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Sufficient Evidence (sufficient + evidence)
Selected AbstractsCLINICAL SCHOLARSHIP: Systematic Review of Educational Interventions for Improving Advance Directive CompletionJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010Christine R. Durbin RN Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed. [source] Classification of Anxiety and Depressive disorders: problems and solutionsDEPRESSION AND ANXIETY, Issue 4 2008G. Andrews MD Abstract The American Psychiatric Association and the World Health Organization have begun to revise their classifications of mental disorders. Four issues related to these revisions are discussed in this study: the structure of the classifications, the relationship between categories and dimensions, the sensitivity of categorical thresholds to definitions, and maximizing the utility and validity of the diagnostic process. There is now sufficient evidence to consider replacing the present groupings of disorders with an empirically based structure that reflects the actual similarities among disorders. For example, perhaps the present depression and anxiety disorders would be best grouped as internalizing disorders. Most mental disorders exist on a severity dimension. The reliability and validity of the classification might be improved if we accepted the dimensional nature of disorders while retaining the use of categorical diagnoses to enhance clinical utility. Definitions of the thresholds that define categories are very susceptible to detail. In International Classification of Diseases-11(ICD-11) and Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), disorders about which there is agreement should be identically defined, and disorders in which there is disagreement should be defined differently, so that research can identify which definition is more valid. The present diagnostic criteria are too complex to have acceptable clinical utility. We propose a reduced criterion set that can be remembered by clinicians and an enhanced criterion set for use with decision support tools. Depression and Anxiety 25:274,281, 2008. © 2008 Wiley-Liss, Inc. [source] The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression: a meta-analysisACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010P. Cuijpers Cuijpers P, van Straten A, Hollon SD, Andersson G. The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression: a meta-analysis. Objective:, Although there is sufficient evidence that combined treatments of psychotherapy and pharmacotherapy are more effective for depression in adults than each of the treatments alone, it remains unclear what the exact contribution of active medication is to the overall effects of combined treatments. This paper examines the contribution of active medication to combined psychotherapy and pharmacotherapy treatments. Method:, Meta-analysis of randomised controlled trials comparing the combination of psychotherapy and pharmacotherapy with the combination of psychotherapy and placebo. Results:, Sixteen identified studies involving 852 patients met our inclusion criteria. The standardised mean difference indicating the differences between the combination of psychotherapy and pharmacotherapy and the combination of psychotherapy and placebo was 0.25 (95% CI: 0.03,0.46), which corresponds to a numbers-needed-to-be-treated of 7.14. No significant differences between subgroups of studies were found. Conclusion:, Active medication has a small but significant contribution to the overall efficacy of combined treatments. [source] BENEFITS TO RESEARCH SUBJECTS IN INTERNATIONAL TRIALS: DO THEY REDUCE EXPLOITATION OR INCREASE UNDUE INDUCEMENT?DEVELOPING WORLD BIOETHICS, Issue 3 2008ANGELA BALLANTYNE ABSTRACT There is an alleged tension between undue inducement and exploitation in research trials. This paper considers claims that increasing the benefits to research subjects enrolled in international, externally-sponsored clinical trials should be avoided on the grounds that it may result in the undue inducement of research subjects. It proceeds from the premise that there are good grounds for thinking that, at least some, international research sponsors exploit trial participants because they do not provide the research population with a fair share of the benefits of research. This provides a prima facie argument for increasing the benefits for research participants. Concern over undue inducement is a legitimate moral concern; however, if this concern is to prevent research populations from receiving their fair share of benefits from research there must be sufficient evidence that these benefits will unduly influence patients' decision-making regarding trial participation. This article contributes to the debate about exploitation versus undue inducement by introducing an analysis of the available empirical research into research participants' motivations and the influence of payments on research subjects' behaviour and risk assessment. Admittedly, the available research in this field is limited, but the research that has been conducted suggests that financial rewards do not distort research subjects' behaviour or blind them to the risks involved with research. Therefore, I conclude that research sponsors should prioritise the prevention of exploitation in international research by providing greater benefits to research participants. [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] Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviewsADDICTION, Issue 5 2010Norah Palmateer ABSTRACT Aims To review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment in the prevention of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs). The interventions assessed were needle and syringe programmes (NSP), alternative modes of needle/syringe provision (pharmacies, vending machines and outreach) and the provision of injecting equipment other than needles/syringes. Methods Systematic searches of the English language literature to March 2007 were undertaken to identify systematic, narrative or meta-analytical reviews (also known as a review of reviews) of the impact of interventions on HCV transmission, HIV transmission or injecting risk behaviour (IRB). Critical appraisal criteria classified the reviews as either high quality (,core') or supplementary: a framework based on the quality of reviews, the reviewers' conclusions and the designs/findings of the primary studies was used to derive evidence statements. Results Three core and two supplementary reviews of injecting equipment interventions were identified. According to the proposed framework, this study found (a) insufficient evidence to conclude that any of the interventions are effective in preventing HCV transmission; (b) tentative evidence to support the effectiveness of NSP in preventing HIV transmission; (c) sufficient evidence to support the effectiveness of NSP (and tentative evidence of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d) little to no evidence on vending machines, outreach or providing other injecting equipment in relation to any of the outcomes. Conclusions The evidence is weaker than given credit for in the literature. The lack of evidence for effectiveness of NSP vis-à-vis biological outcomes (HCV and HIV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission. [source] Use of mechanistic data in IARC evaluationsENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 2 2008Vincent James Cogliano Abstract Consideration of mechanistic data has the potential to improve the analysis of both epidemiologic studies and cancer bioassays. IARC has a classification system in which mechanistic data can play a pivotal role. Since 1991, IARC has allowed an agent to be classified as carcinogenic to humans (Group 1) when there is less than sufficient evidence in humans but there is sufficient evidence in experimental animals and "strong evidence in exposed humans that the agent acts through a relevant mechanism of carcinogenicity." Mechanistic evidence can also substitute for conventional cancer bioassays when there is less than sufficient evidence in experimental animals, just as mechanistic evidence can substitute for conventional epidemiologic studies when there is less than sufficient evidence in humans. The IARC Monographs have used mechanistic data to raise or lower a classification that would be otherwise based on epidemiologic studies and cancer bioassays only. Recently, the IARC Monographs have evaluated several agents where mechanistic data were pivotal to the overall evaluation: benzo[a]pyrene, carbon black and other poorly soluble particles, ingested nitrates and nitrites, and microcystin-LR. In evaluating mechanistic data, it is important to consider alternative mechanistic hypotheses, because an agent may induce tumors through multiple mechanisms. Environ. Mol. Mutagen., 2008. © 2008 Wiley-Liss, Inc. [source] Mercury-induced reproductive impairment in fish,,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 5 2009Kate L. Crump Abstract Mercury is a potent neurotoxin, and increasing levels have led to concern for human and wildlife health in many regions of the world. During the past three decades, studies in fish have examined the effects of sublethal mercury exposure on a range of endpoints within the reproductive axis. Mercury studies have varied from highly concentrated aqueous exposures to ecologically relevant dietary exposures using levels comparable to those currently found in the environment. This review summarizes data from both laboratory and field studies supporting the hypothesis that mercury in the aquatic environment impacts the reproductive health of fish. The evidence presented suggests that the inhibitory effects of mercury on reproduction occur at multiple sites within the reproductive axis, including the hypothalamus, pituitary, and gonads. Accumulation of mercury in the fish brain has resulted in reduced neurosecretory material, hypothalamic neuron degeneration, and alterations in parameters of monoaminergic neurotransmission. At the level of the pituitary, mercury exposure has reduced and/or inactivated gonadotropin-secreting cells. Finally, studies have examined the effects of mercury on the reproductive organs and demonstrated a range of effects, including reductions in gonad size, circulating reproductive steroids, gamete production, and spawning success. Despite some variation between studies, there appears to be sufficient evidence from laboratory studies to link exposure to mercury with reproductive impairment in many fish species. Currently, the mechanisms underlying these effects are unknown; however, several physiological and cellular mechanisms are proposed within this review. [source] Wastewater treatment polymers identified as the toxic component of a diamond mine effluentENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2004Simone J. C. de Rosemond Abstract The EkatiÔ Diamond Mine, located approximately 300 km northeast of Yellowknife in Canada's Northwest Territories, uses mechanical crushing and washing processes to extract diamonds from kimberlite ore. The processing plant's effluent contains kimberlite ore particles (,0.5 mm), wastewater, and two wastewater treatment polymers, a cationic polydiallydimethylammonium chloride (DADMAC) polymer and an anionic sodium acrylate polyacrylamide (PAM) polymer. A series of acute (48-h) and chronic (7-d) toxicity tests determined the processed kimberlite effluent (PKE) was chronically, but not acutely, toxic to Ceriodaphnia dubia. Reproduction of C. dubia was inhibited significantly at concentrations as low as 12.5% PKE. Toxicity identification evaluations (TIE) were initiated to identify the toxic component of PKE. Ethylenediaminetetraacetic acid (EDTA), sodium thiosulfate, aeration, and solid phase extraction with C-18 manipulations failed to reduce PKE toxicity. Toxicity was reduced significantly by pH adjustments to pH 3 or 11 followed by filtration. Toxicity testing with C. dubia determined that the cationic DADMAC polymer had a 48-h median lethal concentration (LC50) of 0.32 mg/L and 7-d median effective concentration (EC50) of 0.014 mg/L. The anionic PAM polymer had a 48-h LC50 of 218 mg/L. A weight-of-evidence approach, using the data obtained from the TIE, the polymer toxicity experiments, the estimated concentration of the cationic polymer in the kimberlite effluent, and the behavior of kimberlite minerals in pH-adjusted solutions provided sufficient evidence to identify the cationic DADMAC polymer as the toxic component of the diamond mine PKE. [source] Report of the ILAE Classification Core GroupEPILEPSIA, Issue 9 2006Jerome Engel Jr Chair Summary:, A Core Group of the Task Force on Classification and Terminology has evaluated the lists of epileptic seizure types and epilepsy syndromes approved by the General Assembly in Buenos Aires in 2001, and considered possible alternative systems of classification. No new classification has as yet been proposed. Because the 1981 classification of epileptic seizure types, and the 1989 classification of epilepsy syndromes and epilepsies are generally accepted and workable, they will not be discarded unless, and until, clearly better classifications have been devised, although periodic modifications to the current classifications may be suggested. At this time, however, the Core Group has focused on establishing scientifically rigorous criteria for identification of specific epileptic seizure types and specific epilepsy syndromes as unique diagnostic entities, and is considering an evidence-based approach. The short-term goal is to present a list of seizure types and syndromes to the ILAE Executive Committee for approval as testable working hypotheses, subject to verification, falsification, and revision. This report represents completion of this work. If sufficient evidence subsequently becomes available to disprove any hypothesis, the seizure type or syndrome will be reevaluated and revised or discarded, with Executive Committee approval. The recognition of specific seizure types and syndromes, as well as any change in classification of seizure types and syndromes, therefore, will continue to be an ongoing dynamic process. A major purpose of this approach is to identify research necessary to clarify remaining issues of uncertainty, and to pave the way for new classifications. [source] Loudness dependence of evoked dipole source activity during acute serotonin challenge in femalesHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2008Christine Norra Abstract Objectives Direct challenge of cortical serotonergic (5-hydroxytryptamine, 5-HT) availability by tryptophan depletion test (TDT) was used to assess the hypothesized inverse relationship between central 5-HT function and loudness dependence of auditory evoked potentials (LDAEPs). Gender must be taken into particular account here, since there are gender differences in 5-HT brain synthesis, with women reacting more strongly to TDT. Methods In a double-blind, controlled cross-over study, 16 healthy females were ingested two highly concentrated amino acid mixtures with (+TRP) or without TRP (,TRP). While monitoring TRP levels and mood states, the AEP of different loudness stimuli were recorded, followed by dipole source analysis. Results Under the ,TRP condition, free plasma TRP levels decreased by 81.10% (±5.14). Most of the loudness change rates of the relevant N1/P2 tangential dipole activities were significantly increased under ,TRP, but calculated LDAEP did not differ significantly between treatments. LDAEP and states of mood were not correlated. Conclusions Despite strong TRP depletion, the results did not reach sufficient evidence that LDAEP is a valid biological marker of central 5-HT activity in females when using TDT. This agrees with the literature and supports the view that LDAEP indicates predominantly biological vulnerability in predisposed individuals. Copyright © 2007 John Wiley & Sons, Ltd. [source] Selenium effects: A weight-of-evidence approachINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2007Blair G McDonald Abstract Selenium is increasingly an issue for a wide range of mining, industrial, and agricultural operations. Appropriate methods for evaluating the impacts of selenium in aquatic ecosystems are vigorously debated in the literature. Two common approaches include the use of tissue residue guidelines and reproductive toxicity testing using field-collected fish; however, each approach on its own does not provide sufficient evidence that wild fish populations are in fact impaired. The limitations of each method are discussed, and recommendations to improve the relevance of each line of evidence are provided. A 3rd line of evidence, field measurement of fish population dynamics, is proposed and also discussed. A framework, consistent with an ecological risk assessment methodology, for the design, application, and interpretation of selenium weight-of-evidence investigations is proposed. [source] Dietary acrylamide and human cancerINTERNATIONAL JOURNAL OF CANCER, Issue 2 2006Claudio Pelucchi Abstract Low levels of acrylamide have been found in several foods cooked at high temperatures. While there is sufficient evidence for the carcinogenicity of acrylamide in experimental animals, the few epidemiologic studies conducted to date on occupational and dietary exposure to acrylamide have found no consistent evidence of association with human cancer risk. Using data from an integrated network of Italian and Swiss hospital-based case-control studies, we analyzed the relation between dietary acrylamide intake and cancers of the oral cavity and pharynx (749 cases, 1,772 controls), esophagus (395 cases, 1,066 controls), large bowel (1,394 cases of colon, 886 cases of rectal cancer, 4,765 controls), larynx (527 cases, 1,297 controls), breast (2,900 cases, 3,122 controls), ovary (1,031 cases, 2,411 controls) and prostate (1,294 cases, 1,451 controls). All the studies included incident, histologically confirmed cancer cases and controls admitted to the same network of hospitals for acute nonneoplastic conditions. We calculated odds ratios (ORs) using multivariate logistic regression models, adjusted for energy intake and other major covariates of interest. The ORs for the highest versus the lowest quintile of acrylamide intake were 1.12 (95% CI = 0.76,1.66) for cancer of the oral cavity/pharynx, 1.10 (95% CI = 0.65,1.86) for esophageal, 0.97 (95% CI = 0.80,1.18) for colorectal, 1.23 (95% CI = 0.80,1.90) for laryngeal, 1.06 (95% CI = 0.88,1.28) for breast, 0.97 (95% CI = 0.73,1.31) for ovarian and 0.92 (95% CI = 0.69,1.23) for prostate cancer. None of the trend in risk was significant. This uniquely large and comprehensive data set does not show any consistent association between intake of acrylamide and the risk of breast and several other common cancers. © 2005 Wiley-Liss, Inc. [source] Scheduling considerations for a branching transit routeJOURNAL OF ADVANCED TRANSPORTATION, Issue 3 2004Aichong Sun This paper addresses the impacts of different scheduling alternatives for a branching transit route. It examines different schedule alternatives that might be used to optimize the route performance in terms of the passenger traveling time distributed among branch passengers and trunk-line passengers. The schedule alternatives considered include transit vehicle allocation to different branches, offset shifting across vehicles on different branches, and vehicle holding (slack time) in the transit vehicle schedule. With these variables, several vehicle schedules are devised and examined based on a wide variety of possible passenger boarding scenarios using deterministic service models. Test outcomes provide general conclusions about the performance of the strategies. Vehicle assignment leading to even headways among branches is generally preferred for the case of low passenger demand. However, when passenger demand is high, or the differences between the passenger demands on branches are significant, unequal vehicle assignment will be helpful to improve the overall route performance. Holding, as a proactive strategy in scheduling, has the potential to be embedded into the schedule as a type of slack time, but needs further evidence and study to determine the full set of conditions where it may be beneficial. Offset shifting does not show sufficient evidence to be an efficient strategy to improve route performance in the case of low or high passenger demand. [source] Improving the design and management of forest strips in human-dominated tropical landscapes: a field test on Amazonian dung beetlesJOURNAL OF APPLIED ECOLOGY, Issue 4 2010Jos Barlow Summary 1.,The future of tropical forest species depends in part on their ability to survive in human-modified landscapes. Forest strips present a priority area for biodiversity research because they are a common feature of many managed landscapes, are often afforded a high level of legal protection, and can provide a cost-effective and politically acceptable conservation strategy. 2.,Despite the potential conservation benefits that could be provided by forest strips, ecologists currently lack sufficient evidence to inform policy and guide their design and management. 3.,We used a quasi-experimental landscape in the Brazilian Amazon to test the importance of four management-relevant variables (forest type, isolation distance, forest structure, and large mammal activity) on the potential biodiversity conservation value of narrow forest strips for dung beetles. 4.,Information-theoretic model selection based on AICc revealed strong support for the influence of large mammal activity and forest type on dung beetle abundance; isolation distance on species richness; and forest structure on the relative abundance of matrix-tolerant species. Multi-dimensional scaling showed a strong influence of forest type and isolation on community composition and structure, with riparian and dry-land strips having complementary sets of species. 5.,Synthesis and applications. To enhance the conservation value and ecological integrity of forest strips in human-modified landscapes we recommend that strip design considers both isolation distance and whether or not the strips encompass perennial streams. In addition, we identify the maintenance of forest structure and the protection of large mammal populations as being crucially important for conserving forest dung beetle communities. [source] A review of outcomes of individualised nursing interventions on adult patientsJOURNAL OF CLINICAL NURSING, Issue 7 2008Riitta Suhonen PhD Aims and objectives., This review describes the outcomes of individualised nursing interventions on adult patients. Background., Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. Methods., A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre- and posttest controlled studies. After a four-stage inclusion strategy 31 documents were accepted for the review. Results., The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. Conclusions., There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non-individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice., Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes. [source] Differentiation of morphology, genetics and electric signals in a region of sympatry between sister species of African electric fish (Mormyridae)JOURNAL OF EVOLUTIONARY BIOLOGY, Issue 4 2008S. LAVOUÉ Abstract Mormyrid fishes produce and sense weak electric organ discharges (EODs) for object detection and communication, and they have been increasingly recognized as useful model organisms for studying signal evolution and speciation. EOD waveform variation can provide important clues to sympatric species boundaries between otherwise similar or morphologically cryptic forms. Endemic to the watersheds of Gabon (Central Africa), Ivindomyrus marchei and Ivindomyrus opdenboschi are morphologically similar to one another. Using morphometric, electrophysiological and molecular characters [cytochrome b sequences and amplified fragment length polymorphism (AFLP) genotypes], we investigated to what extent these nominal mormyrid species have diverged into biological species. Our sampling covered the known distribution of each species with a focus on the Ivindo River, where the two taxa co-occur. An overall pattern of congruence among datasets suggests that I. opdenboschi and I. marchei are mostly distinct. Electric signal analysis showed that EODs of I. opdenboschi tend to have a smaller initial head-positive peak than those of I. marchei, and they often possess a small third waveform peak that is typically absent in EODs of I. marchei. Analysis of sympatric I. opdenboschi and I. marchei populations revealed slight, but significant, genetic partitioning between populations based on AFLP data (FST , 0.04). Taken separately, however, none of the characters we evaluated allowed us to discriminate two completely distinct or monophyletic groups. Lack of robust separation on the basis of any single character set may be a consequence of incomplete lineage sorting due to recent ancestry and/or introgressive hybridization. Incongruence between genetic datasets in one individual, which exhibited a mitochondrial haplotype characteristic of I. marchei but nevertheless fell within a genetic cluster of I. opdenboschi based on AFLP genotypes, suggests that a low level of recent hybridization may also be contributing to patterns of character variation in sympatry. Nevertheless, despite less than perfect separability based on any one dataset and inconclusive evidence for complete reproductive isolation between them in the Ivindo River, we find sufficient evidence to support the existence of two distinctive species, I. opdenboschi and I. marchei, even if not ,biological species' in the Mayrian sense. [source] Trace Element Fingerprinting of Australian Ocher Using Laser Ablation Inductively Coupled Plasma-Mass Spectrometry (LA-ICP-MS) for the Provenance Establishment and Authentication of Indigenous Art,JOURNAL OF FORENSIC SCIENCES, Issue 4 2007Rachel L. Green B.Sc. Abstract:, The expansion of indigenous art and the interest it has generated both at a domestic and international level means large monetary transactions are taking place between art galleries or centers and purchasers. As such, an accurate and conclusive method for provenance determination of traditional indigenous artistic materials must be established that can, if necessary, be used to assist in authentication of artworks. Laser ablation inductively coupled plasma mass spectrometry was utilized for elemental differentiation and provenance establishment of ocher samples. This research was used to develop a robust scientific protocol which facilitates definitive and accurate determination of provenance of Australian ochers and the artworks created using them. Analysis of the results obtained through this study show that the trace metal distribution patterns alone appear to be sufficient evidence to establish provenance of specific ochers, although additional differentiation between ocher samples, using major element distribution patterns, was achieved through the utilization of X-ray analytical techniques. [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] Using the chronic care model to tackle depression among older adults who have long-term physical conditionsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2007P. MCEVOY phd bsc Effective psychological and pharmacological treatments are available, but for depressed older adults with long-term physical conditions, the outcome of routine care is generally poor. This paper introduces the chronic care model, a systemic approach to quality improvement and service redesign, which was developed by Ed Wagner and colleagues. The model highlights six key areas that need to be addressed, if depression is to be tackled more effectively in this neglected patient group: delivery system design, patient,provider relationships, decision support, clinical information systems, community resources and healthcare organization. Three influential programmes, the Improving Mood Promoting Access to Collaborative Treatment programme, the Prevention of Suicide in Primary Care Elderly Collaborative Trial, and the Program to Encourage Active, and Rewarding Lives for Seniors, have shown that when the model is adopted, significant improvements in outcomes can be achieved. The paper concludes with a case study, which illustrates the difference that adopting the chronic care model can make. Radical changes in working practices may be required, to implement the model in practice. However, Greg Simon, a leading researcher in the field of depression care, has suggested that there is already sufficient evidence to justify a shift in emphasis from research towards dissemination and implementation. [source] Alcohol, Psychological Dysregulation, and Adolescent Brain DevelopmentALCOHOLISM, Issue 3 2008Duncan B. Clark While adolescent alcohol consumption has been asserted to adversely alter brain development, research in human adolescents has not yet provided us with sufficient evidence to support or refute this position. Brain constituents actively developing during adolescence include the prefrontal cortex, limbic system areas, and white matter myelin. These areas serving cognitive, behavioral, and emotional regulation may be particularly vulnerable to adverse alcohol effects. Alternatively, deficits or developmental delays in these structures and their functions may underlie liability to accelerated alcohol use trajectories in adolescence. This review will describe a conceptual framework for considering these relationships and summarize the available studies on the relationships among risk characteristics, alcohol involvement and brain development during this period. The cross-sectional designs and small samples characterizing available studies hamper definitive conclusions. This article will describe some of the opportunities contemporary neuroimaging techniques offer for advancing understanding of adolescent neurodevelopment and alcohol involvement. [source] Treatment of chronic hepatitis C in polytransfused thalassaemic patients: a meta-analysisJOURNAL OF VIRAL HEPATITIS, Issue 4 2010S.-M. Alavian Summary., Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassaemic patients. In order to analyse the effect of the current anti-HCV treatment in this subset of HCV-infected patients, we conducted a systematic review with meta-analysis of the available literature. The outcome was sustained viral response. Both comparative [odds ratio (OR)] and non-comparative indeces (success rate) were used to run the meta-analytical procedure. Data encompassing 429 thalassaemic HCV-infected patients treated with conventional or pegylated interferon monotherapy or combination therapy with ribavirin were collected from 13 articles (10 prospective cohort studies, 1 randomized-controlled trial and 2 controlled trials). Pooled sustained viralogical response (SVR) was 44.7% (34.6,54.9). Pooled ORs of SVR for Genotype 1 vs non-Genotype 1 infected thalassaemic patients were 0.46 (95% CI: 0.22,0.95) in IFN monotherapy and 1.7 (95% CI: 0.46,6.04) in ribavirin combination therapy. Our meta-analysis shows that thalassaemic patients with Genotype 1 infection significantly benefit from the addition of ribavirin to their therapeutic regimen. It seems that using ribavirin in thalassaemic patients increases transfusion need by a median of 30,40%, but does not increase major adverse events or treatment withdrawal. Current literature is lacking sufficient evidence about the use of PEG-IFN as monotherapy or in combination with ribavirin in thalassaemic patients. [source] Introduction of the flash-lamp pulsed-dye laser treatment of facial port-wine stains in childhood: A case of health care technology assessmentLASERS IN SURGERY AND MEDICINE, Issue 2 2001C.A.J.M. De Borgie MSc Abstract Background and Objective Lasers have been used in the treatment of port-wine stains (PWS) for more than 30 years. With the introduction of the flash-lamp pulsed-dye laser (FPDL) it was assumed that infants could be treated safely, effectively, and probably more efficiently. Nowadays, FPDL treatment is an established form of treatment of PWS in childhood. Study Design/Materials and Methods On the basis of the iterative Health Care Technology Assessment (HCTA) loop, we examined whether sufficient evidence from evaluations has been present to support the introduction of FPDL treatment for facial PWS at an early age. Such an assessment requires an interdisciplinary approach focusing on aspects of safety, efficacy, effectiveness, quality of life, costs, and the ethical issues of treatment. Results Assessment of the FPDL in PWS treatment of children did not follow the model of medical innovation and evaluation. Most assessments have been focused on laser applications that were already in clinical use. Efficacy and effectiveness of laser treatment have been the major concern in most assessments. Only a few studies have looked at costs and ethical aspects of treating children. Conclusions The introduction and diffusion of the use of the FPDL in the treatment of PWS in childhood were uncontrolled, and the field was not prepared to use this technique properly. We believe that this nonadherence to the iterative HCTA model reflects the gradual way by which innovations find their way into clinical practice. Lasers Surg. Med. 28:182,189, 2001. © 2001 Wiley-Liss, Inc. [source] The Ordovician Biodiversification: revolution in the oceanic trophic chainLETHAIA, Issue 2 2008THOMAS SERVAIS The Early Palaeozoic phytoplankton (acritarch) radiation paralleled a long-term increase in sea level between the Early Cambrian and the Late Ordovician. In the Late Cambrian, after the SPICE ,13Ccarb excursion, acritarchs underwent a major change in morphological disparity and their taxonomical diversity increased to reach highest values during the Middle Ordovician (Darriwilian). This highest phytoplankton diversity of the Palaeozoic was possibly the result of palaeogeography (greatest continental dispersal) and major orogenic and volcanic activity, which provided maximum ecospace and large amounts of nutrients. With its warm climate and high atmospheric CO2 levels, the Ordovician was similar to the Cretaceous: a period when phytoplankton diversity was at its maximum during the Mesozoic. With increased phytoplankton availability in the Late Cambrian and Ordovician a radiation of zooplanktonic organisms took place at the same time as a major diversification of suspension feeders. In addition, planktotrophy originated in invertebrate larvae during the Late Cambrian,Early Ordovician. These important changes in the trophic chain can be considered as a major palaeoecological revolution (part of the rise of the Palaeozoic Evolutionary Fauna of Sepkoski). There is now sufficient evidence that this trophic chain revolution was related to the diversification of the phytoplankton, of which the organic-walled fraction is partly preserved. [source] The pyroxene pallasites, Vermillion and Yamato 8451: Not quite a coupleMETEORITICS & PLANETARY SCIENCE, Issue 4 2000Joseph S. BOESENBERG Both meteorites contain low-Ca and high-Ca pyroxenes (<2% by volume) and have been dubbed "pyroxene pallasites." Pyroxene occurs as large individual grains, as inclusions in olivine and in other pyroxene, and as grains along the edges of olivine. Symplectic overgrowths, sometimes found in Main Group and Eagle Station pallasites, are not seen in the pyroxene pallasites. Olivine compositions are Fa10,12, similar to those of Main Group pallasites. Siderophile trace element data show that metal in the two meteorites have significantly differing compositions that are, for many elements, outside the range of the Main Group and Eagle Station pallasites. These compositions also differ from those of IAB and IIIAB iron meteorites. Rare earth element (REE) patterns in merrillite are similar to those seen in other pallasites, indicating formation by subsolidus reaction between metal and silicate, with the merrillite inheriting its pattern from the surrounding silicates. The O-isotopic compositions of Vermillion and Y-8451 are similar but differ from Main Group or Eagle Station pallasites, as well as other achondrite and primitive achondrite groups. Although Vermillion and Y-8451 have similar mineralogy, pyroxene compositions, REE patterns, and O-isotopic compositions, there is sufficient evidence to resist formally grouping these two meteorites. This evidence includes the texture of Vermillion, siderophile trace element data, and the presence of cohenite in Vermillion. [source] Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice,,MOVEMENT DISORDERS, Issue 16 2008Claudia Trenkwalder MD Abstract Only in the last three decades, the restless legs syndrome (RLS) has been examined in randomized controlled trials. The Movement Disorder Society (MDS) commissioned a task force to perform an evidence-based review of the medical literature on treatment modalities used to manage patients with RLS. The task force performed a search of the published literature using electronic databases. The therapeutic efficacy of each drug was classified as being either efficacious, likely efficacious, investigational, nonefficacious, or lacking sufficient evidence to classify. Implications for clinical practice were generated based on the levels of evidence and particular features of each modality, such as adverse events. All studies were classed according to three levels of evidence. All Level-I trials were included in the efficacy tables; if no Level-I trials were available then Level-II trials were included or, in the absence of Level-II trials, Level-III studies or case series were included. Only studies published in print or online before December 31, 2006 were included. All studies published after 1996, which attempted to assess RLS augmentation, were reviewed in a separate section. The following drugs are considered efficacious for the treatment of RLS: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Drugs considered likely efficacious are rotigotine, bromocriptine, oxycodone, carbamazepine, valproic acid, and clonidine. Drugs that are considered investigational are dihydroergocriptine, lisuride, methadone, tramadol, clonazepam, zolpidem, amantadine, and topiramate. Magnesium, folic acid, and exercise are also considered to be investigational. Sumanirole is nonefficacious. Intravenous iron dextran is likely efficacious for the treatment of RLS secondary to end-stage renal disease and investigational in RLS subjects with normal renal function. The efficacy of oral iron is considered investigational; however, its efficacy appears to depend on the iron status of subjects. Cabergoline and pergolide (and possibly lisuride) require special monitoring due to fibrotic complications including cardiac valvulopathy. Special monitoring is required for several other medications based on clinical concerns: opioids (including, but not limited to, oxycodone, methadone and tramadol), due to possible addiction and respiratory depression, and some anticonvulsants (particularly, carbamazepine and valproic acid), due to systemic toxicities. © 2008 Movement Disorder Society [source] Critical review of the World Health Organization's (WHO) 2007 report on ,evidence of the long-term effects of breastfeeding: systematic reviews and meta-analysis' with respect to obesityOBESITY REVIEWS, Issue 6 2008M. B. Cope Summary Obesity among children and adults has become a highly recognized public health concern and there is an increasing need to discover causes and evaluate preventative measures. One putatively causal influence on obesity is breastfeeding (BF). The World Health Organization (WHO) recently published a report (WR) on ,Evidence of the Long-Term Effects of Breastfeeding: Systematic Reviews and Meta-Analysis' and concluded ,that the evidence suggests that breastfeeding may have a small protective effect[emphasis added] on the prevalence of obesity . . . [and] the effect of breastfeeding was not likely to be due to publication bias or confounding.' Here we provide a critical overview of the WR's section on BF and obesity by addressing eight questions: Q1: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity in children? Q2: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity among breastfed offspring once they reach adulthood? Q3: If there are such associations, what are their magnitudes in comparison with other putatively causal factors and with respect to the potential impact on individual or population levels of obesity? Q4: Is there sufficient evidence to conclude that BF causes a reduction in risk of obesity during childhood? Q5: Is there sufficient evidence to conclude that BF does not cause a reduction in risk of obesity during childhood? Q6: Is there sufficient evidence to conclude that BF causes a long-term reduction in risk of obesity that persists into adulthood? Q7: Is there sufficient evidence to conclude that BF does not cause a long-term reduction in risk of obesity that persists into adulthood? Q8: What further research might be done to address these questions? We conclude that, while BF may have benefits beyond any putative protection against obesity, and benefits of BF most likely outweigh any harms, any statement that a strong, clear or consistent body of evidence shows that BF causally reduces the risk of overweight or obesity is unwarranted at this time. [source] Aestheticized Politics,1 or the Long Shadow of Ernst Jünger's "Old Testament?"ORBIS LITERARUM, Issue 1 2000Karlheinz Hasselbach In his "Old Testament," inasmuch as its legacy crystallizes in the essay The Worker (1932), Jünger conceives of an anti-bourgeois, technological society whose signature is the rule of soldier cum technocrat. Without renouncing its theories, the author appears to reverse himself in his subsequent writings, notably in the fictitious works On the Marble Cliffs (1939) and Heliopolis (1949). However, the aestheticism of the essay also informs his later fiction, both casting doubt on the nature of the reversal and handicapping a proper appreciation of the author's politics. It will be argued that, while Jünger's aesthetic perception of reality has evolved intact from his "Old Testament," there is sufficient evidence in both his writing and conduct to contradict the captivating notion that aestheticized politics equals fascism. [source] The Agreement on Trade-Related Aspects of Intellectual Property Rights Flexibilities on Intellectual Property Enforcement: The World Trade Organization Panel Interpretation of China-Intellectual Property Enforcement of Criminal Measures and Its ImplicationsTHE JOURNAL OF WORLD INTELLECTUAL PROPERTY, Issue 5 2010Xuan Li Criminal procedure is one of the three major points in the China-Intellectual Property (IP) case brought about by the United States. A number of experts believed that United States failed on this point because of lack of sufficient evidence. However, the author is of the view that the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) text-based interpretation of IP enforcement flexibility served as the core of the panel decision. This article starts with the criminal thresholds of China's criminal laws, and focuses on analysing the interpretation by the panel on the scope of responsibility and its limitations as enshrined in article 61, which led to the conclusion that the essence of the dispute is how to interpret and determine "IP enforcement flexibility". On this basis, the article expounds the concept and content of the "IP enforcement flexibility" and highlights the implications of this concept on current international TRIPS-plus initiatives. Some implications are given on how the World Trade Organization members can take advantage of the enforcement flexibility to serve the needs of innovation and development in their own countries. [source] Building the Powerful 10-Minute Office Visit: Part II.THE LARYNGOSCOPE, Issue 1 2001Beginning a Critical Literature Review Abstract Objective This is the second part in a series of sequential Tutorials in Clinical Research. The objective of this tutorial is to introduce methods of searching the vast stores of information now available, to review some of the computer resources available, to reintroduce the concept of an a priori design for the search, and to reveal the need for assessment of the clinical importance and validity of each pertinent article found. Study Design Tutorial. Methods An open working group has been formed with the specific aim of surveying and translating the large volume of complex information on research design and statistics into easily understood, useable, and non-threatening tutorials for the busy practitioner. The hypotheses under which this work is conducted are highly intelligent, but extremely busy, surgeons are interested in evidence-based medicine and will increase personal participation in critical reading of the literature, pending an expanded familiarity with clinical research design and statistics. Results Available resources for literature searching, methods of quick personal overviews, and quick question-specific reviews are discussed. Additionally, the methods, with examples, of beginning a critical literature review are presented. Conclusions Rapid, personal, critical literature review requires succinct formulation of the question, efficient search for the best available evidence, and critical appraisal of the pertinent individual articles to determine if sufficient evidence exists to support a clinical contention. [source] | ||||||||||||||||||||||||||||||||||||||||