Introduction true vertigo is a type of vertigo identifie

1. Introduction
True vertigo is a type of vertigo identified by failing to
sense gravity and spinning feeling. The patient might
have hallucinations of self or surroundings’ motion
(Marple and Meyerhoff, 1998). Currently, there are
various methods for treating patients with vertigo such
as drug, surgery, and vestibular rehabilitation (Gananca
et al., 2002; Girardi and Konrad, 2005). Treatments in
the emergency department are symptomatic and aim to
eliminate vertigo and other accompanying symptoms
(Kerber, 2009).
Diazepam as a benzodiazepine compound plays a
major role in treatment of disorders with central origin.
It has also been effective in vertigo treatment as shown
in various studies. This drug, as a gamma-aminobutyric
acid (GABA) receptor regulator, centrally leads to
inhibition of vestibular response. In low doses, this
drug is very effective and beneficial. However, its
addictiveness, bringing about memory problems, and
increasing the chance of falling for the patient are
among the limitations of its consumption. These might
be the reasons that researchers are looking for
replacement methods and treatments (Tan et al., 2014).
Antihistamine, anticholinergic, and anti-nausea drugs
have been suggested for this purpose (Hain and Uddin,
2003; Hain and Yacovino, 2005).
On the other hand, hyoscine is one of the oldest

2. medicines. This drug is extracted from a plant called
henbane from the family of Solanaceae. Hyoscine is an
anticholinergic, antispasmodic, analgesic and sedative
drug that exerts its relaxing effect directly on smooth
muscles. In addition to its peripheral anticholinergic
activities, this drug also affects the central nervous
system and has a slow but long sedative effect on the
brain (King et al., 2014; Renner et al., 2005). Hyoscine is
one of the most commonly used drugs for motion
sickness and it has been suggested that it might also be
effective in treating or decreasing vertigo symptoms. A
systematic review showed that very few studies have
been carried out to assess the role of hyoscine in
treatment of balance disorders and the existing
A Journal of the Bangladesh Pharmacological Society (BDPS)
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Abstract
The present study was a double-blind clinical trial to compare
the efficiency
of hysocine and diazepam in vertigo treatment. Eligible patients
(n=69) were

3. randomly divided into 2 groups of 5 mg hyoscine and 10 mg
diazepam.
Severity of vertigo was measured in supine and sitting position,
and while
turning the head. Vertigo severity was assessed before, and 1
and 2 hours
after administration of the drug. Treatment success rate of
diazepam in
relieving vertigo in different positions varied between 88.9 and
100%, while
this rate was 31.2–73.5% in hyoscine treatment group (p<0.01).
Prescription of
diazepam led to complete relief of vertigo in 40–63% of the
patients, while this
rate was only 2.6–12.5% in hyoscine treatment group (p<0.001).
It is likely that
diazepam is a better option than hyoscine for management of
true vertigo in
patients presenting to the emergency department.
Article Info
Received: 13 October 2016
Accepted: 16 March 2017
Available Online: 3 April 2017
DOI: 10.3329/bjp.v12i2.29962
Cite this article:
Kariman H, Vajihi F, Amini A, Shah-
rami A, Arhami-Dolatabadi A, Sho-
jaee M, Baratloo A. Hyoscine versus
diazepam for the management of true
vertigo in the emergency department.
Bangladesh J Pharmacol. 2017; 12: 95-

4. 100.
Hyoscine versus diazepam for the management of true vertigo in
the emergency department
Hamid Kariman1, Firoozeh Vajihi1, Afshin Amini1, Ali
Shahrami1, Ali Arhami-Dolatabadi1,
Majid Shojaee1 and Alireza Baratloo2
1Department of Emergency Medicine, Imam Hossein Hospital,
Shahid Beheshti University of Medical Sciences, Tehran,
Iran; 2Department of Emergency Medicine, Sina Hospital,
Tehran University of Medical Sciences, Tehran, Iran.
C
lin
ic
al
T
ri
al
This work is licensed under a Creative Commons Attribution 4.0
International License. You are free to copy, distribute and pe r -
form the work. You must attribute the work in the manner
specified by the author or licensor
evidence and conclusions regarding effectiveness of this
drug in reducing vertigo symptoms and motion

5. sickness are mostly based on animal studies and second
or third class evidence. As a result, they had suggested
carrying out more studies in this field (Spinks et al.,
2011). Therefore, the present clinical trial was designed
aiming to evaluate the effectiveness of hyoscine com-
pared to diazepam in management of true vertigo in
patients presenting to the emergency department.
Materials and Methods
Study design and setting
The present study is a double-blind clinical trial
performed during 6 months, from March 2015 to
September 2015, in Imam Hossein Hospital, Tehran,
Iran. The main goal of the study was comparing the
effectiveness of hyoscine with 5 mg dose and 10 mg
diazepam in managing and relieving vertigo.
Participants
All patients over 18 years old with complaint of vertigo,
who were categorized as true vertigo cases based on
clinical definition were included in the study. Receiving
prophylaxis treatment with vertigo reducing drugs,
allergy to hyoscine or diazepam, pregnancy, lactating,
renal failure, and recent visit to the hospital were
considered as exclusion criteria.
Sample size
To determine sample size the formula for comparing
means in analysis of repeated measures was used.
Considering the results of previous studies, sample size
for finding significant difference in mean response of

6. the 2 groups after drug treatment with a test power of
90% ( =0.9), type 1 error of 5% ( =0.05), combined
standard deviation of 18, individual observation
correlation of 0.8 (rho=0.8) and correlation structure of 1
for individual observation was estimated to be 21
patients in each group using the formula. This number
was multiplied by 20% probability of loss to reach the
final sample size of 26 patients in each group.
Randomization and blinding
Solution
s were prepared by an emergency medicine
specialist that did not participate in the process of
evaluation and prescription of drugs. They were placed
in similar packs covered by aluminum foil. The
solutions were anonymous and both were diluted in 10
mL distilled water. The solution containing hyoscine
was named pack A, and the one containing diazepam
was named pack B. It should be noted that the compo-
sition of packs was confidential until the end of the
study. To ensure double blinding of the study, prepa-
ring solutions and drug injection and recording the
results were done by 2 separate physicians. Information

7. regarding the administered drug was only revealed
when adverse side effects or other clinical changes were
seen in a patient that needed knowledge of the
administered drug.
In the present study, randomization was done using
random numbers table. For this purpose, each patient
was given a number; if the number was odd, pack A
was administered and if it was even, pack B was used.
Intervention
Initially, demographic data and baseline characteristics
including age, sex, history of using drugs, duration of
vertigo and history of vertigo were recorded. Patients
were also questioned about accompanying symptoms
including nausea, vomiting, hearing loss, tinnitus, ear
fullness, double vision, blurred vision, dysarthria,
dysphagia, hypoesthesia, paresthesia, and weakness of
one side of the face and extremities. There were also
questions regarding the characteristics of vertigo
including it being spinning or not, its central or
peripheral origin and estimated duration of vertigo.
Presence and direction of nystagmus were other
studied factors. This category was defined in 5 levels of

8. nystagmus free, horizontal, vertical, and rotary
nystagmus, and other. In addition, before prescription
of drug, the patients’ feeling of vertigo was evaluated in
supine position, while sitting and while turning their
head to one side. After gathering baseline
characteristics and demographic data, patients were
divided into 2 groups of 5 mg hyoscine and 10 mg
diazepam using a random numbers table. After
administration of drug, 500 mL normal saline was
prescribed for the patients.
Outcome
Severity of vertigo was classified as no vertigo, mild,
moderate, and severe vertigo. In the present study, at
least 1 level improvement or relief of vertigo was
defined as successful treatment. The patients’ vertigo
sensation was re-evaluated in supine and sitting
positions and while turning their head to one side in the
first and second hour of drug administration. Probable
side effects of the drugs were monitored since injection
until 2 hours after administration. They were recorded
based on patient’s report and clinical appearance. After
2 hours of follow-up, if vertigo was relieved, the patient
was discharged with approval of the in-charge

9. physician. In case of unsuccessful treatment, rescue
medication was prescribed by the in-charge physician.
Statistical analysis
Data were entered to SPSS 21 and were analyzed using
STATA 11.0 software. Severity of vertigo and accom-
panying symptoms of the patient on admission, and 1
and 2 hours after treatment initiation were reported as
frequency and percentage. To evaluate the age differ-
ence between the 2 groups, t-test was applied. Duration
96 Bangladesh J Pharmacol 2017; 12: 95-100
of vertigo was compared using Mann-Whitney test. To
compare other baseline characteristics and
demographic data of the patients between the groups
on admission, Chi-squared or Fisher’s exact tests were
used. Non-parametric chi-squared for trend test and
Kaplan-Meier curve were used for comparing the trend
of treatment success between hyoscine and diazepam
groups in the first and second hours after treatment. For

10. this purpose, at least 1 level improvement in vertigo
severity was considered as successful treatment. In
another part, to be sure of the findings and approve the
analyses, treatment success was considered complete
relief of vertigo and findings were separately reported
in tables and figures. In all analyses, p<0.05 was
considered as significance level.
Ethics
Protocol of this study was assessed by the Ethics
Committee of the Shahid Beheshti University of Medi-
cal Sciences and was given the code number
IR.SBMU.SM.REC.1394.134. Patients voluntarily partici-
pated in the study and informed written consent was
obtained from them. Throughout the study, the
researchers adhered to declaration of Helsinki princi-
ples. Protocol of the study was registered on the Iranian
registry of clinical trials located at www.irct.ir under
the code number IRCT2016100815640N5.
Results
Demographic and baseline findings

11. Finally, 69 patients with the mean age of 55.4 ± 15.7
years (age range: 21-80 years) were included in the
study (68.1% female). 39 patients were treated with
hyoscine and 30 received diazepam. CONSORT
flowchart of studied patients was showed in Figure 1.
Table I shows demographic data and baseline
characteristics of the studied patients and the findings
of clinical examinations based on the groups. According
to the results, there was no significant difference
between mean age of the patients (p=0.57) and their sex
distribution (p=0.18). History of vertigo, characteristics
and type of vertigo, its duration, direction of
nystagmus, and accompanying symptoms were also
similar between the 2 groups (p>0.05).
Treatment effectiveness in supine position
Presence of vertigo in supine position did not show a
significant difference between the 2 groups (p=0.18).
Considering at least one level improvement, after 1
hour, 4 patients in hyoscine group and 12 in diazepam
group reported improvement in supine position
vertigo. These counts were 5 and 16 patients,
respectively, 2 hours after treatment initiation. Non-

12. parametric Chi-squared for trend test
showed that success rate was significantly
higher in diazepam group compared to
hyoscine treatment group (p<0.001).
Complete relief of vertigo was seen in 1 case
after hyoscine treatment and 4 after
diazepam administration in the first hour.
After 2 hours, these values were 2 and 11
patients, respectively (p=0.001).
Treatment effectiveness in sitting position
Presence of vertigo in sitting position on
admission did not show a significant differ-
ence between the 2 groups on admission
(p=0.99). Considering at least 1 level
improvement in vertigo in sitting position,
after 1 hour, 26 patients in hyoscine group
and 27 in diazepam group reported feeling
better regarding vertigo. These values were
30 and 29 patients, respectively, after 2
hours. Non-parametric Chi-squared for
trend test showed that success rate was
significantly higher in diazepam group
compared to hyoscine treatment group

13. (p=0.02). Hyoscine administration could
completely relieve vertigo in sitting position
in the first hour. However, 2 hours after
injection, vertigo was completely relieved
for 1 patient in hyoscine group and 12
patients in diazepam group (p=0.001).
A
llo
ca
tio
n
F
ol
lo
w
-
up
A

14. na
ly
si
s
E
nr
ol
lm
en
t
Hyoscine
Allocated to intervention (n = 39)
Received allocated intervention (n
= 0)
Did not receive allocated interven-
tion (n = 0)

15. Lost to follow-up (n = 0)
Discontinued intervention
(n = 0)
Excluded (n = 2)
Refused to participate (n = 4)
Randomized (n = 69)
Assessed for eligibility (n = 75)
Diazepam
Allocated to intervention (n = 30)
Received allocated intervention (n
= 0)
Did not receive allocated interven-
tion (n = 0)
Analyzed (n = 39)

16. Excluded from analysis
(n = 0)
Lost to follow-up (n = 0)
Discontinued intervention
(n = 0)
Analyzed (n = 30)
Excluded from analysis
(n = 0)
Figure 1: CONSORT flowchart of studied patients
Bangladesh J Pharmacol 2017; 12: 95-100
97
http://www.irct.ir
Treatment effectiveness while turning the head

17. Presence of vertigo while turning the head did not
show a significant difference between the 2 groups on
admission (p=0.78). Considering at least 1 level
improvement in vertigo while turning the head, after 1
hour 21 patients in hyoscine group and 21 in diazepam
group reported feeling improvement in their vertigo.
These values were 25 and 27 patients, respectively, after
2 hours. Non-parametric Chi-squared for trend test
showed that success rate was significantly higher in
diazepam group compared to hyoscine treatment group
(p=0.03). Hyoscine administration could not completely
relieve vertigo for any patients in the first hour.
However, diazepam administration led to complete
relief of 3 patients during this time. In addition, 2 hours
after drug administration vertigo was completely
relieved in 4 patients in hyoscine group and 17 cases in
diazepam group.
Table II depicts the results in terms of effectiveness of
hyoscine and diazepam administration in treatment of
vertigo in supine position, in sitting position and while
turning the head. Figure 2 presents complete vertigo
relief failure rate of hyoscine and diazepam in treating
vertigo in various positions.

18. Side effects
In evaluation of treatment side effects, follow -up did
not reveal any side effect of drug administration.
Discussion
Findings of the present study showed that efficiency of
diazepam is significantly higher than hyoscine in
treatment of vertigo and its symptoms. Treatment
success rate of diazepam in relieving vertigo in
different positions varied between 88.9 and 100%, while
this rate was 31.2–73.5% in hyoscine treatment group.
Prescription of diazepam led to complete relief of
vertigo in 40–63% of the patents, while this rate was
only 2.6–12.5% in hyoscine treatment group.
Although hyoscine, as an anticholinergic drug, has been
used for a long time and in various clinical settings,
effectiveness of this drug in controlling true vertigo has
been evaluated in few studies. For instance, a syste-
Table I

19. Demographic data and baseline characteristics
Variable Hyoscine
(n = 39)
Diazepam
(n = 30)
P
Age (year) 54.5 56.6 0.57
Sex
Female 24 23 0.18
Male 15 7
History of underlying
illness
17 14 0.80
History of vertigo 3 2 0.99a

20. Vertigo characteristic
Spinning 36 24 0.16a
Non-spinning 3 6
Type of vertigo
Central 9 10 0.34
Peripheral 30 20
Duration of vertigo
(hours)
4 3.5 0.99b
Vertigo symptoms
Nausea 34 27 0.99a

21. Vomiting 31 25 0.76a
Dysarthria 2 2 0.99a
Dysphagia 1 0
Hyposthesia 1 0
Tinnitus 0 1
Nystagmus
No 4 6 0.50a
Horizontal 31 21
Horizontal-vertical 4 3
aBased on Fisher’s exact test; bbased on Mann-Whitney test
Analysis time
0 1 2 3

22. Kaplan-Meier failure estimates A
1.00
0.75
0.50
0.25
0.00
Number at risk
Hyscine 16 15 14 14
Diazepam 18 14 7 7
Hyoscine Diazepam
Time (hour)
B

23. Number at risk
Hyscine 39 39 36 36
Diazepam 30 30 18 18
Hyoscine Diazepam
Kaplan-Meier failure estimates
1.00
0.75
0.50
0.25
0.00
Time (hour)
C

24. Number at risk
Hyscine 34 34 30 30
Diazepam 27 24 10 10
Hyoscine Diazepam
Kaplan-Meier failure estimates
1.00
0.75
0.50
0.25
0.00
0 1 2 3 0 1
2 3

25. Figure 2: Complete vertigo relief failure rate of hyoscine and
diazepam in treating vertigo in supine position (A), in sitting
position
(B), and while turning the head (C)
98 Bangladesh J Pharmacol 2017; 12: 95-100
matic review on 35 studies in 2011 aiming to assess the
efficacy of transdermal hyoscine in motion sickness
symptom relief showed that although this drug is
effective in relieving the symptoms of this problem, all
the evidence obtained are level 2 and 3 evidence and
this makes it hard to reach a final decision regarding
use of this drug in treating vertigo and motion sickness
(Spinks et al., 2011). Even three decades ago, Rahko and
Karma also attempted to evaluate treatment value of
transdermal hyoscine in treatment of peripheral vertigo
in 30 patients. This study showed that using this treat-
ment brings about desirable outcome in reducing symp-
toms of Menier’s disease. However, the researchers
stated that blurred vision and dry mouth are observed

26. side effects of this drug. Finally, they concluded that
transdermal hyoscine could be used as a replacement
option in treatment of peripheral vertigo (Rahko and
Karma, 1985). The reason for the contradicting results
obtained in this study, compared to other studies,
might be the route of administration. All the mentioned
studies had evaluated the effectiveness of transdermal
hyoscine in relieving vertigo symptoms. The effects of
systemic and local administration of a drug might be
significantly different.
Findings of the present study show the acceptable
effectiveness of diazepam in treatment of acute vertigo.
Findings of other studies are also indicative of the same
result. For example, Ganança et al. in their study
showed that clonazepam leads to complete relief of
vertigo in 77.4% of vertigo patients (Gananca et al.,
2002). In another clinical trial lorazepam and
dimenhydrinate were compared for treatment of
vertigo in patients. Findings of the study also confirmed
the effectiveness of lorazepam in vertigo symptom
relief and walking of the patients (Marill et al., 2000).
Although a study by Amini et al. showed that
promethazine is more efficient than lorazepam in

27. treating vertigo, its findings also indicated the effective-
ness of lorazepam in this regard (Amini et al., 2014).
Conclusion
It is likely that diazepam is a better option than
hyoscine for management of true vertigo in patients
presenting to emergency department.
Conflict of Interest
All authors have completed the ICMJE uniform disclosure
form and declare no support from any organization for the
submitted work.
Acknowledgement
The authors appreciate the cooperation of the Emergency
Department staff of Imam Hossein and Shohadaye Tajrish
Hospitals, Tehran, Iran.
Table II

28. Effectiveness of hyoscine and diazepam prescription in
treatment of vertigo in different positions
Variable In supine position In sitting position While turning
the head
Hyoscine
(n = 39)
Diazepam
(n = 30)
p
value
Hyoscine
(n = 39)
Diazepam
(n = 30)
p
value

29. Hyoscine
(n = 39)
Diazepam
(n = 30)
p
value
On admission
None 23 12 0.18a 0 0 0.99a 5 3 0.78a
Mild 10 8 1 1 2 1
Moderate 0 1 1 0 0 0
Severe 6 9 37 29 32 26
An hour after
treatment
None 24 16
---

30. 0 0
---
5 6
---
Mild 10 11 1 10 4 8
Moderate 3 2 27 17 20 12
Severe 2 1 11 3 10 4
Two hours after
treatment
None 25 23
---
3 12
---
9 20

31. ---
Mild 10 6 2 3 4 2
Moderate 0 1 28 14 19 8
Severe 4 0 6 1 7 0
aBased on Fisher’s exact test
Bangladesh J Pharmacol 2017; 12: 95-100
99
Author Info
Firoozeh Vajihi (Principal contact)
e-mail: [email protected]
References
Amini A, Heidari K, Asadollahi S, Habibi T, Shahrami A,
Mansouri B, Kariman H. Intravenous promethazine versus
lorazepam for the treatment of peripheral vertigo in the

32. emergency department: A double blind, randomized clinical
trial of efficacy and safety. J Vestib Res. 2014; 24: 39-47.
Gananca MM, Caovilla HH, Gananca FF, Gananca CF,
Munhoz MS, da Silva ML, Serafini F. Clonazepam in the
pharmacological treatment of vertigo and tinnitus. Int
Tinnitus J. 2002; 8: 50-53.
Girardi M, Konrad H. Imbalance and falls in the elderl y. In:
Otolaryngology: Head and neck surgery. 4th ed. St. Louis,
Elsevier-Mosby, 2005, pp 3319-20.
Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS
drugs. 2003; 17: 85-100.
Hain TC, Yacovino D. Pharmacologic treatment of persons
with dizziness. Neurol Clin. 2005; 23: 831-53.
Kerber KA. Vertigo and dizziness in the Emergency
Department. Emerg Med Clin North Am. 2009; 27: 39.
Kerber KA, Baloh RW. Dizziness, vertigo, and hearing loss. In:
Neurology in clinical practice. Bradley WG. 5th ed.
Burlington, Mass, Butterworth-Heinemann, 2008, pp 50021-
22.

33. King LA, Fortson QCR, Ujvary I, Ramsey J, Nutt DJ.
Scopolamine: Useful medicine or dangerous drug? Sci
Justice. 2014; 54: 321-22.
Marill KA, Walsh MJ, Nelson BK. Intravenous lorazepam
versus dimenhydrinate for treatment of vertigo in the
Emergency Department: A randomized clinical trial. Ann
Emerg Med. 2000; 36: 310-19.
Marple B, Meyerhoff W. Aging and the auditory and vestibu-
lar system. Bailey’s head and neck surgery otolaryngology.
2nd ed. New York, Lippincott-Raven, 1998, pp 2217-19.
Rahko T, Karma P. Transdermal scopolamine for peripheral
vertigo (a double-blind study). J Laryngol Otol. 1985; 99: 653-
56.
Renner UD, Oertel R, Kirch W. Pharmacokinetics and
pharmacodynamics in clinical use of scopolamine. Ther
Drug Monit. 2005; 27: 655-65.
Spinks A, Wasiak J, Bernath V, Villanueva E. Scopolamine
(hyoscine) for preventing and treating motion sickness. The
Cochrane Library. 2011; 15: CD002851.

34. Tan J, Yu D, Feng Y, Song Q, You J, Shi H, Yin S.
Comparative
study of the efficacy of the canalith repositioning procedure
versus the vertigo treatment and rehabilitation chair. Acta
Oto-laryngologica. 2014; 134: 704-08.
100 Bangladesh J Pharmacol 2017; 12: 95-100
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Two (2) Colleagues post :
1st Colleagues post:
Sara DiCostanzo
RE: Discussion - Week 7
COLLAPSE

35. Top of Form
The goal I want to achieve deals with equality and treating
everyone fairly as the value of justice was one of my highest
scores on the personal values survey. I have never been one to
sit back and watch people talk poorly about another person
because they are different from them and my goal is to one day
stop the stereotype conversations from going on in the
department I work in (Tavakoli, 2015). Especially with all the
negative scenes we have seen in the news this past year, it is
time for a positive change to stop the negative comments
because someone may be different than us.
The questions asked during the week six discussion did not have
me question or dig deeper into the goal that I had written.
There were some good questions but none that made me think
differently about my goal or want to modify my goal in
anyway. My goal pertains to the value of justice and one of the
questions asked was whether I think I could be taken advantage
of for the value of humanity where I have a tendency of going
out of my way to help others and not learning to say no
(DiCostanzo, 2021). While humanity and justice can go hand in
hand, I do not see how being taken advantage of will alter or
impact the goal of removing stereotype comments from the
workplace.
One will be to provide additional training to everyone in the
shop to include a question-and-answer session at the end (Kegan

36. & Lahey, 2010). Have human relations be a core presenter as
they tend to focus on ensuring everyone is treated equally and
fairly and they will be able to provide direct guidance from the
policies and procedures that the company already has in place.
Another objective will be an off-site teambuilding day where a
workshop will be set up to have an interactive role play with
pre-setup scripts where the employees will have the ability to
act out a scenario and then discuss the scenario and what parts
would be considered inclusive, diverse, equal, etc.
One measurable milestone will be that the workers,
as well as supervisors, will no longer make comments about
another’s race, gender, religion, sexuality, etc. Also, creating a
survey for the employees to take and measure their
understanding (before and after training) of what can be
considered discrimination/inequality after some training wil l
help in determining if the training is being efficient. A second
measurable milestone will be the number of reports or
complaints to the employee concerns program (ECP) will
decrease from what they are today (DiCostanzo, 2021). I will
document the number of reports to date and after eighteen
months, I will tally up the total reports and see should see a
decrease.
References
DiCostanzo, S. (2021). Discussion – Week 6: Shared Practice:
Values, Principles, Ethics, and Goals for WMBA6000.

37. Kegan, R., & Lahey, L. (2010). Adult development and
organizational leadership. In N. Nohria & R. Khurana
(Eds.), Handbook of leadership theory and practice: A Harvard
Business School centennial colloquium (pp. 769–788). Boston,
MA: Harvard Business Review.
Tavakoli, M. (2015). Diversity & inclusion drive success for
today’s leaders: effective organizations and leaders are those
that recognize diversity and inclusion as essential to business
operations. TD Magazine, (5), 46.
Bottom of Form
2nd Colleagues post:
Shared Practice: Clarifying Your Goals with a Plan of Action”.
Goal: Finish Master’s Degree program at Walden University
Objective for goals:
To become a director by June 2022, I must complete the
Master’s program by February 2022. In order to complete the
Master’s degree program at Walden by June 2022, I must
continue straight through taking classes only taking two breaks
if needed.
Once my director retires in the upcoming year, I will need to
land an interview with the VP.
Timeline:

38. · June 2021, I must complete three safety events to land the
interview.
· September 2021, I will need to have the budget report and
reconciliation process aligned, to land the interview.
· January 2022 If I go straight through to complete my degree.
· May 2022, If I need to take off up to16 weeks.
Completing my degree is vitally important to the completion of
my professional career goals. I have laid out a timeline for my
goals that I must complete to even be considered for a director
position within the organization in which I work. There are a
couple of things I must do for me to even be considered for the
interview with the VP and getting this director position. I have
listed that I must complete three safety events. In completing
three safety events lead and spared headed by me it will show
my potential, what I am made of, how I can create and follow
through. Just applying for this position is a desire of mine to
show my potential, to keep from holding myself back, from
leadership in which I know and believe I have been working
hard for as well as destiny for. “This type of initiative takes
time, humility, and a willingness to confront weaknesses, fears,
and blind spots that many of us would rather ignore” (Kaplan,
R. S. (2008)). Taking the time to complete these three events
this year 2021 will show I am capable and willing to take on the
responsibility. It will also show that I have overcome my

39. weaknesses and fears as well as able to conquer the blind spots.
Creating processes that will help the flow of the budget, Is an
additional portion that must be put in place in order for me to
land this interview for the director position. This process will
ensure every cent is properly allocated. Having a process in
place will ensure if in fact an error was to take place it will be
rapidly found and corrected. for organization processes are
important so that if anyone was to come behind me in my
position they could step in without having to be trained. So
every process will be published electronically as well as paper .
This way any director could come in and fill in. Knowing what
will bring success in this position is vitally important. The
budget in this position is most important it is a $10.5 billion
budget that will be in my hands. Now I assist in this budget in
the new position I will handle OK the budget period which
means distributing funds to each Department assuring funds are
not being misused. What also is important the “need to know
what will drive success in the new position and then, ask
yourself whether you enjoy those key tasks” (Kaplan, R. S.
(2008). Enjoying what you do in this position is vital important
because there will be some hard moments and when things get
stressful and get hard you may feel like you want to abandon it.
But when you love what you do you understa nd tomorrow is in
will be a better day.
Lastly, completing my degree has been a challenge. I have

40. started and stopped started and stopped and now starting again.
I have a total of seven classes to complete that includes the
class I am presently in. At this time hopefully I finish this class
well I've also had some challenges during this semester where I
am not submitted my best work, but I'm doing my best now
hopefully this will pull me through to at least finish with a B. I
spread out the time to complete my Master’s degree because we
don't know what the future holds and there may come a time
where I may have to take a couple of weeks off and that could
change my completion date. But it was important for me to
understand and lay everything out so I know if I created too big
of a cushion, I would miss the opportunity to interview for this
director’s position.
Kaplan, R. S. (2008). Reaching your potential. Harvard
Business Review, 86(7/8), 45– 49.
Read a selection of your colleagues’ postings.
Respond to at least two of your colleagues “see attachment”,
offering each of them feedback on the action plan he or she
created to succeed at his or her goal. Consider offering feedback

41. based on the following areas:
· Suggest to your colleague milestones that appear to be missing
or that may be easier to measure that you think might help him
or her progress toward his or her goal.
· Provide feedback on whether your colleague’s suggested
timeline for his or her goal or milestones seem realistic and
achievable.
· Suggest clarifications so that the objectives and milestones
support the goal in a clear, measurable, and logical manner.
· No plagiarism
· APA 7th edition
Remember, the feedback you offer should help your colleague
reflect on his or her goals in a meaningful way.
International Statistical Review (2010), 78, 2, 316–328
doi:10.1111/j.1751-5823.2010.00118.x
Short Book Reviews
Editor: Simo Puntanen
Linear Model Methodology

42. André I. Khuri
Chapman & Hall/CRC, 2010, xix + 542 pages, £ 63.99 / US$
99.95, hardcover
ISBN: 978-1-58488-481-1
Table of contents
1. Linear models: some historical perspectives 8. Balanced
linear models
2. Basic elements of linear algebra 9. The adequacy of
Satterthwaite’s approximation
3. Basic concepts in matrix algebra 10. Unbalanced fixed-
effects models
4. The multivariate normal distribution 11. Unbalanced random
and mixed models
5. Quadratic forms in normal variables 12. Additional topics in
linear models
6. Full rank linear models 13. Generalized linear models
7. Less-than-full-rank linear models
Readership: All readers interested in regression presented with
a mix of theory and practice.
The material on which this book is based has been taught in a
couple of courses at the University

43. of Florida for about 20 years and the author’s skills and
experience in doing this are superbly
represented in this fine text. The presentation itself leans more
toward the theoretical aspects,
but there are numerous exercises that reinforce both the
theoretical and the practical aspects of
regression. (However, no solutions are provided.) “Chapters 11
and 12 can be particularly helpful
to graduate students looking for dissertation topics.” (Preface)
This is an excellent, reliable, and
comprehensive text.
Norman R. Draper: [email protected]
Department of Statistics, University of Wisconsin – Madison
1300 University Avenue, Madison, WI 53706-1532, USA
Knowledge Discovery for Counterterrorism and Law
Enforcement
David Skillicorn
Chapman & Hall/CRC, 2008, xx + 330 pages, £ 49.99 / US$
79.95, hardcover
ISBN: 978-1-4200-7399-7
Table of contents

44. 1. Introduction 6. Looking inside groups – relationship
discovery
2. Data 7. Discovery from public textual data
3. High-level principles 8. Discovery in private communication
4. Looking for risk – prediction and anomaly detection 9.
Discovering mental and emotional state
5. Looking for similarity – clustering 10. The bottom line
Readership: Anyone first venturing into knowledge discovery
for counterterrorism.
C© 2010 The Authors. Journal compilation C© 2010
International Statistical Institute. Published by Blackwell
Publishing Ltd, 9600 Garsington Road,
Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148,
USA.
SHORT BOOK REVIEWS 317
This is a discursive book, outlining all sorts of methods, which
might be used in counterterrorism,
and speculating on how they might be employed. There are very

45. few real applied examples
and these are only described in brief. I suppose this should not
surprise us for this area
of application, but it detracts from the text’s interest. There is a
whole 30-page chapter on
cluster analysis, which has just one artificial example of three
people and their height and
age. Even if no counterterrorism examples can be used, surely
something more stimulating
could have been found. The standard result on the large number
of false positives that arise in
searching information for terrorists properly appears, though the
calculation itself is not given
(and strangely enough Bayes’ Theorem does not appear at all).
The author’s comment on the
result is worth quoting in full: “. . . the ACM committee assume
that 99.999% accuracies are
unattainably remote, despite the fact that defect rates well
below this are commonplace in many
industrial settings, not by some kind of magic but by working at
the process to reduce defects.”
As a statistician, this kind of positive thinking leaves me very
skeptical.
Antony Unwin: [email protected]

46. Universität Augsburg, Institut für Mathematik
D-86135 Augsburg, Germany
Statistical Methods for Categorical Data Analysis, Second
Edition
Daniel A. Powers, Yu Xie
Emerald Group, 2008, xvii + 317 pages, £ 39.99 / US$ 69.95,
hardcover
ISBN: 978-0-1237-2562-2
Table of contents
1. Introduction 6. Statistical models for event occurrence
2. Review of linear regression models 7. Models for ordinal
dependent variables
3. Models for binary data 8. Models for nominal dependent
variables
4. Loglinear models for contingency tables A. The matrix
approach to regression
5. Multilevel models for binary data B. Maximum likelihood
estimation
Readership: Social science researchers.

47. There are quite a few books on analyzing categorical data. This
one has the expressed aim
of integrating the transformational approach familiar to
statisticians with the latent variable
approach “often taken by economists.” It covers a fairly wide
range of models in a reasonably
successful manner. Though it has a certain amount of
mathematics, this is not covered in any
great depth. Linear regression is explained in matrix form in an
appendix and the Bayes factor is
described as “complicated and beyond the scope of this book.”
In keeping with the other books
in this area, there are disappointingly few graphics and mosaic
plots that do not get a mention.
In contrast with some of the other books, there are not many
motivating examples and when
the examples included are analyzed the results are not discussed
in any detail. If they had been
(or if graphics had been used) the authors might have noticed
the two errors in Table 6.8 on
page 191 that I spotted. Although there are no exercises, there is
a supporting website, which
includes code for the examples using a variety of software
packages. The book is now in its
second edition, so it has already achieved a certain amount of

48. recognition. With better examples
it could get more.
Antony Unwin: [email protected]
Universität Augsburg, Institut für Mathematik
D-86135 Augsburg, Germany
International Statistical Review (2010), 78, 2, 316–328
C© 2010 The Authors. Journal compilation C© 2010
International Statistical Institute
318 SHORT BOOK REVIEWS
From Finite Sample to Asymptotic Methods in Statistics
Pranab K. Sen, Julio M. Singer, Antonio C. Pedroso de Lima
Cambridge University Press, 2009, xii + 386 pages, £ 45.00 /
US$ 70.00, hardcover
ISBN: 978-0-521-87722-0
Table of contents
1. Motivation and basic tools 7. Asymptotic distributions

49. 2. Estimation theory 8. Asymptotic behavior of estimators and
tests
3. Hypothesis testing 9. Categorical data models
4. Elements of statistical decision theory 10. Regression models
5. Stochastic processes: an overview 11. Weak convergence and
Gaussian processes
6. Stochastic convergence and probability inequalities
Readership: Advanced undergraduate or beginning graduate
students in statistics, biostatistics,
or applied statistics, academic researchers in statistically
oriented fields.
The authors point out in the preface that “. . . , our intent is to
provide a broad view of finite-
sample statistical methods, to examine their merits and caveats,
and to judge how far asymptotic
results eliminate some of the detected impasses, providing the
basis for sound application of
approximate statistical inference in large samples.” The book
succeeds admirably in its aim of
providing an overview of finite-sample (exact or small)
methods, appraising their scope and
integrating them to asymptotic (approximate or large-sample)
inference. The treatment of the

50. material is application-oriented and yet mathematically
rigorous.
In Chapter 1 the authors motivate their approach through a set
of illustrative examples ranging
from very simple to more complex applications. Also a
summary of some basic tools and results
(on matrix algebra, real analysis, probability distributions, order
statistics, and quantiles) needed
in the text is provided. Chapters 2 and 3 lay out the two
building blocks of statistical inference,
estimation and testing, and in these chapters the authors address
the important issues relating
to likelihood, sufficiency and invariance, among others. The
chapter titles shown above indicate
the range of topics covered in the text.
The book is very well written and clear. The overall standard of
explanation is very good,
new ideas are accompanied by several worked examples,
although one might have wished also
numerical examples with some indication of how the theory
performs in practice. There are
also a large number of suitable exercises for the reader. In my
view, this text can be warmly

51. recommended for lecture courses in asymptotic statistics and
courses in statistical inference.
Erkki P. Liski: [email protected]
Department of Mathematics and Statistics
FI-33014 University of Tampere, Finland
International Statistical Review (2010), 78, 2, 316–328
C© 2010 The Authors. Journal compilation C© 2010
International Statistical Institute
SHORT BOOK REVIEWS 319
Steps Towards a Unified Basis for Scientific Models and
Methods
Inge S. Helland
World Scientific, 2010, xviii + 257 pages, £ 56.00 / US$ 75.00,
hardcover
ISBN: 978-981-4280-85-3
Table of contents
1. The basic elements 8. Multivariate data analysis and statistics

52. 2. Statistical theory and practice 9. Quantum mechanics and the
diversity of concepts
3. Statistical inference under symmetry 10. Epilogue
4. The transition from statistics to quantum theory A.1.
Mathematical aspects of basic statistics
5. Quantum mechanics from a statistical basis A.2.
Transformation groups and group transformations
6. Further development of quantum mechanics A.3. Technical
aspects of quantum mechanics
7. Decisions in statistics A.4. Some aspects of parti al least
squares regression
Readership: Those interested in the broader aspects of statistical
theory and concepts and
especially those with a concern with links to quantum theory.
This wide-ranging book aims to address and link broad
conceptual issues, in particular in
statistical theory and quantum theory. The introductory chapter
discusses complementarity in a
wide sense and introduces the notion of conceptually defined
variables, c-variables. These link
with counterfactual variables and latent variables in the sense
used in statistical theory, but are
intended to be broader. There follows a remarkably clear and

53. compact summary of the theory
of statistical inference, limited mainly by a concentration on
transformation models. Remarks
on a range of more applied issues make an interesting
commentary on the more mathematical
parts. Chapters 5 and 6 deal with quantum mechanics, starting
with a summary account of the
conventional approach and then leading to a development from
a new set of axioms claimed
to have a clearer intuitive content, an aspect which the author
considers important. The final
Chapters cover a wide range of topics, mostly statistical. The
writing is lucid. Whether a useful
synthesis has been achieved is unclear to this reviewer.
David Cox: [email protected]
Nuffield College, New Road
Oxford, OX1 1NF, UK
International Statistical Review (2010), 78, 2, 316–328
C© 2010 The Authors. Journal compilation C© 2010
International Statistical Institute

54. 320 SHORT BOOK REVIEWS
A First Course in Probability and Statistics
B. L. S. Prakasa Rao
World Scientific, 2008, xii + 317 pages, £ 26.00 / US$ 48.00,
softcover (also available as hard-
cover)
ISBN: 978-981-283-654-0
Table of contents
1. Why statistics? 8. Estimation
2. Probability on discrete sample spaces 9. Interval estimation
and testing of hypotheses
3. Discrete probability distributions 10. Linear regression and
correlation
4. Continuous probability distributions Appendix A. References
5. Multivariate probability distributions Appendix B. Answers
to selected exercises
6. Functions of random vectors Appendix C. Tables
7. Approximations to some probability distributions
Readership: Undergraduate courses in statistics and probability,
mathematics students who are

55. studying probability.
This book assumes that the reader has completed a course on
calculus and has a thorough
knowledge and understanding of this. The approach is very
mathematical, with many proofs
included. The text while advertised for those doing Social
Science and Business Administration
may find the title misleading as it is certainly suitable for those
studying mathematics and
statistics but maybe be difficult for the other subject
disciplines.
The book is very comprehensive in its coverage of the topics
included and contains a wealth
of exercises at the end of each chapter.