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Yesterday, the Organisation for Economic Co operation and Development (OECD), a 34 member international economic organization founded in 1961 that traces its origins back to the World War II era Marshall Plan, published results on the state of adult skills in 24 countries, most of them European. Compared to other countries surveyed, Japan ranks as one of the best performing surveyed countries in both literacy and numeracy.

The piston is connected to the crankshaft by a connecting rod. As the crankshaft revolves, it has the effect of “resetting the cannon.” Here’s what happens as the engine goes through its cycle:The piston starts at the top, the intake valve opens, and the piston moves down to let the engine take in a cylinder full of air and gasoline.

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to treatment has been espoused as a judicial concept since a British case in 1767.1 In that case the physician initially set the patient’s femoral fracture in accordance with practice at the time but at a follow up visit rebroke the healing fracture and placed the rebroken bone in a mechanical device with teeth. Physicians called into court to testify reported that physicians usually secured their patients’ consent before embarking on a medical intervention, but there was little said in the judge’s written opinion about what should be said to patients before an experimental intervention, as opposed to a clinical intervention. The judge concluded that

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IntroductionSample size varies greatly among trials, ranging from tens of patients to thousands of patients,1 even within a meta analysis investigating the same question. For example, a meta analysis in cardiology2 included trials with sizes ranging from 62 patients to 45852 patients. Our knowledge about the influence of trial sample size on treatment effect estimates is based on the small study effect the tendency for small trials to report greater treatment benefits than large trials in the same meta analysis.3 4 5 A study based on a collection of meta analyses in osteoarthritis showed that trials including fewer than 100 patients per arm yielded, on average, greater treatment effect estimates than did larger trials.6