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Selected AbstractsHLA,DRB1 genotype associations in 793 white patients from a rheumatoid arthritis inception cohort: Frequency, severity, and treatment biasARTHRITIS & RHEUMATISM, Issue 9 2002James F. Fries Objective The HLA,DRB1 "shared epitope" (SE) genotypes are associated with rheumatoid arthritis (RA), but it remains controversial whether the association is with incidence, severity, or both, whether there are associations in seronegative patients, and whether different DRB1 alleles that contain the SE have similar effects on RA susceptibility and/or severity. The present study was undertaken to study these issues in a large cohort of patients with RA. Methods White patients with RA of <6 months' duration (n = 793) were enrolled in an inception cohort. HLA,DRB1 typing was performed, and patients were categorized into 21 DRB1 genotype groups. The disability index of the Health Assessment Questionnaire was the primary outcome measure. Results DRB1 associations in seronegative RA patients closely resembled those in controls. Of seropositive patients, 21% had 2 copies of the epitope, 52% had 1 copy, and 27% had none. However, not all genotypes with 1 copy were associated with increased susceptibility; for example, frequencies of DRB1*0404/X and *01/X did not differ from those in controls. Absolute differences between seropositive RA patients and controls were greatest for DRB1*0401 homozygosity (3.8% versus 0.8%, respectively) and *0401/0404 heterozygosity (4.7% versus 1.0%). DRB1*0404 was increased in frequency in seropositive RA but, unlike *0401, an increased frequency was seen only with 2 epitope copies. The relatively rare DRB1*10 had an unexpected association with seropositive RA, being present in 1.7% of seropositive RA patients and 0.7% of controls, and also showed a trend toward association with greater disease severity. The presence of 2 epitope copies was associated with increased frequency of seropositivity and younger age at disease onset, not with disease severity. Treatment indication bias was substantial and may have accounted for some of these effects. HLA,DRB1*0401/0404 was found much more frequently in men and in patients with a lower age at disease onset, and there was a trend toward a higher frequency of *0404/0401 in women. Conclusion This large inception cohort study confirms previously identified major associations and provides additional insights. Only one dominant association was found: *0401, which differs from other SE alleles in a single Lys-for-Arg substitution. The association of the rare DRB1*10 allele has not previously been postulated. Sex associations were confirmed. Associations with seronegative RA were not seen. Not all genotypes containing an SE copy showed increased susceptibility to RA. The association of SE genotypes found in this study related to disease susceptibility rather than severity. [source] Six-month-old infants use analog magnitudes to represent durationDEVELOPMENTAL SCIENCE, Issue 5 2006Kristy VanMarle While many studies have investigated duration discrimination in human adults and in nonhuman animals, few have investigated this ability in infants. Here, we report findings that 6-month-old infants are able to discriminate brief durations, and, as with other animal species, their discrimination function is characterized by Weber's Law: proportionate difference rather than absolute difference between stimuli determined successful discrimination. Importantly, paralleling results found with nonhuman animals, the Weber function that we found for infants' discrimination of time is the same as that found for their discrimination of number. Infants discriminated durations of an audiovisual event differing by a 1:2 ratio, but not those differing by a 2:3 ratio, over a range of durations. This suggests that (a) in human as in nonhuman animals, the same mental mechanism may underlie the ability to measure duration as to represent number, and (b) we may share this mental mechanism with other animal species. [source] A double-blind, randomized trial of intravenous versus intramuscular antivenom for Red-back spider envenomingEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2005Rodney M Ellis Abstract Objective:, To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Red-back spider (RBS) envenoming. Methods:, Randomized, double-dummy, double-blind, multicentre trial of patients with red-back spider envenoming requiring AV treatment recruited from five hospital EDs in Western Australia. Results:, Thirty-five patients were recruited; two were excluded; 33 were available for initial analysis, but two who were unblinded after one ampoule of trial AV and given i.v. AV had limited data; 31 remained in the study and had more complete data. After AV, pain scores for both i.m. and i.v. groups improved rapidly. At 24 h, the i.v. group was better with a 55% absolute difference (76% vs. 21%; 95% CI 25,85% difference) in the proportion pain-free. There were no safety issues. Conclusions:, Red-back spider antivenom was initially effective by both i.m. and i.v. routes. The study generates the hypothesis that at 24 h, significantly more patients are pain-free with i.v. administration. Definitive recommendations on the optimal route of administration of RBS AV await the results of further studies. [source] An Approximation for the Rank Adjacency Statistic for Spatial Clustering with Sparse DataGEOGRAPHICAL ANALYSIS, Issue 1 2001John Paul Ekwaru The rank adjacency statistic D provides a simple method to assess regional clustering. It is defined as the weighted average absolute difference in ranks of the data, taken over all possible pairs of adjacent regions. In this paper the usual normal approximation to the D statistic is found to give inaccurate results if the data are sparse and some regions have tied ranks. Adjusted formulae for the moments of D that allow for the existence of ties are derived. An example of analyses of sparse mortality data (with many regions having no deaths, and hence tied ranks) showed satisfactory agreement between the adjusted formulae and the empirical distribution of the D statistic. We conclude that the D statistic, when used with adjusted moments, provides a valid approximate method to evaluate spatial clustering, even in sparse data situations. [source] Prospective Validation of a Modified Thrombolysis In Myocardial Infarction Risk Score in Emergency Department Patients With Chest Pain and Possible Acute Coronary SyndromeACADEMIC EMERGENCY MEDICINE, Issue 4 2010Erik P. Hess MD Abstract Objectives:, This study attempted to prospectively validate a modified Thrombolysis In Myocardial Infarction (TIMI) risk score that classifies patients with either ST-segment deviation or cardiac troponin elevation as high risk. The objectives were to determine the ability of the modified score to risk-stratify emergency department (ED) patients with chest pain and to identify patients safe for early discharge. Methods:, This was a prospective cohort study in an urban academic ED over a 9-month period. Patients over 24 years of age with a primary complaint of chest pain were enrolled. On-duty physicians completed standardized data collection forms prior to diagnostic testing. Cardiac troponin T-values of >99th percentile (,0.01 ng/mL) were considered elevated. The primary outcome was acute myocardial infarction (AMI), revascularization, or death within 30 days. The overall diagnostic accuracy of the risk scores was compared by generating receiver operating characteristic (ROC) curves and comparing the area under the curve. The performance of the risk scores at potential decision thresholds was assessed by calculating the sensitivity and specificity at each potential cut-point. Results:, The study enrolled 1,017 patients with the following characteristics: mean (±SD) age 59.3 (±13.8) years, 60.6% male, 17.9% with a history of diabetes, and 22.4% with a history of myocardial infarction. A total of 117 (11.5%) experienced a cardiac event within 30 days (6.6% AMI, 8.9% revascularization, 0.2% death of cardiac or unknown cause). The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy (area under the ROC curve = 0.83 vs. 0.79; p = 0.030; absolute difference 0.037; 95% confidence interval [CI] = 0.004 to 0.071). The specificity of the modified score was lower at all cut-points of >0. Sensitivity and specificity at potential decision thresholds were: >0 = sensitivity 96.6%, specificity 23.7%; >1 = sensitivity 91.5%, specificity 54.2%; and >2 = sensitivity 80.3%, specificity 73.4%. The lowest cut-point (TIMI/modified TIMI >0) was the only cut-point to predict cardiac events with sufficient sensitivity to consider early discharge. The sensitivity and specificity of the modified and original TIMI risk scores at this cut-point were identical. Conclusions:, The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy. However, it had lower specificity at all cut-points of >0, suggesting suboptimal risk stratification in high-risk patients. It also lacked sufficient sensitivity and specificity to safely guide patient disposition. Both scores are insufficiently sensitive and specific to recommend as the sole means of determining disposition in ED chest pain patients. ACADEMIC EMERGENCY MEDICINE,2010; 17:368,375 © 2010 by the Society for Academic Emergency Medicine [source] No-Reference Image Quality Evaluation Model for JPEG and JPEG2000 ImagesIEEJ TRANSACTIONS ON ELECTRICAL AND ELECTRONIC ENGINEERING, Issue 3 2008Z. M. Parvez Sazzad Non-member Abstract In this paper, we present a new no-reference (NR) image quality evaluation model for Joint Photographic Experts Group (JPEG) and JPEG2000 coded images. The proposed model is based on the blockiness around the block boundary, average absolute difference between adjacent pixels within the block, and zero-crossing (ZC) rate within the block of the image. Subjective experimental results of the Laboratory for Image and Video Engineering (LIVE) Image Quality Assessment Database were used to train and test the model, which achieved sufficient quality prediction performance. Copyright © 2008 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc. [source] A simple mounting model for consistent determination of the accuracy and repeatability of apex locatorsINTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2006A. ElAyouti Abstract Aim, To develop a precise and simple mounting model (MM) for evaluating apex locators and to compare the repeatability of the MM with a conventional visual method (VM). Methodology, Electronic working length determination was performed in 32 maxillary central incisors using two methods: (i) the MM method and (ii) a conventional VM. The MM utilizes a micrometer to determine the distance travelled by the measuring file during working length determination. In the VM, the length of the measuring file (representing the working length) is determined visually using a caliper and a microscope at 6× magnification. Each measurement was repeated once. The repeatability of each method was evaluated by calculating the coefficient of repeatability. Results, The coefficient of repeatability, which includes 95% of the differences between repeated measurements, was 0.04 mm for MM compared with 0.9 mm for VM. The measurement error of MM was significantly lower than VM (0.02 and 0.4 mm respectively). There was a statistically significant difference between the means of absolute difference in repeated measurements: MM 0.01 mm (95% confidence interval (CI): 0.01; 0.02 mm) compared with VM 0.4 mm (95% CI: 0.3; 0.5 mm). Conclusion, The new MM had superior repeatability in comparison with the conventional method where visual interpretation is a source of inaccurate measurement. [source] Exercise When Young Provides Lifelong Benefits to Bone Structure and Strength,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2007Stuart J Warden PT Abstract Short-term exercise in growing rodents provided lifelong benefits to bone structure, strength, and fatigue resistance. Consequently, exercise when young may reduce the risk for fractures later in life, and the old exercise adage of "use it or lose it" may not be entirely applicable to the skeleton. Introduction: The growing skeleton is most responsive to exercise, but low-trauma fractures predominantly occur in adults. This disparity has raised the question of whether exercised-induced skeletal changes during growth persist into adulthood where they may have antifracture benefits. This study investigated whether brief exercise during growth results in lifelong changes in bone quantity, structure, quality, and mechanical properties. Materials and Methods: Right forearms of 5-week-old Sprague-Dawley rats were exercised 3 days/week for 7 weeks using the forearm axial compression loading model. Left forearms were internal controls and not exercised. Bone quantity (mineral content and areal density) and structure (cortical area and minimum second moment of area [IMIN]) were assessed before and after exercise and during detraining (restriction to home cage activity). Ulnas were removed after 92 weeks of detraining (at 2 years of age) and assessed for bone quality (mineralization) and mechanical properties (ultimate force and fatigue life). Results: Exercise induced consistent bone quantity and structural adaptation. The largest effect was on IMIN, which was 25.4% (95% CI, 15.6,35.3%) greater in exercised ulnas compared with nonexercised ulnas. Bone quantity differences did not persist with detraining, whereas all of the absolute difference in bone structure between exercised and nonexercised ulnas was maintained. After detraining, exercised ulnas had 23.7% (95% CI, 13.0,34.3%) greater ultimate force, indicating enhanced bone strength. However, exercised ulnas also had lower postyield displacement (,26.4%; 95% CI, ,43.6% to ,9.1%), indicating increased brittleness. This resulted from greater mineralization (0.56%; 95% CI, 0.12,1.00%), but did not influence fatigue life, which was 10-fold greater in exercised ulnas. Conclusions: These data indicate that exercise when young can have lifelong benefits on bone structure and strength, and potentially, fracture risk. They suggest that the old exercise adage of "use it or lose it" may not be entirely applicable to the skeleton and that individuals undergoing skeletal growth should be encouraged to perform impact exercise. [source] Calculation of the vibration frequencies of ,-quartz: The effect of Hamiltonian and basis setJOURNAL OF COMPUTATIONAL CHEMISTRY, Issue 15 2004C. M. Zicovich-Wilson Abstract The central-zone vibrational spectrum of ,-quartz (SiO2) is calculated by building the Hessian matrix numerically from the analytical gradients of the energy with respect to the atomic coordinates. The nonanalytical part is obtained with a finite field supercell approach for the high-frequency dielectric constant and a Wannier function scheme for the evaluation of Born charges. The results obtained with four different Hamiltonians, namely Hartree,Fock, DFT in its local (LDA) and nonlocal gradient corrected (PBE) approximation, and hybrid B3LYP, are discussed, showing that B3LYP performs far better than LDA and PBE, which in turn provide better results than HF, as the mean absolute difference from experimental frequencies is 6, 18, 21, and 44 cm,1, respectively, when a split valence basis set containing two sets of polarization functions is used. For the LDA results, comparison is possible with previous calculations based on the Density Functional Perturbation Theory and usage of a plane-wave basis set. The effects associated with the use of basis sets of increasing size are also investigated. It turns out that a split valence plus a single set of d polarization functions provides frequencies that differ from the ones obtained with a double set of d functions and a set of f functions on all atoms by on average less than 5 cm,1. © 2004 Wiley Periodicals, Inc. J Comput Chem 25: 1873,1881, 2004 [source] Increasing the Homogeneity of CAT's Item-Exposure Rates by Minimizing or Maximizing Varied Target Functions While Assembling Shadow TestsJOURNAL OF EDUCATIONAL MEASUREMENT, Issue 3 2005Yuan H. Li A computerized adaptive testing (CAT) algorithm that has the potential to increase the homogeneity of CAT's item-exposure rates without significantly sacrificing the precision of ability estimates was proposed and assessed in the shadow-test (van der Linden & Reese, 1998) CAT context. This CAT algorithm was formed by a combination of maximizing or minimizing varied target functions while assembling shadow tests. There were four target functions to be separately used in the first, second, third, and fourth quarter test of CAT. The elements to be used in the four functions were associated with (a) a random number assigned to each item, (b) the absolute difference between an examinee's current ability estimate and an item difficulty, (c) the absolute difference between an examinee's current ability estimate and an optimum item difficulty, and (d) item information. The results indicated that this combined CAT fully utilized all the items in the pool, reduced the maximum exposure rates, and achieved more homogeneous exposure rates. Moreover, its precision in recovering ability estimates was similar to that of the maximum item-information method. The combined CAT method resulted in the best overall results compared with the other individual CAT item-selection methods. The findings from the combined CAT are encouraging. Future uses are discussed. [source] The existence of a relationship between increased serum alanine aminotransferase levels detected in premarketing clinical trials and postmarketing published hepatotoxicity case reportsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010L. LLANOS Aliment Pharmacol Ther,31, 1337,1345 Summary Background, Drug-induced liver injury (DILI) profile in most drugs' available information is based on both the incidence of alanine aminotansferase (ALT) elevations in clinical trials and published case reports. Aim, To assess the relationship between ALT elevations in clinical trials and the number of published case reports in the postmarketing setting. Methods, Hepatotoxic drugs were identified from product labelling and classified in high-medium risk (Black Box Warning or Precautions section) or low risk (a statement in the Adverse Reactions section). Incidence of ALT elevations (,3 × ULN) for drug (ID) and placebo (IC) treated patients in premarketing clinical trials and DILI published case reports were retrieved from product labelling and MEDLINE. Results, The median IC was 10/1000. The high-medium-risk drugs' median ID was significantly higher compared with low-risk drugs (17/1000 vs. 10/1000; P = 0.046). Chi-squared test, absolute difference and odds ratio comparing ID and IC identified 35%, 51% and 77% of high-medium-risk drugs respectively. Less number of case reports were associated with low- than high-medium-risk drugs (1 vs. 7; P = 0.001). A high odds ratio in clinical trials (ID vs. IC) was the strongest predictor of published DILI case reports. Conclusion, A relationship between increased ALT incidence in premarketing clinical trials and postmarketing published case reports exists. [source] Omeprazole-Mg 20.6 mg is superior to lansoprazole 15 mg for control of gastric acid: a comparison of over-the-counter doses of proton pump inhibitorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010P. B. MINER JR Aliment Pharmacol Ther,31, 846,851 Summary Background, Over-the-counter (OTC) proton pump inhibitors (PPIs) relieve heartburn by decreasing the production of gastric acid, but may not do so with equal effectiveness. It is important for healthcare professionals to compare the ability of OTC PPIs to control gastric acid when recommending them for patients with frequent heartburn. Aim, To compare the effects of omeprazole-Mg 20.6 mg and lansoprazole 15 mg (OTC doses in the US) on 24-h steady state gastric acid suppression. Methods, This single-centre, randomized, double-blind clinical study compared the steady-state gastric acid control of omeprazole-Mg 20.6 mg vs. lansoprazole 15 mg, dosed before breakfast. Volunteers were enrolled in a 3-period, cross-over design (ABB, BAA) with 24-h gastric pH monitoring on dosing day 5. The primary efficacy variable was the percentage time intragastric pH was >4.0 over 24 h on day 5 of dosing. Results, Forty subjects were enrolled; all completed the study. The mean (SE) percentage time pH was >4.0 was 45.7% (3.45%) for omeprazole-Mg 20.6 mg and 36.8% (3.45%) for lansoprazole 15 mg, an absolute difference of 8.9% (P < 0.0001), and a relative difference of 24.2%. Both drugs were well tolerated. Conclusion, Omeprazole-Mg 20.6 mg provided a statistically significantly (P < 0.0001) greater acid control than lansoprazole 15 mg. [source] A randomized, double-blind study of certoparin vs. unfractionated heparin to prevent venous thromboembolic events in acutely ill, non-surgical patients: CERTIFY StudyJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 6 2010H. RIESS Summary.,Background:,In medically ill patients, no contemporary double-blind head-to-head evaluation of low molecular weight heparin vs. unfractionated heparin (UFH) for the prevention of venous thromboembolic events is available. Objectives:,To compare the efficacy and safety of certoparin with those of UFH. Patients/Methods:,In this double-blind, randomized, controlled trial, acutely ill, non-surgical patients aged , 70 years were randomized to certoparin (3000 U of anti-factor Xa once daily) or to UFH (5000 IU t.i.d.). The primary endpoint was the composite of proximal deep vein thrombosis as assessed by bilateral compression ultrasonography, symptomatic non-fatal pulmonary embolism and venous thromboembolism-related death, and was assessed by a blinded central adjudication committee. Non-inferiority margins were set at 1.8 for the odds ratio (OR) and 3.45% for the absolute difference. Results:,Three thousand two hundred and thirty-nine patients aged 78.8 ± 6.3 years were treated for 9.1 ± 3.4 days. The incidence of the primary endpoint was 3.94% in the certoparin group and 4.52% in the UFH group, with a difference in proportions of , 0.59% [95% confidence interval (CI) ,2.09 to 0.92; P < 0.0001 for non-inferiority], and an OR of 0.87 (95% CI 0.60,1.26; P = 0.0001 for non-inferiority). Major bleeding occurred in 0.43% of certoparin-treated patients and 0.62% of UFH-treated patients (OR 0.69; 95% CI 0.26,1.83). Any bleeding occurred at 3.20% in certoparin-treated patients vs. 4.58% in UFH-treated patients (OR 0.69; 95% CI 0.48,0.99; P < 0.05), and 5.73% of certoparin-treated patients and 6.63% of UFH-treated patients experienced serious adverse events. All-cause mortality was 1.27% in certoparin-treated patients and 1.36% in UFH-treated patients. Conclusions:,In acutely ill, non-surgical elderly patients, thromboprophylaxis with certoparin (3000 U of anti-FXa once daily) was non-inferior to 5000 IU of UFH t.i.d., with a favorable safety profile. [source] Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndromeMUSCULOSKELETAL CARE, Issue 2 2008Francis A. Fatoye MSc Abstract Background:,Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. Aim:,To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. Methods:,Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. Results:,Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque were excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. Conclusions:,Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution. Copyright © 2008 John Wiley & Sons, Ltd. [source] Predicting marital satisfaction: Social absorption and individuation versus attachment anxiety and avoidancePERSONAL RELATIONSHIPS, Issue 2 2007MAHNAZ R. CHARANIA The incremental validity of social absorption and social individuation in predicting relationship satisfaction beyond anxious and avoidant attachment was assessed in a sample of 400 heterosexual couples. Results indicated that the actor's and partner's social absorption scores and the absolute difference between the partners' social individuation scores made significant unique contributions to the actor's satisfaction in a model that included avoidant and anxious attachment. This model accounted for 49% of the variance in the actors' satisfaction scores. Satisfaction was high when both partners were predisposed toward behavioral interdependence but suffered when the partners were discrepant in their need to cognitively distinguish self and other. Possible explanations for these findings and their implications for marital satisfaction are discussed. [source] Latest news and product developmentsPRESCRIBER, Issue 2 2008Article first published online: 11 FEB 200 NICE should evaluate all new medicines NICE should determine the cost effectiveness of all new medicines, the Health Select Committee has concluded in its second review of the Institute. The review, prompted by criticisms from patients, health professionals and the pharmaceutical industry, found that NICE is doing ,a vital job in difficult circumstances'. The Committee called for the costs to carers and society to be included in cost effectiveness estimates (this is currently prohibited) and for cost per QALY thresholds to be aligned with NHS affordability. NICE should publish brief appraisals at the time of a product launch , these could be used to negotiate prices. GPs responsible for unlicensed co-proxamol GPs who prescribe co-proxamol are now responsible for the consequences, the MHRA warns. The Agency agrees that the drug may be needed by ,a small group of patients who are likely to find it very difficult to change from co-proxamol or where alternatives appear not to be effective or suitable'. Following the withdrawal of product licences, stock that is currently in the supply chain may be dispensed but no new stock should be released by suppliers. The Drug Tariff price of co-proxamol has now increased from £2.79 to £20.36 per 100 tablets. Vitamin D deficiency on the increase Pregnant and breastfeeding women may need vitamin D supplements, the Department of Health has warned, and GPs are seeing increasing numbers of patients with vitamin D deficiency. Endogenous synthesis may be low in some ethnic groups and dark-skinned people, and north of Birmingham there is no light of the appropriate wavelength for the synthesis of vitamin D during the winter. The Department says free vitamin supplements are available for eligible patients through its Healthy Start Scheme (www.healthystart.nhs.uk) and may also be supplied at low cost by some PCTs. Innovation and good practice recognised Innovative practice and better outcomes for patients have been recognised through awards from the NHS Alliance and Improvement Foundation presented by the Secretary of State for Health, Rt Hon Alan Johnson, at the annual NHS Alliance conference held in Manchester. The Mountwood Surgery in Northwood, Middlesex, won the CHD QOF GP Practice Award sponsored by Schering Plough for their outstanding multidisciplinary approach to tackling CHD. In addition to having a highly organised in-house cardiology team, they have produced an interactive, patient-empowering booklet for CHD. Mountwood Surgery achieved blood pressure targets of 96.79 per cent in their CHD patients. North Tees PCT wins the CHD QOF PCO Award, also sponsored by Schering Plough, for their support and encouragement to GP practices to ,own' CHD care. They provide timely feedback of performance data using funnel plots and regular communication by the CHD LIT and Cardiac Network. Even though North Tees PCT has a high CHD prevalence, 4.2 per cent vs 3.6 per cent nationally, across the 27 practices 85 per cent of patients achieved cholesterol targets and 91 per cent reached the QOF blood pressure target. The St Benedict's Hospice Day Centre Project (for the Sunderland Teaching Primary Care Trust) won the Guy Rotherham Award for its excellent multidisciplinary team improvement of the palliative care provided. This team demonstrated a thorough understanding of the use of quality improvement methods to improve patient care, and carefully measured the individual improvements they made. Through the use of a referral ,decision tree', nonattenders were reduced by 300 per cent and average waiting times halved. The Extended Primary Care (EPC) Gynaecology Service (for the Practice Based Commissioning Consortium South Manchester Hub) was highly commended for its development of an effective and innovative service offering gynaecological treatment managed within a primary care setting, allowing patients improved access closer to home. The Salford Perinatal Mental Health Project was also highly commended for effectively challenging the high levels of maternal suicides. The awards were also supported by Prescriber, the British Cardiac Patients Association and the British Cardiac Society. Anastrozole superior to tamoxifen in long term A new analysis of the ATAC trial (Lancet Oncology 2008;9:45-53) shows that the advantages of the aromatase inhibitor anastrozole (Arimidex) over tamoxifen as adjuvant therapy for breast cancer persist for at least four years after the end of treatment. After primary treatment with surgery, chemotherapy or radiotherapy, postmenopausal women with localised invasive breast cancer were randomised to five years' treatment with anastrozole or tamoxifen. Among 5216 women who were hormone-receptor positive, anastrozole increased disease-free survival by 15 per cent after 100 months. Time to recurrence and distant recurrence were also increased, though overall survival was similar; the absolute difference in time to recurrence was greater at nine years (4.8 per cent) than at five years (2.8 per cent). Joint symptoms and fractures were more frequent with anastrozole during treatment but not thereafter. Use a steroid with a LABA , MHRA reminder The MHRA has reminded clinicians that patients treated with an inhaled long-acting beta-agonist (LABA) should also use an inhaled steroid. In the latest edition of Drug Safety Update (2008;1:No.6), the Agency reviews the implications of the SMART study (Chest 2006;129:15-26), which reported an increased risk of respiratory- and asthma-related deaths among patients using salmeterol (Serevent). This is contradicted by epidemiological data suggesting that asthma-related admissions have declined since LABAs were introduced. Randomised trials also do not support such a risk, probably because inhaled steroids are used more consistently in trial settings. The latest Update notes that product licences for carisoprodol (Carisoma) have been suspended due to concerns about the risk of abuse and psychomotor effects. It also includes a comprehensive summary of drug interactions with statins, a warning that methylene blue should not be prescribed for a patient taking a drug with serotonergic activity, and a reminder that only oral formulations of desmopressin are now licensed for primary nocturnal enuresis. This issue of Update is available at www.mhra.gov.uk. Copyright © 2008 Wiley Interface Ltd [source] Life Insurance for Living Kidney Donors: A Canadian Undercover InvestigationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009R. C. Yang Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied. [source] The effect of heart rate variability on request for labour epidural analgesiaANAESTHESIA, Issue 8 2009H.-C. Lao Summary Maternal heart rate variability of 62 parturients were compared based on their choice of using (epidural group, 44 women) or not using (control, 18 women) epidural analgesia. Baseline heart rate variability and visual analogue scores were recorded when the cervix of the parturient dilated to 2,4 cm, and paired data were collected 1 h later. We found that parturients in the epidural group had greater heart rate variability at the beginning of labour. Multiple logistic regression analysis identified percentage of absolute difference in successive RR intervals exceeding 20 ms as the best indicator of choosing epidural analgesia. Almost all heart rate variability measures were unchanged 1 h later in both groups. We concluded that parturients who chose epidural analgesia had greater heart rate variability, and that percentage of absolute difference in successive RR intervals exceeding 20 ms could reflect their likelihood of requesting epidural analgesia at the beginning of labour. [source] Social Inequality: Social inequality in perceived oral health among adults in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2004Anne E. Sanders Objective: To establish population estimates of self-assessed tooth loss and subjective oral health and describe the social distribution of these measures among dentate adults in Australia. Methods: Self-report data were obtained from a nationally representative sample of 3,678 adults aged 18,91 years who participated in the 1999 National Dental Telephone Interview Survey and completed a subsequent mail survey. Oral health was evaluated using (1) self-assessed tooth loss, (2) the 14-item Oral Health Impact Profile, and (3) a global six-point rating of oral health. Results: While the absolute difference in tooth loss across household income levels increased at each successive age group (18,44 years, 45,64 years, 65+ years) from 0.7 teeth to 6.1 teeth, the magnitude of the difference was approximately twofold at each age group. For subjective oral health measures, the magnitude of difference across income groups was most pronounced in the 18,44 years age group. In multivariate analysis, low household income, blue-collar occupation, and high residential area disadvantage were positively associated with social impact from oral conditions and pathological tooth loss. Speaking other than English at home (relative to English), low household income (relative to high income), and vocational relative to tertiary education were each associated with more than twice the odds of poor self-rated oral health. Conclusions: Significant social differentials in perceived oral health exist among dentate adults. Inequalities span the socio-economic hierarchy. Implications: In addition to improving overall levels of oral health in the adult community, goals and targets should aim to reduce social inequalities in the distribution of outcomes. [source] Procedures Can Be Learned on the Web: A Randomized Study of Ultrasound-guided Vascular Access TrainingACADEMIC EMERGENCY MEDICINE, Issue 10 2008Jordan Chenkin MD Abstract Objectives:, Web-based learning has several potential advantages over lectures, such as anytime,anywhere access, rich multimedia, and nonlinear navigation. While known to be an effective method for learning facts, few studies have examined the effectiveness of Web-based formats for learning procedural skills. The authors sought to determine whether a Web-based tutorial is at least as effective as a didactic lecture for learning ultrasound-guided vascular access (UGVA). Methods:, Participating staff emergency physicians (EPs) and junior emergency medicine (EM) residents with no UGVA experience completed a precourse test and were randomized to either a Web-based or a didactic group. The Web-based group was instructed to use an online tutorial and the didactic group attended a lecture. Participants then practiced on simulators and live models without any further instruction. Following a rest period, participants completed a four-station objective structured clinical examination (OSCE), a written examination, and a postcourse questionnaire. Examination results were compared using a noninferiority data analysis with a 10% margin of difference. Results:, Twenty-one residents and EPs participated in the study. There were no significant differences in mean OSCE scores (absolute difference = ,2.8%; 95% confidence interval [CI] = ,9.3% to 3.8%) or written test scores (absolute difference = ,1.4%; 95% CI = ,7.8% to 5.0%) between the Web group and the didactic group. Both groups demonstrated similar improvements in written test scores (26.1% vs. 25.8%; p = 0.95). Ninety-one percent (10/11) of the Web group and 80% (8/10) of the didactic group participants found the teaching format to be effective (p = 0.59). Conclusions:, Our Web-based tutorial was at least as effective as a traditional didactic lecture for teaching the knowledge and skills essential for UGVA. Participants expressed high satisfaction with this teaching technology. Web-based teaching may be a useful alternative to didactic teaching for learning procedural skills. [source] Marriage still protects pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2005Kaisa Raatikainen Objective To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. Design Hospital-based cohort study. Setting A university-teaching hospital in Finland. Population The 25,373 singleton pregnancies of known marital and cohabiting status. Methods Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. Main outcome measures Small-for-gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birthweight (LBW; under 2500 g). Results Of the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P= 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The differences in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. Conclusion Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference. [source] A Comparison of Door-to-balloon Times and False-positive Activations between Emergency Department and Out-of-hospital Activation of the Coronary Catheterization TeamACADEMIC EMERGENCY MEDICINE, Issue 8 2008Scott T. Youngquist MD Abstract Objectives:, The objectives were to compare the proportion of false-positive activations and intervention times between emergency department (ED) and field-based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out-of-hospital (OOH) 12-lead electrocardiogram (ECG) with ST-segment elevation myocardial infarction (STEMI). Methods:, This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer-interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door-to-balloon (DTB) and ultimate diagnosis. Results:, From May 2007 through March 2008, there were 23 field activations and 33 ED activations. There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9/23 (39%) were false-positives, while 3/33 (9%) were false-positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = ,9 to 27). Conclusions:, Emergency physician activation of the cath team results in a lower proportion of false-positive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG. [source] Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2010Validation of a Prototype Software Abstract We investigate the accuracy of a new software system (C-THV, Paieon) designed to calculate the optimal projection (OP) view for transcatheter aortic valve implantation (TAVI) based on two aortograms, and its agreement with the operator's choice. An optimal fluoroscopic working view projection with all three aortic cusps depicted in one line, is crucial during TAVI. In our institution selection of the OP is based on multislice computed tomography (MSCT). Seventy-three consecutive patients referred for TAVI were divided into two groups. For the first group (53 patients, retrospective cohort) we compared the OP views estimated by C-THV with the ones estimated by MSCT. For the second group (20 patients, prospective cohort), we compared the OP views estimated by C-THV with the operator's choice during TAVI. For the retrospective cohort, the mean absolute difference (mean ± SD) between C-THV and MSCT was 6.6 ± 4.9 degrees. In 77% of the cases the mean difference between C-THV and MSCT was <10 degrees. For the prospective cohort, the mean absolute difference (mean ± SD) between C-THV and the operator's choice was 5.5 ± 3.4 degrees. A mean difference of <10 degrees was found in 90% of the cases. In this study we found that the C-THV software estimated the OP view for TAVI with good accuracy. The level of agreement between C-THV and either the MSCT or the operator's choice was deemed satisfactory, with the vast majority of observed differences being <10 degrees. © 2010 Wiley-Liss, Inc. [source] Soft constraints in interactive behavior: the case of ignoring perfect knowledge in-the-world for imperfect knowledge in-the-head,,COGNITIVE SCIENCE - A MULTIDISCIPLINARY JOURNAL, Issue 3 2004Wayne D. Gray Abstract Constraints and dependencies among the elements of embodied cognition form patterns or microstrategies of interactive behavior. Hard constraints determine which microstrategies are possible. Soft constraints determine which of the possible microstrategies are most likely to be selected. When selection is non-deliberate or automatic the least effort microstrategy is chosen. In calculating the effort required to execute a microstrategy each of the three types of operations, memory retrieval, perception, and action, are given equal weight; that is, perceptual-motor activity does not have a privileged status with respect to memory. Soft constraints can work contrary to the designer's intentions by making the access of perfect knowledge in-the-world more effortful than the access of imperfect knowledge in-the-head. These implications of soft constraints are tested in two experiments. In experiment 1 we varied the perceptual-motor effort of accessing knowledge in-the-world as well as the effort of retrieving items from memory. In experiment 2 we replicated one of the experiment 1 conditions to collect eye movement data. The results suggest that milliseconds matter. Soft constraints lead to a reliance on knowledge in-the-head even when the absolute difference in perceptual-motor versus memory retrieval effort is small, and even when relying on memory leads to a higher error rate and lower performance. We discuss the implications of soft constraints for routine interactive behavior, accounts of embodied cognition, and tool and interface design. [source] Relative vs. absolute measures of benefit and risk: what's the difference?ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010L. Citrome Citrome L. Relative vs. absolute measures of benefit and risk: what's the difference? Objective:, When appraising evidence clinicians are confronted with two types of comparisons: ratios, such as relative risk, and absolute differences, such as number needed to treat (NNT) or number needed to harm (NNH). Method:, A review of the definition, calculation and interpretation of relative measures such as relative risk, odds ratio and the hazard ratio, and how they are different from absolute measures such as NNT and NNH. Results:, Relative and absolute measures provide different perspectives. Ratios can be misleading and exaggerate clinical differences, but NNT can appear to trivialize the risk of potentially important adverse events. Conclusion:, There is a need to understand both relative and absolute differences in order to make informed decisions. [source] Assessment of different techniques for subcutaneous glucose monitoring in Type 1 diabetic patients during ,real-life' glucose excursionsDIABETIC MEDICINE, Issue 3 2010J. K. Mader Diabet. Med. 27, 332,338 (2010) Abstract Aims, To compare the accuracy of two marketed subcutaneous glucose monitoring devices (Guardian RT, GRT; GlucoDay S, GDS) and standard microdialysis (CMA60; MD) in Type 1 diabetic patients. Methods, Seven male Type diabetic patients were investigated over a period of 26 h simulating real-life meal glucose excursions. Catheters of the three systems were inserted into subcutaneous adipose tissue of the abdominal region. For MD, interstitial fluid was sampled at 30- to 60-min intervals for offline glucose determination. Reference samples were taken at 15- to 60-min intervals. All three systems were prospectively calibrated to reference. Median differences, median absolute relative differences (MARD), median absolute differences (MAD), Bland,Altman plot and Clark Error Grid were used to determine accuracy. Results, Bland,Altman analysis indicated a mean glucose difference (2 standard deviations) between reference and interstitial glucose of ,10.5 (41.8) % for GRT, 20.2 (55.9) % for GDS and 6.5 (35.2) % for MD, respectively. Overall MAD (interquartile range) was 1.07 (0.39; 2.04) mmol/l for GRT, 1.59 (0.54; 3.08) mmol/l for GDS and 0.76 (0.26; 1.58) mmol/l for MD. Overall MARD was 15.0 (5.6; 23.4) % (GRT), 19.7 (6.1; 37.6) % (GDS) and 8.7 (4.1; 18.3) % (MD), respectively. Total sensor failure occurred in two subjects using GRT and one subject using GDS. Conclusions, The three investigated technologies had comparable performance. Whereas GRT underestimated actual blood glucose, GDS and MD overestimated blood glucose. Considerable deviations during daily life meal glucose excursions from reference glucose were observed for all three investigated technologies. Present technologies may require further improvement until individual data can lead to direct and automated generation of therapeutic advice in diabetes management. [source] On the performance of eleven DFT functionals in the description of the vibrational properties of aluminosilicatesINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 2 2010Raffaella Demichelis Abstract The performance of eleven DFT functionals in describing the equilibrium structure and the vibrational spectra at the , point of pyrope (Mg3Al2Si3O12), forsterite (,-Mg2SiO4), ,-quartz (,-SiO2) and corundum (,-Al2O3) is discussed. The four systems, for which accurate experimental data are available, are here used as a representative sample of the large aluminosilicates family. Calculations were performed with the periodic ab initio CRYSTAL code by using all-electron Gaussian-type basis sets. All the functionals here considered provide reasonable structural predictions, the hybrid PBE0 giving the least deviation from the experimental unit cell volumes (from ,0.3% to +0.6%). At the other extreme, SVWN and SPWLSD (,,3%) and PBE and PW91 (, +3%) provide the largest volume under- and over-estimation, respectively. Vibrational frequencies are more accurate when computed with hybrid functionals, with the best performance provided by B3LYP and WC1LYP (mean absolute differences with respect to experiments evaluated on a set of 134 vibrational frequencies, ||t , 5.5 cm,1). The three recently proposed GGA functionals, PBEsol, SOGGA-PBE and WC-PBE, provide a good description of the vibrational spectra, of the same quality as the one provided by PBE0 and B1WC (||t , 10 cm,1), whereas poorer results are obtained with PBE (||t , 17 cm,1). © 2009 Wiley Periodicals, Inc. Int J Quantum Chem, 2010 [source] Local co-adaptation leading to a geographical mosaic of coevolution in a social parasite systemJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 5 2004B. Fischer Abstract The geographical mosaic theory of coevolution predicts differences in the advance or trajectory of the coevolutionary process between local communities due to their composition and the strength of ecological selection pressures through competition and resource availability. In this study, we investigate local co-adaptation in different populations of a social parasite. We conducted cross-fostering experiments to test for interpopulational differences in raiding efficiency between various populations of a slave-making ant and the defence abilities of local hosts. Here, we demonstrate that the success of raids strongly depends on the combination of populations of the parasite Harpagoxenus sublaevis and its host Leptothorax acervorum, indicating very localized coevolution. We found no absolute differences between slave-maker populations; the outcome of an encounter depended more on whether the two opponents occur in sympatry or allopatry. Furthermore, this study supports the results of our earlier work, that the unparasitized English L. acervorum population is most aggressive against the parasite. [source] DFT-GIAO 1H and 13C NMR prediction of chemical shifts for the configurational assignment of 6,-hydroxyhyoscyamine diastereoisomersMAGNETIC RESONANCE IN CHEMISTRY, Issue 7 2009Marcelo A. Muñoz Abstract 1H and 13C NMR chemical shift calculations using the density functional theory,gauge including/invariant atomic orbitals (DFT,GIAO) approximation at the B3LYP/6-311G++(d,p) level of theory have been used to assign both natural diastereoisomers of 6,-hydroxyhyoscyamine. The theoretical chemical shifts of the 1H and 13C atoms in both isomers were calculated using a previously determined conformational distribution, and the theoretical and experimental values were cross-compared. For protons, the obtained average absolute differences and root mean square (rms) errors for each comparison showed that the experimental chemical shifts of dextrorotatory and levorotatory 6,-hydroxyhyoscyamines correlated well with the theoretical values calculated for the (3R,6R,2,S) and (3S,6S,2,S) configurations, respectively, whereas for 13C atoms the calculations were unable to differentiate between isomers. The nature of the relatively large chemical shift differences observed in nuclei that share similar chemical environments between isomers was asserted from the same calculations. It is shown that the anisotropic effect of the phenyl group in the tropic ester moiety, positioned under the tropane ring, has a larger shielding effect over one ring side than over the other one. Copyright © 2009 John Wiley & Sons, Ltd. [source] Reproducibility of tricuspid regurgitant jet velocity measurements in children and young adults with sickle cell disease undergoing screening for pulmonary hypertension,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2010Robert I. Liem The reproducibility of tricuspid regurgitant jet velocity (TRJV) measurements by Doppler echocardiography has not been subjected to systematic evaluation among individuals with sickle cell disease (SCD) undergoing screening for pulmonary hypertension. We examined sources of disagreement associated with peak TRJV in children and young adults with SCD. Peak TRJV was independently measured and interpreted a week apart by separate sonographers and readers, respectively, in 30 subjects (mean age, 15.8 ± 3.3 years) who provided 120 observations. We assessed intra-/inter-reader, intra-/inter-sonographer, sonographer-reader, and within subject agreement using Intraclass Correlation Coefficient (ICC) and Cohen's kappa (,). Agreement was examined graphically using Bland-Altman plots. Although sonographers could estimate and measure peak TRJV in all subjects, readers designated tricuspid regurgitation nonquantifiable in 10,17% of their final interpretations. Intra-reader agreement was highest (ICC = 0.93 [95% CI 0.86, 0.97], P = 0.0001) and within subject agreement lowest (ICC = 0.36 [95% CI 0.02, 0.64], P = 0.021) for single TRJV measurements. Similarly, intra-reader agreement was highest (, = 0.74 [95% CI 0.53, 0.95], P = 0.0001) and within subject lowest (, = 0.14 [95% CI ,0.17, 0.46], P = 0.38) when sonographers and readers categorized TRJV measurements. On Bland-Altman plots, absolute differences in observations increased with higher mean TRJV readings for intra-/inter-reader agreement. Peak TRJV measurements in individual children and young adults with SCD are affected by several sources of disagreement, underscoring the need for methodological improvements that ensure reproducibility of this screening modality for making clinical decisions in this population. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||