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Firm Evidence (firm + evidence)
Selected AbstractsPossible Interaction Between Aspirin and ACE Inhibitors: Update on Unresolved ControversyCONGESTIVE HEART FAILURE, Issue 6 2000Israel M. Barbash BmedSc The widespread use of aspirin and angiotensin converting enzyme (ACE) inhibitors in patients with coronary artery disease contributes significantly to the reduction in morbidity and mortality from this common health problem. These agents are widely and concomitantly used, and they share mechanisms that may interact in negative or positive pathways. Data derived from in vitro preparations, animal studies, human studies, and case-control studies are inconsistent. No study has established firm evidence regarding the safety or adverse effect of aspirin on patients who are on ACE inhibitors. The efficacy and safety of aspirin in combination with ACE inhibitors has been questioned and debated. If a negative interaction does exist, it will affect daily practice in treating patients with coronary artery disease and heart failure. This article reviews the available data regarding the safety of combined aspirin and ACE-inhibitor treatment among patients with ischemic heart disease, to assess the possible interaction between the two drugs and to discuss thesignificance and implications of the data. [source] DISRUPTING ILLEGAL FIREARMS MARKETS IN BOSTON: THE EFFECTS OF OPERATION CEASEFIRE ON THE SUPPLY OF NEW HANDGUNS TO CRIMINALS,CRIMINOLOGY AND PUBLIC POLICY, Issue 4 2005ANTHONY A. BRAGA Research Summary: The question of whether the illegal firearms market serving criminals and juveniles can be disrupted has been vigorously debated in policy circles and in the literature on firearms and violence. To the extent that prohibited persons, in particular, are supplied with guns through systematic gun trafficking, focused regulatory and investigative resources may be useful in disrupting the illegal supply of firearms to criminals. In Boston, a gun market disruption strategy was implemented that focused on shutting down illegal diversions of new handguns from retail sources. Multivariate regression analyses were used to estimate the effects of the intervention on new handguns recovered in crime. Our results suggest that focused enforcement efforts, guided by strategic analyses of ATF firearms trace data, can have significant impacts on the illegal supply of new handguns to criminals. Policy Implications: The problem-oriented policing approach provides an appropriate framework to uncover the complex mechanisms at play in illicit firearms markets and to develop tailor-made interventions to disrupt the illegal gun trade. Strategic enforcement programs focused on the illegal diversion of new firearms from primary markets can reduce the availability of new guns to criminals. However, the extent to which criminals substitute older guns for new guns and move from primary markets to secondary markets in response to an enforcement strategy focused on retail outlets remains unclear. Our evaluation also does not provide policy makers with any firm evidence on whether supply-side enforcement strategies have any measurable impacts on gun violence. Jurisdictions suffering from gun violence problems should implement demand-side violence prevention programs to complement their supply-side efforts. [source] GRADUAL VERSUS PUNCTUATED EQUILIBRIUM EVOLUTION IN THE TURKANA BASIN MOLLUSCS: EVOLUTIONARY EVENTS OR BIOLOGICAL INVASIONS?EVOLUTION, Issue 3 2008Bert Van Bocxlaer A running controversy in evolutionary thought was Eldredge and Gould's punctuated equilibrium model, which proposes long periods of morphological stasis interspersed with rapid bursts of dramatic evolutionary change. One of the earliest and most iconic pieces of research in support of punctuated equilibrium is the work of Williamson on the Plio-Pleistocene molluscs of the Turkana Basin. Williamson claimed to have found firm evidence for three episodes of rapid evolutionary change separated by long periods of stasis in a high-resolution sequence. Most of the discussions following this report centered on the topics of (eco)phenotypy versus genotypy and the possible presence of preservational and temporal artifacts. The debate proved inconclusive, leaving Williamson's reports as one of the empirical foundations of the paradigm of punctuated equilibrium. Here we conclusively show Williamson's original interpretations to be highly flawed. The supposed rapid bursts of punctuated evolutionary change represent artifacts resulting from the invasion of extrabasinal faunal elements in the Turkana palaeolakes during wet phases well known from elsewhere in Africa. [source] Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Vinidh Paleri MS FRCS (ORL-HNS) Abstract Background. The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. Methods. We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. Results. A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852,0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. Conclusions. The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Species richness, rarity and endemicity on Italian offshore islands: complementary signals from island-focused and species-focused analysesJOURNAL OF BIOGEOGRAPHY, Issue 4 2008Leonardo Dapporto Abstract Aims, To investigate the relative explanatory power of source faunas and geographical variables for butterfly incidence, frequency, richness, rarity, and endemicity on offshore islands. Location, The western Italian offshore islands (Italy and Malta). Methods, Thirty-one islands were examined. Data were taken from our own field surveys and from the literature. Two approaches were undertaken, described as island-focused and species-focused, respectively. Offshore islands were allocated to their neighbouring source landmasses (Italian Peninsula, Sicily and Sardinia,Corsica) and compared with each other for faunal attributes, source and island geography. Generalized linear and stepwise multiple regression models were then used to determine the relationships of island species richness, rarity and endemicity with potential geographical predictors and source richness, rarity, and endemicity (island-focused). Species frequency and incidence were assessed in relation to geographical and source predictors using stepwise linear and logistic regression, and inter-island associations were examined using K-Means clustering and non-metric scaling (species-focused). Results, The analysis reveals firm evidence for the influence of the nearest large landmass sources on island species assemblages, richness, rarity and endemicity. A clear distinction in faunal affinities occurs between the Sardinian islands and islands lying offshore from the Italian mainland and Sicily. Islands neighbouring these three distinct sources differ significantly in richness, rarity and endemicity. Source richness, rarity, and endemicity have explanatory power for island richness, rarity, and endemicity, respectively, and together with island geography account for a substantial part of the variation in island faunas (richness 59%, rarity 60% and endemicity 64%). Source dominates the logistic regression parameters predicting the incidence of island species [13 (38%) of 34 species that could be analysed]; three ecological factors (source frequency, flight period and maximal altitude at which species live) explained 75% of the variation in the occurrence of species on the islands. Species found more frequently on islands occurred more frequently at sources, had longer flight periods, and occurred at lower altitudes at the sources. The incidence of most species on islands (84%) is correctly predicted by the same three variables. Main conclusions, The Italian region of the Mediterranean Sea has a rich butterfly fauna comprising endemics and rare species as well as more cosmopolitan species. Analysis of island records benefited from the use of two distinct approaches, namely island-focused and species-focused, that sift distinct elements in island and source faunas. Clear contemporary signals appear in island,source relationships as well as historical signals. Differences among faunas relating to sources within the same region caution against assuming that contemporary (ecological) and historical (evolutionary) influences affect faunas of islands in different parts of the same region to the same extent. The implications of source,island relationships for the conservation of butterflies within the Italian region are considered, particularly for the long-term persistence of species. [source] Role of radiology in the treatment of malignant hilar biliary strictures 1: Review of the literatureJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2004Michael WJ Hii SUMMARY Malignant strictures of the biliary tree are an uncommon cause of obstructive jaundice. There are a number of pathological subtypes, but tumours in this region tend to have similar clinical and diagnostic features and therapeutic and prognostic implications. We review the published literature on this topic discussing diagnostic modalities and treatment options with a focus on radiological intervention. Diagnosis currently is best achieved using a range of procedures. Direct cholangiography remains the gold standard in delineating anatomy, but the invasiveness of this procedure limits its use as a purely diagnostic tool. Magnetic resonance technology, in particular magnetic resonance cholangiopancreatography, has an increasing role as accessibility is improved. Treatment of these tumours is difficult. Surgical resection and palliative biliary enteric bypass are the most common methods used with endoscopic and percutaneous therapies reserved for palliating patients not fit for surgery. There is little firm evidence to suggest that any one palliative modality is superior. Interventional radiology is particularly suitable for palliative management of difficult and expansive lesions as the anatomy can preclude easy access by surgical or endoscopic techniques. Good palliative results with minimal mortality and morbidity can be achieved with percutaneous stenting . [source] Infliximab treatment for symptomatic Crohn's disease stricturesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009A.-L. PELLETIER Summary Background, Some reports have suggested that infliximab may induce obstructive symptoms and, although there is no firm evidence, it is usually contra-indicated in-patients with Crohn's disease (CD) and strictures. Aims, To evaluate the effect of infliximab on symptomatic strictures of the small intestine in CD and to identify predictive factors of clinical response. Methods, This retrospective study included symptomatic patients treated with infliximab after conventional treatment had failed. The short-term (week 8) and long-term results were classified according to predefined criteria as complete, partial response, or failure. Results, Before infliximab, 18 patients had complete obstruction or intermittent chronic abdominal pain. Fourteen patients were treated by corticosteroids and 13 received immunosuppressive drugs. At week 8, complete, partial response and failure were observed in 10, 7 and 1 patients, respectively. Fourteen patients continued maintenance infliximab treatment after week 8. During the most recent evaluation (median follow-up: 18 months), 8 patients were on maintenance infliximab treatment; only eight were still on prednisone; there were five complete responses, 10 partial responses and three failures. Initiating prednisone or increasing its dosage was the only factor associated with a short-term complete response. Conclusions, Infliximab may be effective in patients with symptomatic strictures from CD, and should be tested before considering surgery. [source] Infant feeding and allergy prevention: a review of current knowledge and recommendations.ALLERGY, Issue 10 2009A EuroPrevall state of the art paper The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies. [source] Solving a sticky problem: new genetic approaches to host cell adhesion by the Lyme disease spirocheteMOLECULAR MICROBIOLOGY, Issue 5 2005Jenifer Coburn Summary The Lyme disease spirochetes, comprised of at least three closely related species, Borrelia burgdorferi, Borrelia garinii and Borrelia afzelii, are fascinating and enigmatic bacterial pathogens. They are maintained by tick-mediated transmission between mammalian hosts, usually small rodents. The ability of these bacteria, which have relatively small genomes, to survive and disseminate in both an immunocompetent mammal and in an arthropod vector suggests that they have evolved elegant and indispensable strategies for interacting with their hosts. Recognition of specific mammalian and tick tissues is likely to be essential for successful completion of the enzootic life cycle but, given the historical difficulties in genetic manipulation of these organisms, characterization of factors promoting cell adhesion has until recently largely been confined to either the manipulation of host cells or the analysis of potential bacterial ligands in the form of recombinant proteins. These studies have led to the identification of several mammalian receptors for Lyme disease spirochetes, including glycosaminoglycans, decorin, fibronectin and integrins, as well as a tick receptor for the bacterium, and also candidate cognate bacterial ligands. Recent advances in our ability to genetically manipulate Lyme disease spirochetes, particularly B. burgdorferi, are now providing us with firm evidence that these ligands indeed do promote bacterial adherence to host cells, and with new insights into the roles of these multifacted Borrelia,host cell interactions during mammalian and arthropod infection. [source] Large-scale cosmic homogeneity from a multifractal analysis of the PSCz catalogueMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 4 2000Jun Pan We investigate the behaviour of galaxy clustering on large scales using the PSCz catalogue. In particular, we ask whether there is any evidence of large-scale fractal behaviour in this catalogue. We find the correlation dimension in this survey varies with scale, consistent with other analyses. For example, our results on small and intermediate scales are consistent those obtained from the QDOT sample, but the larger PSCz sample allows us to extend the analysis out to much larger scales. We find firm evidence that the sample becomes homogeneous at large scales; the correlation dimension of the sample is D2=2.992±0.003 for r>30 h,1 Mpc. This provides strong evidence in favour of a universe that obeys the cosmological principle. [source] Levodopa in the treatment of Parkinson's disease: Current controversiesMOVEMENT DISORDERS, Issue 9 2004C. Warren Olanow Abstract Levodopa is the most effective symptomatic agent in the treatment of Parkinson's disease (PD) and the "gold standard" against which new agents must be compared. However, there remain two areas of controversy: (1) whether levodopa is toxic, and (2) whether levodopa directly causes motor complications. Levodopa is toxic to cultured dopamine neurons, and this may be a problem in PD where there is evidence of oxidative stress in the nigra. However, there is little firm evidence to suggest that levodopa is toxic in vivo or in PD. Clinical trials have not clarified this situation. Levodopa is also associated with motor complications. Increasing evidence suggests that they are related, at least in part, to the short half-life of the drug (and its potential to induce pulsatile stimulation of dopamine receptors) rather than to specific properties of the molecule. Treatment strategies that provide more continuous stimulation of dopamine receptors provide reduced motor complications in MPTP monkeys and PD patients. These studies raise the possibility that more continuous and physiological delivery of levodopa might reduce the risk of motor complications. Clinical trials to test this hypothesis are underway. We review current evidence relating to these areas of controversy. © 2004 Movement Disorder Society [source] The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in womenBJU INTERNATIONAL, Issue 1 2003H.M. Dallosso OBJECTIVES To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause. SUBJECTS AND METHODS A random sample of women aged , 40 years living at home took part in a prospective cohort study. Baseline data on urinary symptoms, diet and lifestyle were collected from 7046 women using a postal survey and food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 6424 of the women in a postal survey 1 year later. Logistic regression was used to investigate the association of food and drink consumption and other lifestyle factors with the incidence of overactive bladder and stress incontinence. RESULTS In the multivariate model for the onset of an overactive bladder, there were significantly increased risks associated with obesity, smoking and consumption of carbonated drinks, and reduced risks with higher consumption of vegetables, bread and chicken. Obesity and carbonated drinks were also significant risk factors for the onset of stress incontinence, while consumption of bread was associated with a reduced risk. CONCLUSIONS Causal associations with obesity, smoking and carbonated drinks are confirmed for bladder disorders associated with incontinence, and additional associations with diet are suggested. Behavioural modification of lifestyle may be important for preventing and treating these disorders. [source] Epilepsy: from consensus to daily practiceACTA NEUROLOGICA SCANDINAVICA, Issue 2003E. Ben-Menachem Most clinicians would accept that epilepsy treatment should begin with monotherapy, and in the majority of cases this is the preferred drug maintenance option. The clinical choice of one antiepileptic drug (AED) over another should be based on firm evidence of efficacy and tolerability as evaluated in comparative monotherapy studies and pharmacokinetics. This paper presents the findings of evidence-based reviews of AED monotherapy in patients newly diagnosed with epilepsy. The main study was conducted in the United Kingdom and investigated the clinical evidence supporting AEDs used as first-line monotherapy. In this paper the general treatment recommendations will focus on valproate, one of the mainstay drugs used in the fight against epilepsy. Finally, with these recommendations in mind, the principles behind AED drug selection in clinical practice will be discussed. Factors for consideration that impact on AED decision-making include: seizure and syndrome diagnosis, AED tolerability profiles, patient characteristics and pharmacokinetic/pharmacodynamic AED interactions. [source] Antibiotic treatment for five days is effective in children with acute cystitisACTA PAEDIATRICA, Issue 1 2002K Abrahamsson Short courses of antibiotics are often recommended to treat children with acute cystitis despite lack of firm evidence to support such management. The aim of this study therefore was to analyse the short-term outcome of such treatment. The retrospective analysis included 300 children (252F, 48M) fulfilling the criteria of first-time acute cystitis and managed according to a protocol recommending 5 d treatment. In 214 (71%) the treatment was given according to the protocol and in the others for 7 or 10 d. Nitrofurantoin was used in 150 (50%) and trimethoprim without or with sulfonamide in 129 (43%). The short-term results were excellent with 96% of the children being free from symptoms at the first follow-up visit after a median of 6 d. Only 2 girls had persisting bacteriuria and thus the frequency of bacteriological treatment failure was 1%. Recurrence within 30 d occurred in 4 girls (2%). Conclusion: A 5 d treatment with antibiotics is adequate in children with acute cystitis. Routine follow-up visits after a first acute cystitis may not be necessary, providing that the bacteria causing the infection are sensitive to the prescribed antibiotic and that there is no history of defective bladder or bowel emptying. [source] | |||||||||||||