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Larger Sample Sizes (larger + sample_size)
Selected AbstractsIncidental Lewy body disease: Clinical comparison to a control cohort,MOVEMENT DISORDERS, Issue 5 2010Charles H. Adler MD Abstract Limited clinical information has been published on cases pathologically diagnosed with incidental Lewy body disease (ILBD). Standardized, longitudinal movement and cognitive data was collected on a cohort of subjects enrolled in the Sun Health Research Institute Brain and Body Donation Program. Of 277 autopsied subjects who had antemortem clinical evaluations within the previous 3 years, 76 did not have Parkinson's disease, a related disorder, or dementia of which 15 (20%) had ILBD. Minor extrapyramidal signs were common in subjects with and without ILBD. Cognitive testing revealed an abnormality in the ILBD group in the Trails B test only. ILBD cases had olfactory dysfunction; however, sample size was very small. This preliminary report revealed ILBD cases have movement and cognitive findings that for the most part were not out of proportion to similarly assessed and age-similar cases without Lewy bodies. Larger sample size is needed to have the power to better assess group differences. © 2010 Movement Disorder Society [source] PROCEED: Prospective Obesity Cohort of Economic Evaluation and Determinants: baseline health and healthcare utilization of the US sample,DIABETES OBESITY & METABOLISM, Issue 12 2008A. M. Wolf Aim:, To summarize baseline characteristics, health conditions, resource utilization and resource cost for the US population for the 90-day period preceding enrolment, stratified by body mass index (BMI) and the presence of abdominal obesity (AO). Methods:, PROCEED (Prospective Obesity Cohort of Economic Evaluation and Determinants) is a multinational, prospective cohort of control (BMI 20,24.0 kg/m2), overweight (BMI 25,29.9 kg/m2) and obese (BMI , 30 kg/m2) subjects with AO and without AO [non-abdominal obesity (NAO)], defined by waist circumference (WC) >102 and 88 cm for males and females, respectively. Subjects were recruited from an Internet consumer panel. Outcomes were self-reported online. Self-reported anthropometric data were validated. Prevalence of conditions and utilization is presented by BMI class and AO within BMI class. Differences in prevalence and means were evaluated. Results:, A total of 1067 overweight [n = 474 (NAO: n = 254 and AO: n = 220)] and obese [n = 493 (NAO: n = 39 and AO: n = 454)] subjects and 100 controls were recruited. Self-reported weight (r = 0.92) and WC (r = 0.87) were correlated with measured assessments. Prevalence of symptoms was significantly higher in groups with higher BMI, as were hypertension (p < 0.0001), diabetes (p < 0.0001) and sleep apnoea (p < 0.0001). Metabolic risk factors increased with the BMI class. Among the overweight class, subjects with AO had significantly more reported respiratory, heart, nervous, skin and reproductive system symptoms. Overweight subjects with AO reported a significantly higher prevalence of diabetes (13%) compared with overweight subjects with NAO (7%, p = 0.04). Mean healthcare cost was significantly higher in the higher BMI classes [control ($456 ± 937) vs. overweight ($1084 ± 3531) and obese ($1186 ± 2808) (p < 0.0001)]. Conclusion:, An increasing gradient of symptoms, medical conditions, metabolic risk factors and healthcare utilization among those with a greater degree of obesity was observed. The independent effect of AO on health and healthcare utilization deserves further study with a larger sample size. [source] Is improved high speed performance following frusemide administration due to diuresis-induced weight loss or reduced severity of exercise-induced pulmonary haemorrhage?EQUINE VETERINARY JOURNAL, Issue S36 2006X. A. ZAWADZKAS Summary Reasons for performing study: Prerace administration of frusemide to horses has been linked with a significant improvement in racing performance, but the basis for this improvement is unclear. Objective: To test whether improved performance with prerace administration of frusemide is due to the drug's diuresis-induced weight loss rather than its apparent alleviation of exercise-induced pulmonary haemorrhage (EIPH). Methods: Eight thoroughbred horses underwent 3 trials in a random order, 2 or 3 weeks apart: control (C), frusemide/unburdened (FU), and frusemide/burdened (FB). None of the horses were known to have exhibited post-exercise epistaxis or endoscopic evidence of EIPH. Endoscope-guided bronchoalveolar lavages (BALs) were performed before and after each horse completed a standardised exercise test (SET) on an inclined treadmill to assess semi-quantitatively the volume of EIPH. For C, horses received an i.v. saline placebo injection (5 ml) and were unburdened while performing the SET. With FU, horses received frusemide (0.5 mg/kg) and were also unburdened. For FB, horses received frusemide and were burdened with weight equal to that lost during the 4 h post frusemide injection period. Erythrocyte number in BAL fluid, mass specific VO2max, time and distance for the entire SET as well as at maximum speed were recorded. A one-way repeated measures analysis of variance was conducted on all results. Results: Mass specific VO2max was significantly higher for the FU than for FB or C. Mass specific VO2max for FB and C were not different. More RBCs were found in BAL samples after C runs than after both FU and FB trial runs. Horses with the frusemide treatment (either burdened or unburdened) produced less EIPH than in the C trial, but their mass specific VO2max values were higher on the FU trial alone. For FU, horses ran longer at 115% VO2max than under C or FB conditions. Conclusion and potential relevance: Improvement of performance in the furosemide trials was due more to the weight-loss related effects of the drug than its apparent alleviation of EIPH. Further research is warranted with the same or similar project design, but with a larger sample size and with horses known to have more severe EIPH. [source] Health-related quality of life in patients with Primary Sjögren's Syndrome and Xerostomia: a comparative studyGERODONTOLOGY, Issue 1 2002Jocelyne Rostron Abstract Objective: To compare the health status of groups of Primary Sjögren's and Xerostomia patients, using the Medical Outcomes Short Form 36 (SF-36). The SF-36 is a generic measure, divided into eight domains, used in the assessment of health-related quality of life. Patients and methods: The SF-36 was given to 2 groups: Group 1 comprised 43 patients diagnosed with Primary Sjögren's Syndrome (1SS) and an unstimulated whole salivary flow rate (UFR) of <0.1 ml/min). Group 2 (n = 40) reported Xerosiomia but had an UFR >0.2 ml/min. Sub groups of patients in Groups 1 and 2 were compared with community normative data, for the SF-36 Results: There were trends to suggest lower SF36 scores for 1SS patients but there were no significant differences between the mean domain scores of Groups 1 and 2. 1SS and Xerostomia patients registered lower mean scores across all 8 domains, compared with normative community data. Conclusion: The SF-36 was unable to detect significant differences between subjects with 1SS and Xerostomia but a larger sample size is required to confirm these findings. The results of this limited study suggest that a disease-specific measure is required to assess the impact 1SS on health-related Quality of life (QOL). [source] BRCA1 and BRCA2 germline mutations in Korean patients with sporadic breast cancer,,HUMAN MUTATION, Issue 4 2004Jae Hong Seo Abstract In order to evaluate the role of BRCA1 and BRCA2 germline mutations in Korean patients with sporadic breast cancer, 97 patients with sporadic breast cancer were analyzed for mutations in the BRCA1 and BRCA2 coding regions, by using a combination of fluorescent-conformation sensitive gel electrophoresis (F-CSGE) and direct sequencing. Fifty-five distinct sequence variants were detected, which included three pathogenic truncating mutations, 15 missense mutations, 16 polymorphisms, and 21 intronic variants. Twenty-six of these variants have never been previously reported and may be of Korean-specific origin. Two pathogenic BRCA1 mutations (c.922_924delinsT, c.5445G>A) and one pathogenic BRCA2 mutation (c.2259delT) were observed, and two of these (BRCA1 c.5445G>A and BRCA2 c.2259delT) are novel. The total prevalence of germline pathogenic mutations in BRCA1 and/or BRCA2 in Korean sporadic breast cancer is estimated to be about 3.1%. Considering that the majority of breast cancer cases are sporadic, the present study will be helpful in the evaluation of the need for the genetic screening of germline BRCA mutations in sporadic breast cancer patients. Further study using a larger sample size is required to determine the merits of genetic diagnosis and counseling in breast cancer patients. © 2004 Wiley-Liss, Inc. [source] The efficacy of dietetic intervention in patients with chronic obstructive pulmonary diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008L. Bottle Background:, Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods:, Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann,Whitney U non parametric tests, paired t -tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results:, Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion:, An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none-the-less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion:, The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References, Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330,336. [source] Computer-aided detection of brain tumor invasion using multiparametric MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2009Todd R. Jensen PhD Abstract Purpose To determine the potential of using a computer-aided detection method to intelligently distinguish peritumoral edema alone from peritumor edema consisting of tumor using a combination of high-resolution morphological and physiological magnetic resonance imaging (MRI) techniques available on most clinical MRI scanners. Materials and Methods This retrospective study consisted of patients with two types of primary brain tumors: meningiomas (n = 7) and glioblastomas (n = 11). Meningiomas are typically benign and have a clear delineation of tumor and edema. Glioblastomas are known to invade outside the contrast-enhancing area. Four classifiers of differing designs were trained using morphological, diffusion-weighted, and perfusion-weighted features derived from MRI to discriminate tumor and edema, tested on edematous regions surrounding tumors, and assessed for their ability to detect nonenhancing tumor invasion. Results The four classifiers provided similar measures of accuracy when applied to the training and testing data. Each classifier was able to identify areas of nonenhancing tumor invasion supported with adjunct images or follow-up studies. Conclusion The combination of features derived from morphological and physiological imaging techniques contains the information necessary for computer-aided detection of tumor invasion and allows for the identification of tumor invasion not previously visualized on morphological, diffusion-weighted, and perfusion-weighted images and maps. Further validation of this approach requires obtaining spatially coregistered tissue samples in a study with a larger sample size. J. Magn. Reson. Imaging 2009;30:481,489. © 2009 Wiley-Liss, Inc. [source] Three-dimensional sonographic volume measurement of the fetal spleenJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2007Toshiyuki Hata Abstract Aim:, The objective of this longitudinal study was to evaluate the growth of the fetal spleen in normal pregnancies, using three-dimensional ultrasound. Methods:, Three-dimensional sonographic examinations were performed on 14 appropriate-for-gestational-age fetuses. Fetal splenic volume was measured every 2,3 weeks after 20 weeks of gestational age until delivery. Results:, Curvilinear relationships were found between the gestational age and splenic volume (R2 = 80.2%, P < 0.0001), and normal ranges of splenic volume measurements for estimating the growth of the fetal spleen during normal pregnancy were generated. We found that the splenic volume calculation based on the equation for the volume of the ellipsoid by conventional two-dimensional ultrasound in previous investigations is about twice as large as that using three-dimensional ultrasound in our study, whereas the present data described in this study is quite comparable with previous data from an autopsy series. Conclusion:, Our findings suggest that the standard curve for the fetal splenic volume using three-dimensional ultrasound provides a superior means for evaluating the normal splenic growth in the fetus and for identifying splenic abnormalities in utero. However, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings. [source] Is the Child Oral Health Quality of Life Questionnaire Sensitive to Change in the Context of Orthodontic Treatment?JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2008A Brief Communication Abstract Objective: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. Methods: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. Results: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and well-being. Conclusion: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure. [source] EVALUATION OF LENTIL TEXTURE MEASUREMENTS BY COMPRESSION TESTINGJOURNAL OF TEXTURE STUDIES, Issue 4 2000S. D. ARNTFIELD ABSTRACT The variability in texture for lentils of different size, from different locations and cooked for varying lengths of time was examined in relation to the sample size and the extent to which the sample was compressed during testing. The force to compress the lentils was found to be dependent on all variables examined and also demonstrated significant interactions between these variables. The coefficient of variability was dependent on the size of the lentil, a two-way interaction between sample size and compression and a three-way interaction between location, cooking time and sample size. Regardless of lentil size, location where the lentil was grown and the cooking time used, the variability in the texture readings was lowest when the larger sample size and maximum compression force were used. [source] Kinetics and Products of Molybdenum Disilicide Powder OxidationJOURNAL OF THE AMERICAN CERAMIC SOCIETY, Issue 2 2002Yuntian T. Zhu In this study, we investigated the kinetics and products of the oxidation of MoSi2 powder with an average particle size of 1.6 ,m at 900°, 1000°, and 1100°C, using a small sample size of 0.5 g. Such a small sample size allowed us to minimize the effect of oxygen transportation through the powder volume, while maintaining a good relative weighing accuracy. X-ray diffraction of oxidized samples indicated the formation of Mo5Si3 and Mo metal. Analysis of the oxidation kinetics suggested that gaseous MoO3 formed initially and amorphous SiO2 film later. The oxidation kinetics and products observed in this study differ from those reported in an early study, in which a larger sample size was used. [source] Comparison of Three Pebble Count Protocols (EMAP, PIBO, and SFT) in Two Mountain Gravel-Bed Streams,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 5 2009Kristin Bunte Abstract:, Although the term "pebble count" is in widespread use, there is no standardized methodology used for the field application of this procedure. Each pebble count analysis is the product of several methodological choices, any of which are capable of influencing the final result. Because there are virtually countless variations on pebble count protocols, the question of how their results differ when applied to the same study reach is becoming increasingly important. This study compared three pebble count protocols: the reach-averaged Environmental Monitoring and Assessment Program (EMAP) protocol named after the EMAP developed by the Environmental Protection Agency, the habitat-unit specific U.S. Forest Service's PACFISH/INFISH Biological Opinion (PIBO) Effectiveness Monitoring Program protocol, and a data-intensive method developed by the authors named Sampling Frame and Template (SFT). When applied to the same study reaches, particle-size distributions varied among the three pebble count protocols because of differences in sample locations within a stream reach and along a transect, in particle selection, and particle-size determination. The EMAP protocol yielded considerably finer, and the PIBO protocol considerably coarser distributions than the SFT protocol in the pool-riffle study streams, suggesting that the data cannot be used interchangeably. Approximately half of the difference was due to sampling at different areas within the study reach (i.e., wetted width, riffles, and bankfull width) and at different locations within a transect. The other half was attributed to using different methods for particle selection from the bed, particle-size determination, and the use of wide, nonstandard size classes. Most of the differences in sampling outcomes could be eliminated by using simple field tools, by collecting a larger sample size, and by systematically sampling the entire bankfull channel and all geomorphic units within the reach. [source] Proposals for 2001 samples of anonymized records: An assessment of disclosure riskJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 3 2001Angela Dale In 1991 Marsh and co-workers made the case for a sample of anonymized records (SAR) from the 1991 census of population. The case was accepted by the Office for National Statistics (then the Office of Population Censuses and Surveys) and a request was made by the Economic and Social Research Council to purchase the SARs. Two files were released for Great Britain,a 2% sample of individuals and a 1% sample of households. Subsequently similar samples were released for Northern Ireland. Since their release, the files have been heavily used for research and there has been no known breach of confidentiality. There is a considerable demand for similar files from the 2001 census, with specific requests for a larger sample size and lower population threshold for the individual SAR. This paper reassesses the analysis of Marsh and co-workers of the risk of identification of an individual or household in a sample of microdata from the 1991 census and also uses alternative ways of assessing risks with the 1991 SARs. The results of both the reassessment and the new analyses are reassuring and allow us to take the 1991 SARs as a base-line against which to assess proposals for changes to the size and structure of samples from the 2001 census. [source] Grb2-associated binder 1 (Gab1) genetic polymorphism, Helicobacter pylori infection, and chronic atrophic gastritis among older adults from GermanyMOLECULAR CARCINOGENESIS, Issue 10 2010Lei Gao Abstract Grb2-associated binder 1 (Gab1) plays an important role in the regulation of cell growth and transformation. A single nucleotide polymorphism (SNP) (rs3805246) in the Gab1 gene has been suggested to be related to the risk of Helicobacter pylori infection and chronic atrophic gastritis (CAG) in a study from Japan. We aimed to assess the associations in a population-based study from Germany. In the baseline examination of ESTHER, a population-based study conducted in Saarland, serum pepsinogen I and II and H. pylori serostatus were measured by ELISA. The Gab1 SNP (rs3805246) was genotyped in 351 serologically defined CAG cases and 351 age- and sex-matched non-CAG controls. A nonsignificant association was observed between the Gab1 SNP and CAG, with an adjusted odds ratio of 1.15 (0.85,1.55) for AA/AG carriers compared to GG carriers. The magnitude of the association did not change when the analysis was restricted to H. pylori seropositive subjects. Furthermore, no significant relation was found between the SNP and H. pylori seropositivity among non-CAG controls. We could not confirm a major association between Gab1 SNP (rs3805246) and the predisposition to H. pylori infection and CAG in this study population from Germany. Further studies with larger sample size are needed to clarify a potential modest effect of Gab1 genetic polymorphisms. © 2010 Wiley-Liss, Inc. [source] The de Quervain's screening tool: Validity and reliability of a measure to support clinical diagnosis and managementMUSCULOSKELETAL CARE, Issue 3 2008DipCOT, Rachel Batteson PhD Abstract Background:,Studies into the effectiveness of interventions for upper limb soft tissue disorders have been hampered by a lack of consistently used diagnostic criteria, meaning that comparison of research results is a problem. To aid homogeneous recruitment into a study of de Quervain's disease, a de Quervain's screening tool (DQST) was developed. This could also be used to facilitate clinical diagnosis and management in practice. Aims:,To provide evidence for the content and construct validity and test,retest and inter-rater reliability of the DQST. Method:,The study was conducted in an acute care, outpatient hand unit in a district general hospital. Three convenience samples of: 59 people with de Quervain's disease; 18 with carpal tunnel syndrome (CTS) and 16 with osteoarthritis (OA) of the carpometacarpal (CMC) joint were recruited. The DQST diagnostic criteria were initially generated from a literature review. Content validity was then established by expert doctors with an interest in upper limb musculoskeletal disorders (n = 7) rating the relevance of the seven items included. The DQST was then tested in people either already diagnosed with, or reported as having some of the symptoms of, de Quervain's disease. Construct validity was tested with people with CTS or OA of the CMC joint. Results:,The median DQST score was 5 (Interquartile range IQR = 4,6) out of a possible seven diagnostic criteria. Inter-rater reliability was excellent (Intra-class coefficient [ICC] = 0.85; 95% confidence interval [CI] = 0.75, 0.91). Test retest reliability was good (ICC = 0.64; 95% CI = 0.20, 0.87). Sensitivity (Se) and specificity (Sp) testing (Se = 1.00; Sp = 1.00) demonstrated that the DQST discriminated between people with de Quervain's disease, CTS or OA of the CMC joint. Conclusions:,The DQST is a valid, reliable tool which could be of assistance in aiding correct diagnosis for recruitment to clinical trials and in clinical practice. Future research is recommended to further examine retest reliability with a larger sample size and to identify the commonest diagnostic criteria required for inclusion. Copyright © 2008 John Wiley & Sons, Ltd. [source] Randomized, single-blind, trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorderPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2010Naghmeh Mokhber MD Aim:, Generalized anxiety disorder (GAD) in elderly people is common, but few systematic studies regarding the best treatments have been performed. The aim of the present study was to evaluate the efficacy and safety of sertraline and buspirone in the treatment of elderly patients with GAD. Methods:, Based on selection criteria, 46 patients were recruited who met DSM-IV criteria for GAD. Patients were randomly assigned to sertraline (50,100 mg/day) or buspirone (10,15 mg/day) for 8 weeks in a single-blind trial. The primary outcome measure used in the present study was the Hamilton Rating Scale for Anxiety (HRSA). Results:, Both sertraline and buspirone had significant anxiolytic efficacy. A steady decrease in the total HRSA scores for both groups was observed throughout the study period. After 2 and 4 weeks, buspirone was found to be significantly superior to sertraline (P < 0.001), but at the end of study period this difference did not reach statistical significance (P = 0.16). The mean HRSA score after 8 weeks significantly decreased in subjects treated with sertraline (P < 0.001), and buspirone (P < 0.001). No clinically adverse events or changes in laboratory test results were observed during the study period. Conclusion:, Both sertraline and buspirone appear to be efficacious and well tolerated in the treatment of GAD in elderly patients. Further studies with larger sample size, evaluating the effect of medical illness, cognitive impairment, depression, and combined therapy with support and psychotherapy are needed. [source] Quality of life in patients diagnosed with primary hepatocellular carcinoma: Hepatic arterial infusion of Cisplatin versus 90-Yttrium microspheres (Therasphere®)PSYCHO-ONCOLOGY, Issue 2 2004Jennifer Steel Background. The aims of the study were to test the difference in health-related quality (HRQL) of life and survival in patients diagnosed with primary hepatocellular carcionma (HCC) and treated with either hepatic arterial infusion (HAI) of Cisplatin or 90-Yttrium microspheres (Therasphere®). Method. The design of the study was a non-randomized parallel cohort study. Twenty-eight patients participated in the present study. HRQL was assessed by administration of the Functional Assessment of Cancer Therapy-Hepatobiliary. Survival was measured using Kaplan Meier methods. Results. The results of present study suggest treatment with Therasphere® had an advantage in regard to HRQL and survival when compared to Cisplatin. At 3-month follow-up, patients who were treated with Therasphere® had a higher level of functional well-being as well as overall quality of life when compared to patients treated with Cisplatin. At 6-month follow-up patients (treated with Therasphere®) continued to have better functional well-being when compared to patients being treated with HAI of Cisplatin. At 6-month follow-up, survival was found to be similar for patients treated with Therasphere® when compared to patients being treated with Cisplatin. Conclusions. Preliminary data suggest that treatment with Therasphere® has a modest advantage in regard to HRQL when compared patients treated with HAI of Cisplatin. Future research with Therasphere®, that includes a larger sample size and longer follow-up, is necessary to make definitive conclusions regarding the efficacy and effect on HRQL. Copyright © 2003 John Wiley & Sons, Ltd. [source] Effects of inhaled fluticasone propionate on CTLA-4-positive CD4+CD25+ cells in induced sputum in mild asthmaticsRESPIROLOGY, Issue 7 2008Tomotaka KAWAYAMA Background and objective: Cytotoxic T-lymphocyte antigen 4 (CTLA-4) signalling of regulatory T cells regulates mucosal lymphocyte tolerance and differentiation, and may therefore have a beneficial effect in allergic diseases such as asthma. The aim of this study was to evaluate the effects of fluticasone propionate (FP) on CD4+CD25+ T cell co-expression of CTLA-4 in the sputum of mild asthmatic subjects. Methods: Eleven mild, stable asthmatic subjects completed a double-blind, randomized, cross-over, placebo-controlled study to compare the effects of 14 days 200 µg twice daily FP and placebo. Before and after treatment, airway hyperresponsiveness was measured, and sputum was induced for measurements of CTLA-4+CD4+CD25+ cells, eosinophils and levels of IL-10, IL-13 and transforming growth factor (TGF)-, Results: FP treatment increased co-expression of CTLA-4 on sputum CD4+CD25+ cells from a mean (SEM) of 7.9% (1.8) to 12.7% (3.3) after 14 days treatment (P < 0.05) compared with placebo. FP treatment also significantly increased IL-10 levels, reduced per cent sputum eosinophils, and reduced airway hyperresponsiveness (P < 0.05). There was a significant negative correlation between the change in airway hyperresponsiveness and per cent sputum eosinophils (P < 0.01), but no correlation with changes in CTLA-4+CD4+CD25+ cells (P > 0.05). There was no change in the levels of sputum IL-13 or TGF-, Conclusions: The percentage of airway CTLA-4+CD4+CD25+ cells increased after FP treatment, coincident with improvements in airway inflammation and hyperresponsiveness. Whether improved asthma assessments are related to the increase in CTLA-4+CD4+CD25+ cells and thus improved regulation of T-cell tolerance and differentiation will require a larger sample size to determine. The normalization of CTLA-4+CD4+CD25+ cells in asthma may contribute to the management of this disease. [source] Searching for Links between Endotoxin Exposure and Pregnancy Loss: CD14 Polymorphism in Idiopathic Recurrent MiscarriageAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2003Jari Karhukorpi Problem: Lipopolysaccharide (LPS) (endotoxin) is a well-known inducer of abortions in mice. In addition it has been proposed that gut-derived LPS of gram-negative bacteria may play a role in triggering idiopathic recurrent miscarriage (IRM) in humans. CD14 is one of the key molecules that mediates the effects of LPS. Promoter region polymorphism (,159C/T) in the CD14 gene is functionally important by regulating CD14 levels. High-producing CD14 genotype (TT) associates with deleterious effects of gut-derived LPS in hepatic cirrhosis in humans. It is not known whether women with IRM are genetically more prone to suffer from toxic effects of LPS. Method of study: By using polymerase chain reaction we analyzed the CD14 promoter region polymorphism in 38 women with IRM and in 127 normal controls of Finnish origin. Results: There were no significant differences in the CD14(,159C/T) allele or the genotype frequencies between the IRM women and the controls. However, there was a trend associating the presence of the T allele with increased odds of miscarriage. Conclusions: Although we were not able to find a statistically significant association between CD14 genotypes and IRM in our relatively small study population, a further study with a larger sample size is warranted to explore the role of high-producing CD14 genotypes in IRM. Also studies highlighting environmental LPS triggers and other intrinsic mediators of LPS signalling are needed to solve the enigmatic role of LPS in IRM in humans. [source] Effect of inflammation on positive margins of basal cell carcinomasAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2010Neil Macpherson ABSTRACT Background/Objectives:, The use of preparations such as imiquimod in the treatment of basal cell carcinoma is well accepted. Imiquimod induces interferon-,, other cytokines, antigen-presenting cells and innate immunity, against tumour cells. The current study investigated whether the inflammation induced from a surgical procedure could have a similar effect on removing residual tumour after an excision. Method:, A retrospective audit was carried out on basal cell carcinoma removed in the Dermatology Clinic of the Royal Newcastle Centre in 2007. The end-point focussed on the features of those tumours which initially had a positive margin, but were found to have no remaining tumour on subsequent excision. Result:, A linear regression was carried out, revealing two significant predictors of outcome. These were the location of the basal cell carcinoma excision and the excision type. Punch biopsies and excisional biopsy had a greater number of histopathologically negative wider excisions despite initial positive margins. Facial lesions had a greater number of negative wider excisions. Conclusion:, The study has shown the majority of negative re-excisions were from lesions on the head which had had an initial surgical procedure. However, the evidence is not strong enough to advocate a protocol for dealing with positive margins. A larger sample size that encompassed all three factors that affect outcome, that is, the location of lesion, type of lesion and type of excision carried out, would be required in order to make a more definitive statement on protocol change for treatment of basal cell carcinoma. [source] Brain dysmorphology in individuals with severe prenatal alcohol exposureDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2001Sarah L Archibald MA Our previous studies revealed abnormalities on structural MRI (sMRI) in small groups of children exposed to alcohol prenatally. Microcephaly, disproportionately reduced basal ganglia volume, and abnormalities of the cerebellar vermis and corpus callosum were demonstrated. The present study used sMRI to examine in detail the regional pattern of brain hypoplasia resulting from prenatal exposure to alcohol using a higher resolution imaging protocol and larger sample sizes than reported previously. Fourteen participants (mean 11.4 years; eight females, six males) with fetal alcohol syndrome (FAS) and 12 participants (mean 14.8 years; four females, eight males) with prenatal exposure to alcohol (PEA) but without the facial features of FAS were compared to a group of 41 control participants (mean 12.8 years, 20 females, 21 males). Findings of significant microcephaly and disproportionately reduced basal ganglia volumes in the FAS group were confirmed. Novel findings were that in FAS participants, white matter volumes were more affected than gray matter volumes in the cerebrum, and parietal lobes were more affected than temporal and occipital lobes. Among subcortical structures, in contrast to the disproportionate effects on caudate nucleus, the hippocampus was relatively preserved in FAS participants. Differences between the PEA group and controls were generally non-significant; however, among a few of the structures most affected in FAS participants, there was some evidence for volume reduction in PEA participants as well, specifically in basal ganglia and the parietal lobe. There were no group differences in cerebral volume asymmetries. Severe prenatal alcohol exposure appears to produce a specific pattern of brain hypoplasia. [source] Platelet hyperactivity in clinical depression and the beneficial effect of antidepressant drug treatment: how strong is the evidence?ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2004R. Von Känel Objective:, Platelet hyperactivity is thought to contribute to the increased coronary artery disease (CAD) risk in depression. This study reviewed the evidence for hyperactive platelets and for effects of antidepressant drug treatment on platelet ,stickiness' in clinical depression. Method:, By means of PubMed electronic library search, 34 studies in English were identified (1983,2003) and critically reviewed. Results:, In depression, flow cytometry studies allowing detection of subtle platelet activation states consistently found at least one platelet activation marker to be increased, while the bulk of platelet aggregation studies did not suggest increased platelet aggregability. Platelets seem to be more activated in depressed patients with CAD than in depressed individuals without CAD. The selective serotonin reuptake inhibitors normalized platelet hyperactivity in four studies. Conclusion:, Data on platelet activity in depression are inconclusive. To resolve this issue and its clinical implications, studies in larger sample sizes controlling for confounders of platelet functioning and prospectively designed are needed. [source] Psycho-educational interventions for children and young people with Type 1 diabetesDIABETIC MEDICINE, Issue 9 2006H. R. Murphy Abstract Background, A systematic review of the literature in 2000 revealed numerous methodological shortcomings in education research, but in recent years progress has been made in the quantity and quality of psycho-educational intervention studies. Summary of contents, This review focuses on diabetes education programmes developed for children, young people and their families in the past 5 years. A comprehensive review of the literature identified 27 articles describing the evaluation of 24 psycho-educational interventions. Data summary tables compare the key features of these, and comparisons are made between individual, group and family-based interventions. Effect sizes are calculated for nine of the randomized studies. Three research questions are posed: firstly has the recent literature addressed the problems highlighted in the previous review; secondly is there sufficient evidence to recommend adaptation of a particular programme; and, finally, what do we still need to do? Conclusions, Progress in the quality and quantity of educational research has not resulted in improved effectiveness of interventions. There is still insufficient evidence to recommend adaptation of a particular educational programme and no programme that has been proven effective in randomized studies for those with poor glycaemic control. To develop a range of effective educational interventions, further research involving larger sample sizes with multicentre collaboration is required. [source] Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2007Ritin Fernandez RN MN (Critical care) PhD Candidate Abstract Background, The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established. Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low. Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors. Objectives, The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease. Search strategy, A literature search was performed using the following databases MEDLINE (1966,2006), CINAHL (1982,2006), EMBASE (1980,current) and up to the Cochrane Controlled Trials Register (Issue 2, 2006 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. Company representatives, experts and investigators were contacted to elicit further information. Selection criteria, All randomised and quasi-randomised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review. Data collection and analysis, Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, trials were considered separately. Main results, Seventeen trials involving a total of 4725 participants were included in the final review: three trials compared the effects of brief structured interventions on diet modification; seven on smoking cessation; and seven on multiple risk factors. Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification. Although there was a tendency for more participants in the intervention arm to lose weight at the 12-week follow up and achieve target cholesterol levels at the 6-month follow up, these results were not statistically significant. Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention. However, no difference in fish, fruit and vegetable intake between the groups was evident. Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation. There was no difference in the smoking cessation rates at the 3- and 6-week follow up, however, there was evidence of a benefit of brief structured interventions for smoking cessation at the 3-, 6- and 12-month follow up. In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups. In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake, weight loss and consequently on reduction in the body mass index, smoking cessation and physical activity among the participants. The findings concerning the effect on blood pressure, blood glucose levels and the lipid profile, however, remain inconclusive. Conclusions, There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease. This review, however, supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease. Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors. [source] Dundee Ready Education Environment Measure: psychometric testing with Chinese nursing studentsJOURNAL OF ADVANCED NURSING, Issue 12 2009Jian Wang Abstract Title.,Dundee Ready Education Environment Measure: psychometric testing with Chinese nursing students. Aim., This paper is a report of the psychometric testing of the Dundee Ready Education Environment Measure with Chinese nursing students. Background., Although the Dundee Ready Education Environment Measure has been widely used to measure educational environments in the healthcare professions, no psychometric evaluation of the measure with Chinese nursing students has been reported. Method., Data from 214 nursing students were collected during a 2-month period between December, 2004 and January, 2005. Exploratory factor analysis, internal consistency reliability and Cronbach's alpha were examined. Results., Five factors were found by principal components analysis with Oblimin with Kaiser Normalization rotation. The original factor names were maintained, but items in each factor changed. These five factors all achieved eigenvalues >1, and in total accounted for 52·186% of the variance. Cronbach's alpha ranged from 0·623 to 0·9 across factors, with an overall alpha of 0·949. Conclusion., The Chinese version of the Dundee Ready Education Environment Measure could be a valuable measurement for nursing educators in professional development programmes and nursing curriculum design. Further studies need in different Chinese nursing schools and larger sample sizes to be conducted to validate its stability and factor structure. [source] The Vulnerability of Middle-Aged and Elderly Patients to Hepatitis C Virus Infection in a High-Prevalence Hospital-Based Hemodialysis SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Anil K. Saxena MD Objectives: To determine the relationship between advancing age and the risk of acquiring hepatitis C virus (HCV) infection, through evaluation and statistical comparison of seroprevalence and seroconversion rates in different age groups of patients on long-term hemodialysis (HD). Design: Retrospective cohort study. Setting: Hemodialysis facility of King Fahad Hospital and Tertiary Care Center, Al-Hasa region of the eastern province of Saudi Arabia. Participants: One hundred ninety-eight patients with end-stage renal disease enrolled for long-term HD therapy from September 1995 to September 2000. Measurements: HCV seroprevalence and seroconversion rates. Results: The overall HCV seroprevalence of 43.4% (86/198) and seroconversion rate of 8.6% per year were recorded. Patients aged 55 to 64 had the highest anti-HCV prevalence (55.3% (26/47)) and annual seroconversion rates (11.0%). Those aged 65 to 74 had the next-highest prevalence (48.9% (24/49)) and seroconversion rate (9.7%), and patients aged 15 to 24 had the lowest prevalence (12.5% (1/8)) and seroconversion rate (2.5%) (reference group). Conclusion: Significantly higher annual seroconversion rates in those aged 55 to 64 and 65 to 74 during a shorter dialysis period (35.6 and 32.7 vs 58.0 months), suggest the greater susceptibility of the middle-aged and elderly patients to acquisition of HCV infection than the younger (15,24 years) group. This could be attributed to the combined effect of immunosuppression associated with advancing age, uremia, and undernutrition, but multicenter molecular follow-up studies with larger sample sizes would be needed to corroborate these findings and plan appropriate strategies for these high-risk groups. [source] Weighted Stair Climbing in Mobility-Limited Older People: A Pilot StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002MD Jonathan Bean MS OBJECTIVES: To evaluate weighted stair climbing exercise (SCE) as a means of increasing lower extremity muscle power in mobility-limited older people. DESIGN: Single-blinded, randomized controlled pilot study INTERVENTIONS: Subjects were randomized into one of two 12-week exercise programs. The intervention group (SCE) (n = 23) ascended and descended stairs, at a set pace, while wearing a weighted vest. The control group (WALK) (n = 22) participated in a standardized walking program. MEASUREMENTS: Primary and secondary outcomes included measures of muscle power and strength, submaximal aerobic capacity, and physical performance. RESULTS: SCE produced 17% improvement in double leg press peak power in comparison with WALK (P = .013) and significant improvement in stair climbing power from baseline (12%). Improvement in submaximal aerobic performance was equivalent for both groups. Although not statistically significant, effect size estimates suggest that SCE can potentially influence knee extension power and strength. Stair climb time was improved in both groups, whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants. CONCLUSIONS: These findings suggest that SCE may be a useful component of a home exercise program designed to enhance lower extremity muscle power, aerobic capacity, and functional performance. Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training. [source] ORIGINAL ARTICLE: Predicting species distributions from small numbers of occurrence records: a test case using cryptic geckos in MadagascarJOURNAL OF BIOGEOGRAPHY, Issue 1 2007Richard G. Pearson Abstract Aim, Techniques that predict species potential distributions by combining observed occurrence records with environmental variables show much potential for application across a range of biogeographical analyses. Some of the most promising applications relate to species for which occurrence records are scarce, due to cryptic habits, locally restricted distributions or low sampling effort. However, the minimum sample sizes required to yield useful predictions remain difficult to determine. Here we developed and tested a novel jackknife validation approach to assess the ability to predict species occurrence when fewer than 25 occurrence records are available. Location, Madagascar. Methods, Models were developed and evaluated for 13 species of secretive leaf-tailed geckos (Uroplatus spp.) that are endemic to Madagascar, for which available sample sizes range from 4 to 23 occurrence localities (at 1 km2 grid resolution). Predictions were based on 20 environmental data layers and were generated using two modelling approaches: a method based on the principle of maximum entropy (Maxent) and a genetic algorithm (GARP). Results, We found high success rates and statistical significance in jackknife tests with sample sizes as low as five when the Maxent model was applied. Results for GARP at very low sample sizes (less than c. 10) were less good. When sample sizes were experimentally reduced for those species with the most records, variability among predictions using different combinations of localities demonstrated that models were greatly influenced by exactly which observations were included. Main conclusions, We emphasize that models developed using this approach with small sample sizes should be interpreted as identifying regions that have similar environmental conditions to where the species is known to occur, and not as predicting actual limits to the range of a species. The jackknife validation approach proposed here enables assessment of the predictive ability of models built using very small sample sizes, although use of this test with larger sample sizes may lead to overoptimistic estimates of predictive power. Our analyses demonstrate that geographical predictions developed from small numbers of occurrence records may be of great value, for example in targeting field surveys to accelerate the discovery of unknown populations and species. [source] An exploratory study of anxiety in carers of stroke survivorsJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Nan Greenwood Aims and objectives., To investigate anxiety in informal carers of stroke survivors in the first three months after discharge. Background., Informal carers, also called caregivers, play a vital role in supporting stroke survivors. However, caring for stroke survivors can have adverse consequences amongst carers such as burden, stress and reduced quality of life. Emotional distress is also commonly reported but anxiety has received less attention than depression. Design., Prospective, longitudinal, descriptive study. Method., Forty-five carers completed the Hospital Anxiety and Depression Scale on two occasions , within one month and at three months after discharge from stroke and rehabilitation units. Results., Carers were more likely to have scores indicating anxiety than depression. In the first month, half the carers (51·1%) scored in the cut-off for anxiety and a third were in the cut-off for depression (31·1%). At three months, the picture was very similar with nearly identical proportions in the anxious and depressed categories (48·9% and 28·9%, respectively). Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores (p = 0·048). Fourteen carers (31·1%) at one month and eleven (24·4%) at three months fell into both anxious and depressed categories. Conclusions., Anxiety is a relatively neglected emotional outcome in stroke carers. Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months. Given the significant role carers play in rehabilitation of stroke survivors, greater recognition of their emotional state is required. Further, longitudinal research with larger sample sizes from a range of geographical areas and improved understanding of factors associated with anxiety is needed. Relevance to clinical practice., Nurses working in the community are ideally placed to identify and support carers suffering from anxiety. [source] How do implementation efforts relate to program adherence? examining the role of organizational, implementer, and program factorsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2008Jacinda K. Dariotis Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32 EBPPs and results indicate that target recipient responsivity, program material quality, implementer prioritization, community collaborative system support, and parental support significantly relate to program adherence. Several differences reached statistical significance, thereby highlighting the importance of these variables and the need for future studies with larger sample sizes to identify factors related to program adherence adequately. © 2008 Wiley Periodicals, Inc. [source] | ||||||||||||||||||||||||||||||||||