the research were found in the form of a form of inferiority of Grandfather's character consisting of feelings of pessimism, feelings of sadness, and feelings of frustration, while the form of inferiority of Grandmother's character is a feeling of excessive worry. The form of superiority is only found in Grandmother's character in the form of a creative self-superiority complex.
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Čekrlija, Đorđe, Dijana Đurić, and Biljana Mirković. "Validation of Adlerian inferiority (COMPIN) and superiority (SUCOMP) complex shortened scales." Civitas 7, no. 2 (2017): 13–35. http://dx.doi.org/10.5937/civitas1701013c.
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Asnawiyah, A., Abd Wahid, Nurullah Amri, and Muhammad Hadi Husni. "PREVENTION OF INFERIORITY COMPLEX ATTITUDES ACCORDING TO THE QUR'AN." QiST: Journal of Quran and Tafseer Studies 3, no. 2 (2024): 234–80. https://doi.org/10.23917/qist.v3i2.8413.
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Man as a caliph on earth was created by Allah in perfect form, but man is never free from emotional challenges such as the inferiority complex, which can hinder his spiritual and social development. The Qur'an calls for people not to feel this way, but also prohibits them from hitting the threshold that makes them arrogant, analysis is needed to find out the answer to how the mufassir interprets the verses related to the inferiority complex? And what are the limits of behaving so as not to have an inferiority complex attitude and not to result in arrogance? This study focuses on the analysis of mufassir's interpretation of Qur'anic verses related to the theme of inferiority complex, with the aim of understanding the boundaries of attitudes between arrogance and inferiority. This research is a literature review with a qualitative approach. The results of this study show that the mufassir emphasize that true strength lies in faith, solid faith is the initial key in overcoming the sense of inferiority complex, inferiority complex is the spiritual part of human beings and spiritual studies sourced from the Qur'an are the initial stages in fighting the inferiority complex. Allah commands His servants not to feel weak because they are created in the best form by Allah, with physical, intellectual, and spiritual virtues. Imam Qurthubi highlighted the importance of arousing enthusiasm and appreciating the privileges given by Allah without triggering behavior of superiority.
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Handayani, Ika, and Eri Rahmawati. "The Main Character Analysis in “The Diamond Necklace” by Guy De Maupassant." Journal of English Language Teaching and Cultural Studies 6, no. 1 (2023): 41–54. http://dx.doi.org/10.48181/jelts.v6i1.19136.
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The present study aims to describe the inferiority feeling and striving for superiority aspects of the main character, "Mathilde Loisel" in the short story "The Diamond Necklace" by a French author, Guy De Maupassant. The data source of this research is primarily taken from the sentences containing dialogues and conflicts experienced by the main character, Mathilde Loisel in the short story of "The Diamond Necklace" by Guy De Maupassant. While the secondary data were taken from any references related to the theory of literature, Alfred Adler’s Individual Psychology, and related researches. This research uses descriptive qualitative method and uses literature and documentation as data collection method. The results of the data analysis showed that the main character Mathilde Loisel struggled from her inferiority (her shortcomings) to her superiority using various forms of complex compensation and superiority. The results of analysis showed that this short story deserves to be discussed in literature study since there are many positive values that can be learned for individual character building.
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Joseph, John E., and Frederick J. Newmeyer. "‘All Languages Are Equally Complex’." Historiographia Linguistica 39, no. 2-3 (2012): 341–68. http://dx.doi.org/10.1075/hl.39.2-3.08jos.
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Summary Throughout most of the history of the discipline, linguists have had little hesitation in comparing languages in terms of their relative complexity, whether or not they extrapolated judgements of superiority or inferiority from such comparisons. By the mid 20th century, however, a consensus had arisen that all languages were of equal complexity. This paper documents and explains the rise of this consensus, as well as the reasons that have led to it being challenged in recent years, from various directions, including language diversity, as analysed by Daniel Everett; arguments about Creoles and Creoloids, as put forward by Peter Trudgill, and others; and views from generative linguistics and evolutionary anthropology.
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Čekrlija, Đorđe, Nikola Miloš Rokvić, Bojana M. Dinić, and Julie Aitken Schermer. "Relationship between the inferiority and superiority complex and the Big Five and Dark Triad traits." Personality and Individual Differences 206 (May 2023): 112123. http://dx.doi.org/10.1016/j.paid.2023.112123.
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Nurazizah, Syfa Aurela, Ujang Rohman, and Shalahudin Ismail. "Fenomena Superiority Complex dan Narcissistic Terhadap Perilaku Individu di Sosial Media Dalam Perspektif Hadis." Journal of Psychology Students 2, no. 2 (2023): 55–62. http://dx.doi.org/10.15575/jops.v2i2.26832.
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Penelitian ini bertujuan untuk memaparkan fenomena superiority complex dan narcissistic yang marak terjadi di media sosial dengan mempertimbangkan perspektif hadis dalam Islam. Penelitian ini menggunakan metode kualitatif dengan pendekatan studi kepustakaan, yaitu metodologis yang penelitian yang memusatkan perhatiannya pada data tertulis, seperti buku, jurnal, majalah, dan sumber-sumber lainnya. Hasil penelitian menunjukkan bahwa superiority complex merupakan gangguan psikologis, yaitu ketika individu merasa lebih baik dalam setiap aspek kehidupannya dibandingkan orang lain dan narcissistic merupakan gangguan kepribadian yang ditandai dengan perasaan haus akan pengakuan diri. Superiority complex dan narcissistic saling berkesinambungan satu sama lain dan media sosial adalah wadah bagi mereka yang memiliki gangguan tersebut untuk menujukan superioritas mereka dan menutupi sisi inferioritas yang ada.
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Halperin, Charles J. "Hierarchy of Hierarchies: Muscovite Society during the Reign of Ivan iv." Russian History 44, no. 4 (2017): 570–84. http://dx.doi.org/10.1163/18763316-04404005.
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Muscovite society during the reign of Ivan iv was hierarchical. Each social class stood in a position of superiority or inferiority toward every other social class. However, each social class also had its own hierarchy of sub-classes. This article examines the internal social pyramids of elite lay society, the dynasty, the boyars, the princes, the gentry, and the secretaries. It concludes that by the sixteenth century, Muscovite society already possessed a complex and sophisticated social structure.
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Willems, Dick, Marieke Bak, Hanno Tan, et al. "Ethical issues in two parallel trials of personalised criteria for implantation of implantable cardioverter defibrillators for primary prevention: the PROFID project—a position paper." Open Heart 8, no. 2 (2021): e001686. http://dx.doi.org/10.1136/openhrt-2021-001686.
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AimTo discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model.MethodThe position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature.ResultsWe identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge.ConclusionThe PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials.
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Abdoellakhan, Rahat A., Nakisa Khorsand, Reinier M. Van Hest, et al. "Randomised controlled trial protocol to evaluate a fixed dose prothrombin complex concentrate against the variable dose in vitamin K antagonist related bleeding (PROPER3)." BMJ Open 8, no. 3 (2018): e020764. http://dx.doi.org/10.1136/bmjopen-2017-020764.
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IntroductionThere is currently little evidence for the optimal dosing strategy of four-factor prothrombin complex concentrates (PCC) in vitamin K antagonist (VKA)-related bleeds. The generally accepted dosing strategy is the use of a variable dose calculated using patient-specific characteristics as per manufacturer’s instruction. However, evidence exists that the use of a fixed low dose of 1000 international units of factor IX (IU fIX) might also suffice. Recent studies indicate that in terms of haemostatic effectiveness, the fixed dosing strategy might be even superior to the variable dosing strategy. The PROPER3 (PROthrombin complex concentrate: Prospective Evaluation and Rationalisation, number 3) study aims to confirm the non-inferiority, and explore superiority, in haemostatic effectiveness of the fixed PCC dosing strategy compared with the variable dosing strategy in VKA-related extracranial bleeding emergencies.Methods and analysisThe study is designed as a randomised controlled multicentre non-inferiority trial. Eligibility criteria are an indication for PCC due to VKA-related extracranial bleeding in subjects 18 years of age or older. The control group will receive a variable dose, determined by patient-specific bodyweight and international normalised ratio. The intervention group is dosed a fixed 1000 IU fIX PCC. Primary outcome is the haemostatic effectiveness of both treatments, as defined by the 2016 International Society on Thrombosis and Haemostasis (ISTH) criteria. The sample size is set at 155 patients per treatment arm, requiring 310 patients in total. Non-inferiority on the proportion (risk) difference of the primary outcome will be evaluated using the asymptotic Wald test for non-inferiority. The non-inferiority margin is set at 6%. The primary analysis will be based on the per-protocol population.Ethics and disseminationStudy results will be published in an international journal, communicated to discipline-specific associations and presented at (inter)national meetings and congresses.Trial registration numberEUCTR2014-000392-33; Pre-results.
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Lima, Brayan de Almeida, Marcos dos Santos, Renato Santiago Quintal, and Enderson Luiz Pereira Junior. "Ordenação de serviços de hospedagem para websites a partir do método Superiority and Inferiority Ranking." Perspectivas Contemporâneas 18 (November 21, 2023): 1–18. http://dx.doi.org/10.54372/pc.2023.v18.3554.
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Com o advento da pandemia do coronavírus (COVID-19), no ano de 2020, os setores de bens de consumo e serviços no Brasil procuraram atender à crescente demanda de forma virtual. O e-commerce no país cresceu 47%, correspondendo a maior alta em 20 anos. O propósito deste artigo é demonstrar a viabilidade da aplicação do Método Superiority and Inferiority Ranking para a seleção da melhor empresa de serviço de hospedagem de website, entre diversas alternativas e critérios. Convém apontar que existe uma grande variedade de empresas deste segmento, fazendo com que a seleção se torne complexa quando sem o auxílio de um método de tomada de decisão. Foi utilizado um método híbrido de apoio à decisão multicritério, o Simple Aggregation of Preferences Expressed by Ordinal Vectors –Multi Decision Makers (SAPEVO-M) e o Superiority and Inferiority Ranking (SIR). O SAPEVO-M auxilia na determinação do vetor peso e o SIR favorece a ordenação das alternativas. As alternativas e os critérios foram selecionados a partir da relevância e importância, respectivamente, para os autores. A solução encontrada foi satisfatória, uma vez que, a empresa de maior preferência, a LocaWeb, apresenta o maior valor do critério de preferência, armazenamento, porém, percebe-se uma grande disparidade entre a melhor e a pior alternativa.
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Sabir, Irfan, Irum Nasim, Muhammad Bilal Majid, Mohad Sadad bin Mahmud, and Naila Sabir. "TikTok Addictions and Its Disorders among Youth of Pakistan." Scholedge International Journal of Multidisciplinary & Allied Studies ISSN 2394-336X 7, no. 6 (2020): 140. http://dx.doi.org/10.19085/sijmas070602.
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This research addresses the TikTok addictions that are affecting those people who are inspired by TikTok videos and people making those videos. TikTok nowadays creating different kinds of conflicts among both of the genders. I.e. inferiority complex and superiority complex and beauty complex. The philosophy of the study was positivism. It was a deductive approach and the Connivance sampling technique is used in this study. It was quantitative research and data has been collected through surveys. .The adapted questionnaire was used to collect data from 190 university students. Statistical analysis through SPSS was performed to check the hypothesis. This research is highly beneficial to create the awareness among people that they are addicted to something very un-useful so their friends and family taking serious note on it and help them to drive them out of TikTok addiction and psychological make them ensure that it is just app use for entertainment and seek and show your talent.
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Rostami, Maryam, and Razieh Eslamieh. "A Comparative Study of Adlerian Masculine Protest in Jonathan Franzen’s The Corrections and Freedom: Individuality despite Similarity." Theory and Practice in Language Studies 8, no. 6 (2018): 640. http://dx.doi.org/10.17507/tpls.0806.14.
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This article is studying some of the characters in The Corrections (2001) and Freedom (2010) by Jonathan Franzen (1959) in the light of Alfred W. Adler's (1870-1937) concept of masculine protest. Adler has introduced different aspects of masculine protest some of which are found in the studied novels. This article intends to find the characters who suffer from masculine protest because of the fact that this concept is one of the elements that demonstrates people's inferiority and superiority complex which are the causes of neurosis. On the next level, the differences between the studied novels based on the studied concept will be mentioned, and finally the link between this concept with post feminism and Freud's theories will be briefly discussed.
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Chen, Huanwan, Guopeng Chen, Qingnian Zhang, and Xiuxia Zhang. "Analysis of network disruption evolution of Chinese fresh cold chain under COVID-19." PLOS ONE 18, no. 1 (2023): e0278697. http://dx.doi.org/10.1371/journal.pone.0278697.
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The spread of the global COVID-19 epidemic, home quarantine, and blockade of infected areas are essential measures to prevent the spread of the epidemic, but efforts to prevent and control the outbreak lead to the disruption of fresh and cold chain agricultural products in the region. Based on the multi-layer management model of non-scale agricultural households in China, we applied the complex network theory to construct an evolutionary model of the Chinese fresh cold chain network with adaptation degree priority connection, dual local world considering transport distance connection relationship, and superiority and inferiority mechanism. Based on this model, we studied the evolution of fresh cold chain disruption, and puts forward the optimal design of fresh cold chain network disruption and reconnection from the perspective of practicality and economy.
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Pujiarohman, Pujiarohman, Arfi Syamsun, Ida Lestari Harahap, Lenny Herlina, and Lalu Abdurrachman Wahid. "Memahami Pengalaman dan Dampak Psikologis pada Tindak Pidana Kekerasan Seksual bagi Korban dan Pelaku dengan Menggunakan Pendekatan Asosiasi Kata." AHKAM 4, no. 2 (2025): 527–50. https://doi.org/10.58578/ahkam.v4i2.6122.
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This study aims to analyze the differences in psychological responses between victims and perpetrators of sexual violence using Carl Gustav Jung's analytical psychology theory approach. The research method used is the word association method, this study explores aspects of personality, such as Persona, Shadow, Archetype, and Complex, to identify the psychological dynamics that influence the behavior and perception of these two groups. The results showed that victims tend to display a stable Persona, supported by elements of family and nature archetypes as a mechanism for healing and emotional recovery. Meanwhile, perpetrators show the use of a manipulative Persona to control the surrounding environment and tend to dominate, which is reinforced by the hero and superiority archetypes. The victim's Shadow mostly contains anxiety and fear related to trauma, while the perpetrator's Shadow is more filled with aggressive traits and lack of empathy. The complexes that appear in victims are related to inferiority and social support, while perpetrators show a superiority complex that emphasizes dominance and manipulation. These fundamental differences provide insight into how victims and perpetrators respond to their life experiences and how psychotherapy approaches can be tailored based on their respective needs. This study offers a new perspective in understanding the psychological dynamics of victims and perpetrators of sexual violence and has the potential to contribute to more effective therapeutic interventions.
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Ahmed, Qazi Ehsan, and Mustanir Ahmad. "LOSS AND REDEMPTION EXPERIENCED BY JAMUBHAI PATEL IN KIRAN DESAI’S THE INHERITANCE OF LOSS: A POST-COLONIAL ANALYSIS." Pakistan Journal of Social Research 04, no. 03 (2022): 1220–24. http://dx.doi.org/10.52567/pjsr.v4i03.1302.
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Kiran Desai as a diasporic Indian novelist has convincingly presented the experiences of life in England or America in her acclaimed Man Booker Prize winning novel The Inheritance of Loss. Immigrants from India, Pakistan or other such third world countries face issues of identity. They become witness to clash of the Eastern and the Western cultures. They show mixed reactions to the happenings over there. Some people show their deep concern about the threat which their native culture and identity face during their lives over there. Some other individuals like Jemubhai Patel in the said novel create a shell around themselves in which they hide their true feelings. The latter want to do mimicry of the White race in their appearance through dress, language, and lifestyle. Because of their non-acceptance by the West as their part, they confine themselves to their very self and remain victim to inferiority complex. After completing education or training abroad and assuming important and influential positions as government officials, their previously experienced inferiority complex turns into superiority complex when they go back to their respective native lands. They imitate the English people and deal their own people with strong hatred by treating them as ignorant and ill-cultured. Their relations are no exception in this regard. They are also in the row of all others who are to be ruled and subjugated. Jemubhai too loses relations like parents, wife, daughter, and granddaughter. For him his pet dog Mutt becomes the recipient of his love, care and attention. It is only through the loss of Mutt his journey of redemption begins. Only then, by the end of the novel, does he realize the significance of human relations. But this realization has been a torture process for him. It costs him mental calm and composure. Keywords: Loss, Redemption, Mimicry, Identity, Diaspora, Relationship.
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Mukherjee, Ankhi. "Eco-Cosmopolitanism as Trauma Cure." Cambridge Journal of Postcolonial Literary Inquiry 6, no. 03 (2019): 411–17. http://dx.doi.org/10.1017/pli.2019.10.
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The fourth chapter of Frantz Fanon’s classic work Black Skin, White Masks, titled “The So-Called Dependency Complex of the Colonized,” is a powerful critique of Mannoni’s Prospero and Caliban: The Psychology of Colonization (1956). Born in France of Corsican parents, Dominique-Octave Mannoni had come to know the African colonial condition primarily through his ethnological work in Madagascar, where he spent twenty years. The argument of Prospero and Caliban is that colonial “situations” are the product of “misunderstanding, of mutual incomprehension.”1 The situation, Mannoni observes in the introduction, is created the very moment a white man appears in the midst of a tribe, and he goes on to elaborate on its distinctive and varied features: dominance of a majority by a minority, economic exploitation, the seemingly benign paternalism of the civilizing mission, and racism. The colonizer’s “grave lack of sociability combined with a pathological urge to dominate” gives him a “Prospero complex”2 while the colonized Malagasy, forced out of their own history, genealogy, and tradition and victimized by a failed European interpellation, develop a corresponding “dependence complex.”3 Neither inferiority nor superiority, “dependence,” Mannoni claims, is Caliban’s reliance on colonizers fostered by a sense of abandonment.
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Yamabe, Shinichi, Wei Guan, and Shigeyoshi Sakaki. "Presence or absence of a novel charge-transfer complex in the base-catalyzed hydrolysis of N-ethylbenzamide or ethyl benzoate." Beilstein Journal of Organic Chemistry 9 (January 29, 2013): 185–96. http://dx.doi.org/10.3762/bjoc.9.22.
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Reaction paths of base-catalyzed hydrolyses of isoelectronic substrates, Ph–C(=O)–X–Et [X = O (ethyl benzoate) and X = NH (N-ethylbenzamide)], were traced by DFT calculations. To simulate bond interchanges accompanied by proton transfers, a cluster model of Ph–C(=O)–X–Et + OH−(H2O)16 was employed. For X = O, three elementary processes and for X = NH four ones were obtained. The rate-determining step of X = O is the first TS (TS1, the OH− addition step), while that of X = NH is TS2. TS2 of X = NH leads to a novel Mulliken charge-transfer complex, Ph–(OH)(O=)C∙∙∙N(H2)–Et. The superiority or inferiority between the direct nucleophilic process or the general base-catalyzed process for TS1 was examined with the model Ph–C(=O)–X–Et + OH−(H2O) n , n = 3, 5, 8, 12, 16, 24 and 32. The latter process was calculated to be more favorable regardless of the number (n, except n = 3) of water molecules. The counter ion Na+ works unfavorably on the ester hydrolysis, particularly on TS1. A minimal model of TS1 was proposed and was found to be insensitive to n.
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Buthelezi, Sandile Johannes, Taurai Hungwe, Solly Matshonisa Seeletse, and Vimbai Mbirimi-Hungwe. "Non-life insurance: The state of the art of determining the superior method for pricing automobile insurance premiums using archival technique." International Journal of Research in Business and Social Science (2147- 4478) 13, no. 2 (2024): 180–88. http://dx.doi.org/10.20525/ijrbs.v13i2.3211.
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The pricing of insurance premiums in the non-life insurance sector remains a challenging and complex task. It demands a delicate balance between accurately estimating risk exposure and ensuring profitability for insurers. Generalised Linear Regression Models (GLMs) have become the preferred methods for premium price modelling in the motor insurance sector. While the approach of using a single superior model on which predictions are based ignores the use of robust estimator models. This paper examines various methodologies and sheds light on superiority of twenty-two models compared to each other for pricing automobile insurance. These methods vary from traditional actuarial methods to the modern statistical models such as machine learning algorithms. By using archival technique, their inferiority and superiority are explored, considering the ever-changing landscape of risk factors and market dynamics. Furthermore, it highlights the potential benefits of leveraging these methods and the mechanism for pricing short-term insurance, particularly in motor vehicle insurance. It also develops a framework that can be used in pricing to cater to risk analysis constituents to mitigate uncertainties and provide good services to clients. Our findings show that ANN, NN, XGB, random forest (RF) are superior models, and we conclude that the modern statistical methods can accurately estimate the risk exposure as compared to traditional methods such as the GLMs.
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Bulanku Maharani and Dewi Candraningrum. "The Film "500 Days of Summer" (2009) Movie By Marc Webb : an Individual Psychological Approach of Friends With Benefits." EduInovasi: Journal of Basic Educational Studies 5, no. 1 (2025): 612–24. https://doi.org/10.47467/edu.v5i1.6901.
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This research discusses the phenomenon of the FWB relationship depicted in the characters Tom and Summer in the movie 500 Days of Summer. Their relationship shows complex emotional conflicts due to differences in mindset, lifestyle, and emotional needs of the two characters. This research uses Adler's individual psychology approach including the principles of superiority, inferiority, lifestyle, creative self, fictional goals, and social interest. This research uses a qualitative approach with a descriptive method, using literature study techniques for data collection. The results of this study show that Tom's dependency based on inferiority contradicts Summer's lifestyle or principles. The incongruity created stems from Tom's constant need for external validation, but Summer chooses freedom in emotional relationships and life paths. This imbalance was a major source of conflict, as Tom expected a deeper commitment, while Summer felt the pressure threatened her freedom. This research contributes to the field of individual psychology. Through the approach of Adler's principles, it offers new insights into the cause and effect in a non-committal relationship or FWB (Friends With Benefit). The results of the study provide new insights into the psychological dynamics in relationships without commitment, particularly from the perspective of Adler's theory. The mismatch of lifestyles and goals between individuals in FWB relationships can trigger deep emotional conflict. This research not only contributes to understanding individual psychology, but also opens further discussion on how films and literary works portray the complexity of human relationships. By understanding FWB relationships through this theory, this research is expected to provide a new understanding of emotional conflict and expectations in romance relationships in the modern era.
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Nemeth, Balazs T., Istvan Hizoh, Fanni Nowotta, et al. "Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial)." Diagnostics 13, no. 1 (2023): 143. http://dx.doi.org/10.3390/diagnostics13010143.
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Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0–142.5) for the vial vs. 120.0 (inter-quartile range: 110.0–180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [−23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective.
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Zhumatay, Gabit, and Akmaral Yskak. "AN ANALYSIS OF FRANTZ FANON’S DISCOURSES ON COLONIALISM, DECOLONIZATION AND COLONIALITY." Адам әлемі 103, no. 1 (2025): 70–79. https://doi.org/10.48010/aa.v103i1.628.
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This paper explores and analyzes Frantz Fanon’s discourses about the psychological effects of Western colonialism on the colonized peoples, the legacy of European colonialism, imperialism and how the classic colonialism morphed into neocolonialism. Frantz Fanon was selected for our study because he was one of the pioneers of postcolonial studies, who greatly contributed to the development of the theoretical and conceptual underpinnings of colonialism, decolonization, neocolonialism and coloniality. A critical analysis of Frantz Fanon’s works and discourses will allow us to get in-depth insights into underlying issues pertaining to the legacy of European colonialism and imperialism. We have specifically examined Frantz Fanon’s works “Black Skin, White Masks”, “A Dying Colonialism” and “The Wretched of the Earth”. Moreover, we have drawn upon studies of leading scholars of postcolonialism and other relevant literature. The results of our study have demonstrated that even though classic European colonialism long came to an end, the consequences and legacy of Western colonialism and imperialism tenaciously persist and shape the development of postcolonial societies. The psychological effects of colonialism are still felt across postcolonial contexts, especially in terms of the persistence of an inferiority complex among former colonized nations and a superiority complex among the former colonizers. Moreover, the dawn of political independence of many Third World nations has not translated into genuine freedom and national development. Quite the opposite, as Fanon emphasized, colonialism transformed into neocolonialism, in which former colonial powers still dominate their former colonies.
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El Aatefi, Khalid. "Intercultural Encounters in Colonial North Africa: the Unmorphed Imagery of Colonial Cinema, the Narratives of Legitimatization, and the Inchoate Politics of Broken Subjectivities." International Journal of Linguistics, Literature and Translation 6, no. 7 (2023): 58–65. http://dx.doi.org/10.32996/ijllt.2023.6.7.7.
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The representational politics of European colonial cinema was effectively decisive in shaping the values and ideologies of the articulated discourse of colonialism in representing cultural encounters and racial differences. This article attempts to analyse and explore how the colonial cinema of the early twentieth century produced a biased politics of representation and persistent modes of constructing North Africans within the confines of an orientalising colonial imaginary that turns cultural encounters into a display of power and superiority. It addresses the ways cinematic representation of North Africans accentuates the homogenising discourse of domination, the legitimization of conquest and the articulation of intercultural encounters on a stereotypical and judgmental basis. While a part of this cinema kept (re)visiting the same classical tropes of exoticism and racial inferiority of the native cultures, favouring the stereotypical portrayals and racial prejudices of “others” that blatantly rest on the “us and them” dichotomy, the other part tried to introduce a sort of paradigm shift that complicates the unquestionable presence of colons in North Africa and interrogates the parameters of their colonial identity. This article argues that colonial cinema of the 1930S has introduced a range of Western protagonists and colons with complex forms of identifications, questionable moral consciousness, and conflicted colonial subjectivities.
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Luo, Can, Dongmei Wei, Yueyue Chen, Ling Mei, and Xiaoyu Niu. "Laparoscopic lateral suspension (Dubuisson) in the treatment of pelvic organ prolapse." Gynecology and Obstetrics Clinical Medicine 4, no. 2 (2024): e000010. http://dx.doi.org/10.1136/gocm-2024-000010.
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BackgroundCurrently, the global ageing population is becoming increasingly severe, and the incidence of pelvic organ prolapse (POP) is rising year by year, which seriously impacts the psychosomatic health and the quality of life in female patients. Surgical treatments for POP still face enormous challenges.MethodsThe aim of this review is to discuss the laparoscopic lateral suspension (LLS) approach to the management of POP. We use MeSH terms for each topic to retrieve relevant literature from the PubMed and Embase databases. Our group reviewed, synthesised and summarised included studies.ResultsLLS has been widely applied in the treatment of middle pelvic compartment defects. In comparison to sacrocolpopexy (SC), the most significant advantage of LLS is that it avoids dissecting the complex sacral region and possesses simple surgical procedures. But its cure, recurrence, reoperation and complication rates have been widely discussed. Issues regarding its value and its potential equivalence in surgical therapeutic effects compared with SC have gained continuous attention.ConclusionsBased on the existing research, LLS demonstrates advantages in the treatment of POP, particularly in cases of middle pelvic compartment defects. However, solely based on current clinical studies, it is premature to establish superiority or inferiority compared with SC. LLS is not yet a substitute for SC.
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Karkouti, Keyvan, Jeannie Callum, Kenichi Tanaka, et al. "Randomized, Active-Control Phase 3 Study of Four-Factor Prothrombin Complex Concentrate Versus Frozen Plasma in Bleeding Adult Cardiac Surgery Patients." Blood 142, Supplement 1 (2023): 5515. http://dx.doi.org/10.1182/blood-2023-186539.
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Background and Significance: Patients following cardiac surgery often develop coagulopathic bleeding and associated poor outcomes. The development of coagulopathy is multifactorial, including anticoagulation, hemorrhage, hemodilution and consumptive losses after tissue injury and during cardiopulmonary bypass (CPB). Reduced thrombin generation due to coagulation factor deficiency is an important contributor to post-CPB bleeding. Prothrombin complex concentrate (PCC; off-label) and frozen plasma (FP) are administered for coagulation factor replacement during surgery. The LEX-211 (FARES-II) study will determine if four-factor PCC (4F-PCC, Octaplex, Octapharma) is clinically non-inferior to FP regarding hemostatic effectiveness in cardiac surgery patients requiring coagulation factor replacement. Study Design and Methods: LEX-211 (FARES-II; NCT05523297) is a multicenter, randomized, active-control, prospective, Phase 3 trial that is being conducted at 13 hospitals in Canada and the United States. The study is being conducted in accordance with the Declaration of Helsinki. The study includes patients ≥18 years old undergoing cardiac surgery with CPB who require coagulation factor replacement due to bleeding and known (e.g., as indicated by international normalized ratio) or suspected coagulation factor deficiency. Exclusion criteria include heart transplant, insertion/removal of ventricular assist devices, high probability of death within 24 hours, severe right heart failure, heparin contraindications, thromboembolic events within the prior 3 months, and IgA deficiency. Patients will be randomized to 4F-PCC or FP when the blood bank receives the first order for coagulation factor replacement (Figure 1). For 4F-PCC dosing, patients weighing ≤60 kg will receive 1,500 international units (IU), and those >60 kg will receive 2000 IU. For FP, patients weighing ≤60 kg will receive 3 U and patients weighing >60 kg will receive 4 U. Patients are treated according to their assigned group until a maximum of 2 doses of 4F-PCC/FP have been administered during the treatment period (24 hours after initiation). If additional treatment is required, patients in both groups receive FP. The primary endpoint is the hemostatic response to 4F-PCC vs. FP, rated ‘effective’ if no further hemostatic intervention (systemic hemostatic agents, i.e., platelets, cryoprecipitate, other coagulation factor products, or a second dose of study drug, or surgical re-opening for bleeding) is required within 60 minutes to 24 hours after initiation of the first dose. Secondary and safety endpoints, with their timings, are described in Table 1. An unblinded interim analysis (100 evaluable patients/group) will test sample size assumptions and enable re-estimation if necessary. Depending upon the interim results, and accounting for dropouts (20% anticipated), the total sample size will range between 513-1,250 patients. The non-inferiority of the primary endpoint of ‘haemostatic response’ will be tested for 4F-PCC vs. FP using a Farrington-Manning score test with a non-inferiority margin of 0.10 at a one-sided significance level alpha of 2.5%. If non-inferiority is demonstrated, the superiority of 4F-PCC with regard to the primary endpoint will be investigated. LEX-211 (FARES-II) is in progress, with the first study site initiated in Q4 2022. Currently, >150 patients have been included in the study. Completion is expected in Q4 2024. The results of this study will inform clinical practice for bleeding cardiac surgery patients requiring coagulation factor replacement, potentially reducing allogeneic blood product usage and improving patient outcomes.
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Zhilwan Tahir and Abdulwahed Jalal Nuri. "Examining the Impact of Religion on Civilization: Insights from Ibn Khaldun and Arnold Toynbee's Theories." DIROSAT: Journal of Education, Social Sciences & Humanities 2, no. 2 (2024): 106–23. http://dx.doi.org/10.58355/dirosat.v2i2.69.
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This paper examines the impact of religion on civilization through the perspectives of two prominent scholars, Ibn Khaldun and Arnold Toynbee. The paper provides an overview of Toynbee's theory of comparative civilizations, highlighting his emphasis on the comparability of diverse societies and his rejection of the notion of inherent superiority or inferiority among civilizations. The paper also explores Ibn Khaldun's cyclical theory of the rise and fall of civilizations, which emphasizes the role of religion in shaping the fortunes of societies. This study utilizes a comparative methodology to analyze the viewpoints of Ibn Khaldun and Arnold Toynbee on the impact of religion on civilization. The work explores the perspectives of individuals on social unity, governing systems, and the development of culture. It utilizes knowledge from their writings and historical circumstances to clarify the complex connection between religion and human communities. The paper investigates the impact of religious beliefs on the rise and fall of civilizations, drawing on insights from both Toynbee and Ibn Khaldun. It examines how religion has influenced the development of civilizations, including its role in shaping cultural values, political structures, and economic systems. The paper also explores how religion has contributed to the decline of civilizations, including through religious conflicts and the erosion of social cohesion. Overall, the paper provides a comparative analysis of the role of religion in civilization and society, drawing on the insights of two influential scholars. It highlights the importance of understanding the complex interplay between religion and civilization, and how religious beliefs have shaped the fortunes of societies throughout history.
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Saltzman, Bryan Michael, Michael L. Redondo, Adam Beer, et al. "Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting." CARTILAGE 12, no. 1 (2018): 7–23. http://dx.doi.org/10.1177/1947603518809398.
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Background The management of complex cartilage pathology in young, otherwise healthy patients can be difficult. Purpose To determine the nature of the design, endpoints chosen, and rate at which the endpoints were met in published studies and ongoing clinical trials that investigate cartilage repair and restoration procedures. Study Design Systematic review. Methods A systematic review of the publicly available level I/II literature and of the publicly listed clinical trials regarding cartilage repair and restoration procedures for the knee was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Seventeen published studies and 52 clinical trials were included. Within the 17 published studies, the most common procedure studied was microfracture (MFX) + augmentation ( N = 5; 29.4%) and the most common comparison/control group was MFX ( N = 10; 58.8%). In total, 13 different cartilage procedure groups were evaluated. For published studies, the most common patient-reported outcome (PRO) measures assessed is the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale–Pain (VAS) ( N = 10 studies, 58.8% each, respectively). Overall, there are 10 different PROs used among the included studies. Ten studies demonstrate superiority, 5 demonstrate noninferiority, and 2 demonstrate inferiority to the comparison or control groups. For the clinical trials included, the most common procedure studied is MFX + augmentation ( N = 16; 30.8%). The most common PRO assessed is KOOS ( N = 36 trials; 69.2%), and overall there are 24 different PROs used among the included studies. Conclusions Recently published studies and clinical trials evaluate a variety of cartilage repair and restoration strategies for the knee, most commonly MFX + augmentation, at various time points of outcome evaluation, with KOOS and VAS scores being used most commonly. MFX remains the most common comparison group for these therapeutic investigations. Most studies demonstrate superiority versus comparison or control groups. Understanding the nature of published and ongoing clinical trials will be helpful in the investigation of emerging technologies required to navigate the regulatory process while studying a relatively narrow population of patients.
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V. R. Sorge, Giovanni. "Between Stereotypes and Hermeneutic Quest." Journal of Jungian Scholarly Studies 18, no. 1 (2024): 116–43. http://dx.doi.org/10.29173/jjs259s.
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G. Jung’s alleged racism with regard to indigenous populations and, by extension, people of color and, specifically, Africans and native Americans, is much debated. The present contribution is based largely on Jung’s writings, some of which are unpublished. Jung’s considerationsoften deriving from his travels in North Africa and New Mexicoseem sometimes to imply the psychic inferiority of certain populations in comparison with the alleged civilized “white man.” To establish context, the essay cites passages from Jung’s published works (including his fear of “going black”), the discussion of the “racial question” among his contemporaries, and secondary literature. It then turns to statements from Jung’s unpublished manuscript “African Journey” (ca. 1925–26) for fresh insights into his views on his “primitive psychology.” On the one hand, Jung’s psychological approach failed to fully account for the social, economic, and historical aspects inherent to cultural differences. Moreover, he followed the widespread notion equating the primitive, the child, and the mentally ill. On the other hand, Jung’s understanding of “primitiveness” appears to be intrinsically linked to a critical approach to the alleged superiority of the “civilized man.” I argue that some passages from his unpublished manuscript “African Journey” demonstrate Jung’s conviction that the Western white man must recover a sense of the sacred and the experience of the numinosum, which the so-called primitive still retains. I discuss this complex and somewhat paradoxical view alongside an epistemologically problematic connotation inherent both to Jung’s empirical approach and his conception of the collective unconscious.
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Fan, Xinyu, Juyi Han, Jie Yin, Li Zheng, and Wei Shao. "The Optimization Design of Variable Valve Parameters for Internal Combustion Engines Considering the Energy Consumption of a Composite Electromagnetic Valve Mechanism." Actuators 14, no. 4 (2025): 168. https://doi.org/10.3390/act14040168.
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The variable valve mechanism, as a critical component for the efficient and low-carbon development of internal combustion engines, faces increasingly stringent requirements regarding its driving efficiency, output force, precision, and energy consumption. To address the limitations of existing technologies, a new composite electromagnetic valve train is proposed, characterized by a high force-to-power ratio, fast response, and high precision, along with a unique single/double drive mode, which offers greater flexibility in controlling valve timing parameters; however, it also introduces complex coupling relationships and increases the difficulty of optimization design. To this end, this paper establishes a thermodynamic model of the engine based on the composite electromagnetic valve mechanism. First, it analyzes the effects of different valve timing parameters and drive modes on engine performance; second, a multi-objective game theory optimization algorithm is employed to optimize the valve timing parameters and obtain the optimal solution set; finally, taking into account the energy consumption of the valve mechanism, engine emissions, and performance, a control strategy for valve timing parameters is developed based on an entropy-weighted method combined with a superiority and inferiority solution distance analysis. The results indicated that, under all the operating conditions of the engine, the average torque increased by 2.56%, the effective fuel consumption rate decreased by 6.23%, and nitrogen oxide emissions reduced by 9.86%. Meanwhile, an efficient and economical operational mode for the variable valve mechanism was obtained, providing new insights for the development of variable valve timing technology.
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Hillmen, Peter, Jeffrey Szer, Ilene C. Weitz, et al. "Results of the Pegasus Phase 3 Randomized Trial Demonstrating Superiority of the C3 Inhibitor, Pegcetacoplan, Compared to Eculizumab in Patients with Paroxysmal Nocturnal Hemoglobinuria." Blood 136, Supplement 1 (2020): 35–37. http://dx.doi.org/10.1182/blood-2020-142174.
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BACKGROUND In paroxysmal nocturnal hemoglobinuria (PNH), intravascular hemolysis (IVH) is mediated by the membrane attack complex, while extravascular hemolysis (EVH) is facilitated by C3 opsonization. Although eculizumab (ECU), a C5 inhibitor, inhibits IVH, ~70% of patients remain anemic and 36% require ≥1 transfusion per year due to C3-mediated EVH. Pegcetacoplan (APL-2), a C3 inhibitor, has the potential to control both IVH and EVH in PNH. AIMS PEGASUS, a phase 3, randomized, open-label, controlled trial (NCT03500549), assessed the efficacy and safety of pegcetacoplan compared to ECU in patients with PNH. METHODS Eighty patients aged ≥18 years with a confirmed diagnosis of PNH, hemoglobin levels <10.5 g/dL (despite stable ECU for ≥3 months), reticulocytes >1.0 × ULN, platelets >50 × 109/L and neutrophils >0.5 × 109/L were included. All patients provided written informed consent and completed a run-in period of 4 weeks with pegcetacoplan plus ECU before 1:1 randomization to monotherapy with pegcetacoplan (41 patients, 1080 mg subcutaneously twice a week) or ECU (39 patients, continuing current dosing regimen). The primary endpoint was change in hemoglobin level from baseline (start of run-in period) to week 16. Key secondary and secondary endpoints were hemoglobin normalization (defined as hemoglobin level greater than or equal to lower limit of normal range) in the absence of transfusions, transfusion avoidance, absolute reticulocyte counts, lactate dehydrogenase (LDH), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score, and adverse events (AEs). Hierarchical significance testing for secondary efficacy endpoints was gated on the success of the primary efficacy endpoint. Post hoc analyses included hemoglobin stabilization (defined as avoidance of a >1 g/dL decrease from baseline) in the absence of transfusions. RESULTS Pegcetacoplan demonstrated superiority to ECU in change in hemoglobin level at week 16, with an adjusted treatment difference of 3.84 g/dL (p<0.0001). The least-squares (LS) mean (SE) changes were 2.37 (0.36) g/dL with pegcetacoplan and −1.47 (0.67) g/dL with ECU, both changed from baseline of 8.7 g/dL (Table). At week 16, a greater proportion of patients receiving pegcetacoplan achieved ≥2 g/dL improvement in hemoglobin (61% vs 0%), hemoglobin normalization (34% vs 0%), and hemoglobin stabilization (85% vs 15%) in the absence of transfusion as compared with ECU. Transfusion avoidance was achieved in 35 (85.4%) patients with pegcetacoplan vs 6 (15.4%) patients with ECU, an adjusted risk difference of 62.5% (95% CI, 48.3-76.8), demonstrating non-inferiority. Non-inferiority was also shown for absolute reticulocyte counts, which decreased with pegcetacoplan and slightly increased with ECU (LS mean [SE] changes of −136 [6.5] and 28 [11.9] 109/L, respectively). LS mean (SE) changes in LDH were −15 (42.7) and −10 (71.0) U/L, respectively. LS mean (SE) FACIT-Fatigue score increased with pegcetacoplan (9.2 [1.61]) and decreased with ECU (−2.7 [2.82]). As the change in LDH did not meet statistical non-inferiority, changes in FACIT-Fatigue score were not tested for non-inferiority due to prespecified hierarchical testing. Thirty-six of 41 (87.8%) patients with pegcetacoplan and 34/39 (87.2%) with ECU reported an AE; 7/41 (17.1%) and 6/39 (15.4%), respectively, had serious AEs. Most AEs were mild. AEs included injection site reactions (pegcetacoplan, 15/41 [36.6%]; ECU, 1/39 [2.6%] patients) and diarrhea (pegcetacoplan, 9/41 [22.0%]; ECU, 1/39 [2.6%]); infections were reported in 12/41 (29.3%) and 10/39 (25.6%) patients, respectively. By week 16, breakthrough hemolysis was reported in 4 (9.8%) patients with pegcetacoplan and 9 (23.1%) with ECU, leading to discontinuation in 3 patients on pegcetacoplan. CONCLUSIONS In this phase 3 trial in patients with PNH, pegcetacoplan demonstrated superiority to ECU in hemoglobin level, and improved clinical outcomes at week 16 with transfusion avoidance in most patients. The safety profile of pegcetacoplan was comparable to that of ECU. The efficacy of pegcetacoplan validates the prevention of extravascular as well as intravascular hemolysis in PNH, leading to a potential new therapeutic option. Disclosures Hillmen: Acerta: Other: Financial or material support; AbbVie: Consultancy, Other: Financial or material support, Research Funding, Speakers Bureau; Roche: Consultancy, Other: Financial or material support, Research Funding, Speakers Bureau; Gilead: Other: Financial or material support, Research Funding; Alexion: Consultancy, Research Funding, Speakers Bureau; Apellis: Consultancy, Research Funding, Speakers Bureau; AstraZeneca: Consultancy, Speakers Bureau; Pharmacyclics: Other: Financial or material support, Research Funding; Janssen: Consultancy, Other: Financial or material support, Research Funding, Speakers Bureau. Szer:Prevail Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Apellis: Consultancy; Takeda: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Weitz:Apellis: Consultancy, Honoraria; Alexion: Consultancy, Honoraria, Speakers Bureau. Röth:Biocryst: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Apellis: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria, Research Funding. Hoechsmann:Alexion: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Apellis: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Panse:Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Apellis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; F. Hoffmann-La Roche Ltd: Consultancy, Membership on an entity's Board of Directors or advisory committees; MSD: Consultancy, Membership on an entity's Board of Directors or advisory committees; Grunenthal: Consultancy, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Chugai: Speakers Bureau; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Blueprint Medicines: Consultancy, Membership on an entity's Board of Directors or advisory committees. Usuki:Apellis: Research Funding; Chugai: Research Funding; Novartis: Research Funding, Speakers Bureau; Alexion: Research Funding, Speakers Bureau. Griffin:Biocryst: Membership on an entity's Board of Directors or advisory committees; Alexion Pharmaceuticals: Honoraria, Other: Conference Support. Kiladjian:Novartis: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; AOP Orphan: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees. de Castro:Biocryst: Honoraria, Other: Data monitoring committee; Novartis: Honoraria, Other: Steering committee; Alexion: Honoraria, Research Funding; Apellis: Consultancy, Honoraria, Research Funding. Tan:Apellis: Consultancy, Patents & Royalties. Hamdani:Apellis: Current Employment, Current equity holder in publicly-traded company. Deschatelets:Apellis: Current Employment, Current equity holder in private company, Patents & Royalties. Francois:Apellis: Current Employment, Current equity holder in private company, Patents & Royalties. Grossi:Apellis: Current Employment, Current equity holder in private company, Patents & Royalties. Risitano:Jazz: Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees; Samsung: Membership on an entity's Board of Directors or advisory committees; Amyndas: Consultancy; RA pharma: Research Funding; Biocryst: Membership on an entity's Board of Directors or advisory committees; Apellis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Achillion: Membership on an entity's Board of Directors or advisory committees; Pfizer: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alnylam: Research Funding; Alexion: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Peffault De Latour:Apellis: Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. OffLabel Disclosure: Pegcetacoplan is an investigational drug for the treatment of paroxysmal nocturnal hemoglobinuria.
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Andreiko, L. V., D. O. Medvedovska, and Yu A. Skarloupina. "Sociolinguistic perspective on varieties of English: implications for teaching." Bulletin of Luhansk Taras Shevchenko National University, no. 7 (345) (2021): 161–69. http://dx.doi.org/10.12958/2227-2844-2021-7(345)-161-169.
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The article explores the issue of language standardisation and sociolinguistic roots of varieties of English. It answers the question why some varieties of the English language become recognised as „standard” whereas other varieties are regarded as less prestigious or inferior and advocates the importance of sociolinguistic competence for teachers. Two models of language standardisation (the „popular” and the „expert” model) are critically discussed, providing a detailed explanation of the process of language standardisation and the formation of standard language ideology. The most frequently described variety of English in the UK, the Received Pronunciation, is described in greater detail, tracking down the reason why it has become recognised as the "standard" variety. A strong standard ideology with World Englishes and the current position of regional variations of English as its „deficient” or „fossilized” versions is discussed. The notions of language system and language use are considered in relation to the superiority or inferiority of different varieties. It has been shown that the social component is pivotal in understanding why certain varieties are regarded as less prestigious or inferior despite having equally rich and complex language systems. Such factors as stereotypes and ownership have an impact on their status too. The article proceeds to the discussion of implications of these sociolinguistic aspects for teaching. The importance of teachers' critical awareness of sociolinguistic realities is emphasised. Such benefits of raising students' awareness of varieties of English are presented: avoiding or reducing misunderstandings and misinterpretations in foreign language communication, recognising linguistic and cultural diversity, demonstrating relevance to real-life situations. Specific examples of practising language varieties are given.
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Han, Yijia. "What role does object detection play in autonomous driving?" Advances in Engineering Innovation 10, no. 1 (2024): 76–84. http://dx.doi.org/10.54254/2977-3903/10/2024105.
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Deep learning-based object detection algorithm is becoming more and more important in autonomous driving area with an increasing amount and trending these days. This article first provides definitions and introduces an autonomous driving and object detection. Subsequently, a detailed discussion is conducted on object detection, comparing traditional object detection methods with deep learning object detection algorithms. The shortcomings of traditional methods highlighted the advantages of deep learning-based object detection algorithms, laying the groundwork for the use of deep learning object detection algorithms in the following text. Finally, several detection objects and detection scenarios are introduced. The detection objects are divided into different parts, including moving targets, stationary targets, and infrared targets. Moving targets such as pedestrians and vehicles, while stationary targets include traffic signs and lanes. The detection scenarios are classified into ordinary scene detection and complex scene detection. In the discussion section, the commonly used datasets for autonomous driving target detection training are listed first, such as the KITTI dataset, the COCO dataset, and so on. Subsequently, a discussion was conducted on algorithms, mainly focusing on the models and features in one stage and two stages. For different types of algorithms, this article discusses the advantages and disadvantages of the algorithms. When judging the superiority or inferiority of algorithms, there are usually two aspects: detection accuracy and detection speed. FPS is a commonly used indicator for detection speed, and detection accuracy mainly covers five aspects, namely accuracy, precision, recall, AP (average precision), and MAP (mean average precision). Finally, how the improved algorithms are applied and solve the existing problems is discussed.
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Ulf, Christoph. "The Impact of Power on Contact Zones and Receptivity." Ancient Civilizations from Scythia to Siberia 26, no. 2 (2020): 243–56. http://dx.doi.org/10.1163/15700577-12341370.
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Abstract The concept of contacts zones, as developed in Ulf 2009, employs differentiating factors to embed the actors involved in the transfers of goods and ideas in their cultural and socio-political environments. Power exerted between people who transfer goods and ideas and those who receive them, is decisive for how receptivity is shaped by their recipients. To discover where power is situated in the complex processes of intercultural interactions, this paper leads attention to the societal characteristics that have an impact on the cultural actors. Referring to the change from the Greek enoikismoi within the scattered settlements of the local population(s) in the hinterland between the Gulf of Taranto and Brindisi to the emergence of recognizable Greek settlements along the coastline from the 8th to the 7th century BC, the example of the feast is chosen to highlight the accompanying change of the scale of power and its exertion. In the terminology of contact zones, a dense contact zone lacking a dominant partner turns into a Middle Ground. From the definition of the various contact zones derives, that the receptivity changed from free adaptation of so far unknown cultural elements to their own intentions and needs to conscious and intentional misunderstandings of the other’s cultural forms and behaviour to gain advantage over the exchange partner. Thus power is a growing factor in their relationship and becomes the more important when the Middle Ground is replaced by a dense zone of contact where one partner is able to dominate. Thereby, it becomes clear that the relationships in cultural transfers are not tied up with ethnic conditions or cultural superiority and inferiority, but determined by the type of contact zones which in turn are characterized by the tools of power involved.
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Lyle, Elysha, Jacob T. Jarreau, Matthew Sanders, et al. "121 A Retrospective, Non-inferiority Treat-at-Home Study Utilizing a Surfactant-based Dressing for Partial-thickness Burn Wounds (HOME)." Journal of Burn Care & Research 45, Supplement_1 (2024): 98–99. http://dx.doi.org/10.1093/jbcr/irae036.120.
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Abstract Introduction Partial thickness (PT) burn injuries are the most common depth of burn seen in the emergency department. While some deep partial thickness injuries will eventually require surgery, the many PT wounds can be successfully managed as an outpatient, given immediate care, education, and supplies. The primary hypothesis was a treat-at-home (TH) strategy, particularly with a surfactant-based dressing (WSD), would result in no greater risk of requiring surgical intervention for PT wounds. Second, we hypothesized there to be a bias toward surgery in the admitted patients. Lastly, a TH strategy results in significant cost savings. Methods This single-center, retrospective study was dual IRB approved and included all patients treated in the burn center emergency department (ED) between May 2019 and May 2023. Patients were excluded for having superficial burns, full-thickness (FT) burns, electrical burn, lack of burn, less than 18 years old, pregnant or incarcerated, or not expected to survive. The years were chosen based on sample size analysis and estimated ED visits. The planned enrollment was designed to fulfill non-inferiority and potential superiority of surfactant-based dressing versus any another TH strategy. Chi-square test was used to determine a difference in number admitted for subsequent surgery. Sigmaplot 15.0 was used for statistical analysis. Results Two-thousand forty-seven patients were screened. After exclusions, 1,458 patients were included in the study group (Figure 1) with two-thirds in the TH group. About half were sent home with WSD vs another dressing (CTL). There were no differences in age, sex, race, medical history, or mechanism of burn. The CTL patients were more likely to be cocaine positive and have a burn involving the head / neck. WSD had larger burns and more likely to have deep PT and extremity burns, and a longer delay from injury. Few in WSD and CTL required subsequent admission for surgery [5 (1.0%) vs 2 (0.4%)]. Although, CTL had significantly more not return for follow up [153 (31.3%) vs 239 (46.7%)]. Patients admitted from the ED were more likely to be older, male, Caucasian, complex medical and social history, inhalation injury, presence of deep PT and larger burns, transfer from another facility, and present with infection. For those admitted, only 36.8% received surgery with a 3 day median time to first operation. The median length of stay for patients not requiring surgery was 1 day. Assuming the presence of social barriers in 1/3 and only considering bed cost, allowing capable patients with PT to treat-at-home would save an estimated annual $3.4 million. Conclusions This is the largest study to evaluate the use of WSD for immediate treatment of PT burns to avoid admission. No matter the choice of home wound treatment, few required subsequent admission for surgery. A TH model could result in millions of dollars of savings. Applicability of Research to Practice A treat-at-home model could save the millions of dollars for patients and hospitals
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Dr.Ohm, Shrivastava. "Voices against the Structure of Caste in Mulk Raj Anand's Untouchable." Voices against the Structure of Caste in Mulk Raj Anand's Untouchable 9, no. 1 (2024): 367–74. https://doi.org/10.36993/ RJOE.2024.9.1.374.
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The structure of caste is so rigid in Indian society that it seems impossible to deconstruct it in the society. All the forms of intellectual movements have failed to eliminate it in society. It has become the mental concept of the people. We live in caste. We die in caste. The caste governs all our social activities. Our humanity is hidden behind the caste. Primarily, we are the caste; secondary, we are human beings. The Hindu religion makes its structure. The work decided it, but later on, it was decided by the birth. The caste decides purity and quality. Generally, it is considered in our society that if one is born into the upper caste, he or she may be a pure and qualitative person; if one is born into the lower caste, he or she may be impure, and he or she may be a less qualitative person. It is said that as you think, as you become. It said through the religion that upper castes are born to rule over the lower castes people and lower castes are born to serve the upper castes people, and this religion has constructed such a rigid structure that it has become a weapon for the politicians for the vote bank. These ideologies rule over all other ideologies. It has made a person king and a person animal. Castes decide everything in society. It has given a superiority complex to upper castes people and an inferiority complex to lower castes. It has given such kind of psychology to the people that one thinks that I am born for this work and I am born for this work. It is said that as you think, as you become. Progressiveness cannot come if you stop thinking or confine yourself to a thinking parameter. Through this paper, an attempt has been made to discuss that Mulk Raj Anand was the first writer to attack issues of caste and class through his works.
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Zali, Kourosh. "Non-inferiority trials and non-inferiority margin: an overview." Int J Epidemiol Health Sci 1 (November 15, 2020): e4. https://doi.org/10.51757/IJEHS.1.4.2020.46956.
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The randomized controlled trial (RCT) is considered the best interventional design to assess issues related to treatment and prevention. The RCTs can have different designs including superiority, equivalence, or non-inferiority design. A superiority trial aims to detect the potential superiority of new therapy compared to an active comparator or a placebo, an equivalence trial tends to demonstrate that a new therapy is an equivalent (within margins) to its active comparator, and a non-inferiority trial (NIT) is going to show that the new therapy is not worse than the comparator, as a typical active drug. Increasingly, major trials are conducted to see if the efficacy of a new treatment is as good as a standard treatment. The new treatment usually has some other advantages (e.g., fewer side effects, ease of administration, lower cost), making it worthwhile to demonstrate non-inferiority in respect to efficacy. Thus, NIT is going to determine whether a new treatment is not worse than a reference treatment by more than an acceptable amount. Among the challenges of NITs compared with superiority, trials are the choices of the non-inferiority margin (NIM), the primary population for analysis, and the comparator treatment considering several choices for the comparator arm in an NIT. This article is going to review the current knowledge about NIM.
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Sormani, Maria Pia. "Why non-inferiority is more challenging than superiority?" Multiple Sclerosis Journal 23, no. 6 (2017): 790–91. http://dx.doi.org/10.1177/1352458517703805.
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Demonstrating non-inferiority in clinical trials is usually more challenging than showing superiority. In multiple sclerosis (MS), non-inferiority trials are rarely designed since they would require prohibitive sample sizes. In this brief report, the reasons why non-inferiority trials are usually larger than superiority trials is explored.
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Xu, Junjie, Yufeng Li, Zipeng Ye, et al. "Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model." American Journal of Sports Medicine 50, no. 1 (2021): 195–207. http://dx.doi.org/10.1177/03635465211053334.
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Background: There is an ongoing debate on the treatment of bursal-sided partial-thickness rotator cuff tears (PTRCTs), including ideal repair techniques. Augmentation using a collagen patch has been introduced as a new surgical approach to treat PTRCTs, while the effect of autogenous biceps augmentation (BA) has not been investigated. Purpose: To analyze the effects of BA on bursal-sided PTRCTs and compare its histological and biomechanical results with those of tear completion followed by repair and in situ repair (ISR). Study Design: Controlled laboratory study. Methods: Unilateral chronic PTRCTs were created in 96 mature New Zealand White rabbits, which were randomly divided into 4 groups: no repair, tear completion repair (TCR), ISR, and BA. A new bicipital groove was fabricated in BA for the biceps tendon that was transferred to augment the bursal-sided PTRCT repair. In each group, we sacrificed 6 rabbits for biomechanical testing of the whole tendon-to-bone complex (WTBC) and 6 for histological evaluation of bursal- and articular-sided layers at 6 and 12 weeks postoperatively. Healing responses between the biceps and new bicipital groove in the BA group were determined using histological analysis, and final groove morphologies were evaluated using micro–computed tomography. Results: The remaining tendon and enthesis in bursal-sided PTRCTs progressively degenerated over time. WTBCs of ISR exhibited a larger failure load than those of TCR, although better healing properties in the bursal-sided repaired site were achieved using TCR based on histological scores and superior articular-sided histological scores were observed using ISR. However, WTBCs of BA displayed the best biomechanical results and superior histological scores for bursal- and articular-sided regions. The new bicipital groove in BA remodeled over time and formed similar morphologies to a native groove, which provided a mature bone bed for transferred biceps tendon healing to augment bursal-sided PTRCTs. Conclusion: BA achieved better biomechanical and histological results for repairing bursal-sided PTRCTs as compared with TCR and ISR. When compared with that of TCR, the WTBC of ISR exhibited a higher failure load, showing histological superiority in the articular-sided repair and inferiority in the bursal-sided repair. Clinical Relevance: BA may be an approach to improve bursal-sided PTRCT repair in humans, which warrants further clinical investigation.
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Cipriani, Andrea, Francesca Girlanda, and Corrado Barbui. "Superiority, equivalence or non-inferiority?" Epidemiology and Psychiatric Sciences 18, no. 4 (2009): 311–13. http://dx.doi.org/10.1017/s1121189x00000269.
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AbstractOne of the most important critical decision to be taken when designing a randomized controlled trial (RCT) in clinical psychopharmacology is the choice of the comparator. This choice is crucial because it affects many issues related to both internal and external validity. The aim of a RCT may be to establish efficacy in absolute terms, against an inert treatment (usually a placebo), or to establish efficacy with respect to another treatment (also known ascomparator), a trial may be designed to demonstrate that the new drug is superior to the control intervention or, by contrast, that the new drug is similar to the control intervention in terms of, say, symptoms' reduction. Three kinds of RCTs may be designed: Superiority trials, Equivalence studies, Non-inferiority studies.
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Murray, Gordon D. "Switching between superiority and non-inferiority." British Journal of Clinical Pharmacology 52, no. 3 (2001): 219. http://dx.doi.org/10.1046/j.0306-5251.2001.01397.x.
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Leung, James T., Stephanie L. Barnes, Sidney T. Lo, and Dominic Y. Leung. "Non-inferiority trials in cardiology: what clinicians need to know." Heart 106, no. 2 (2019): 99–104. http://dx.doi.org/10.1136/heartjnl-2019-315772.
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Clinical trials traditionally aim to show a new treatment is superior to placebo or standard treatment, that is, superiority trials. There is an increasing number of trials demonstrating a new treatment is non-inferior to standard treatment. The hypotheses, design and interpretation of non-inferiority trials are different to superiority trials. Non-inferiority trials are designed with the notion that the new treatment offers advantages over standard treatment in certain important aspects. The non-inferior margin is a predetermined margin of difference between the new and standard treatment that is considered acceptable or tolerable for the new treatment to be considered ‘similar’ or ‘not worse’. Both relative difference and absolute difference methods can be used to define the non-inferior margin. Sequential testing for non-inferiority and superiority is often performed. Non-inferiority trials may be necessary in situations where it is no longer ethical to test any new treatment against placebo. There are inherent assumptions in non-inferiority trials which may not be correct and which are not being tested. Successive non-inferiority trials may introduce less and less effective treatments even though these treatments may have been shown to be non-inferior. Furthermore, poor quality trials favour non-inferior results. Intention-to-treat analysis, the preferred way to analyse randomised trials, may favour non-inferiority. Both intention-to-treat and per-protocol analyses should be recommended in non-inferiority trials. Clinicians should be aware of the pitfalls of non-inferiority trials and not accept non-inferiority on face value. The focus should not be on the p values but on the effect size and confidence limits.
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Aberegg, Scott K., Andrew M. Hersh, and Matthew H. Samore. "Do non-inferiority trials of reduced intensity therapies show reduced effects? A descriptive analysis." BMJ Open 8, no. 3 (2018): e019494. http://dx.doi.org/10.1136/bmjopen-2017-019494.
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ObjectivesTo identify non-inferiority trials within a cohort where the experimental therapy is the same as the active control comparator but at a reduced intensity and determine if these non-inferiority trials of reduced intensity therapies have less favourable results than other non-inferiority trials in the cohort. Such a finding would provide suggestive evidence of biocreep in these trials.DesignThis metaresearch study used a cohort of non-inferiority trials published in the five highest impact general medical journals during a 5-year period. Data relating to the characteristics and results of the trials were abstracted.Primary outcome measuresProportions of trials with a declaration of superiority, non-inferiority and point estimates favouring the experimental therapy and mean absolute risk differences for trials with outcomes expressed as a proportion.ResultsOur search yielded 163 trials reporting 182 non-inferiority comparisons; 36 comparisons from 31 trials were between the same therapy at reduced and full intensity. Compared with trials not evaluating reduced intensity therapies, fewer comparisons of reduced intensity therapies demonstrated a favourable result (non-inferiority or superiority) (58.3%vs82.2%; P=0.002) and fewer demonstrated superiority (2.8%vs18.5%; P=0.019). Likewise, point estimates for reduced intensity therapies more often favoured active control than those for other trials (77.8%vs39.7%; P<0.001) as did mean absolute risk differences (+2.5% vs −0.7%; P=0.018).ConclusionsNon-inferiority trials comparing a therapy at reduced intensity to the same therapy at full intensity showed reduced effects compared with other non-inferiority trials. This suggests these trials may have a high rate of type 1 errors and biocreep, with significant implications for the design and interpretation of future non-inferiority trials.