Change In Median Values Research Articles

Fractional order calculus model-derived histogram metrics for assessing pathological complete response to neoadjuvant chemotherapy in locally advanced rectal cancer

AimThis study evaluates the value of diffusion fractional order calculus (FROC) model for the assessment of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC) by using histogram analysis derived from whole-tumor volumes. Materials and methodsNinety-eight patients were prospectively included. Every patient received MRI scans before and after nCRT using a 3.0-Tesla MRI machine. Parameters of the FROC model, including the anomalous diffusion coefficient (D), intravoxel diffusion heterogeneity (β), spatial parameter (μ), and the standard apparent diffusion coefficient (ADC), were calculated. Changes in median values (ΔX-median) and ratio (rΔX-median) were calculated. Receiver operating characteristic (ROC) curves were used for evaluating the diagnostic performance. ResultsPre-treatmentβ-10th percentile values were significantly lower in the pCR group compared to the non-pCR group (p < 0.001). The Δβ-median showed higher diagnostic accuracy (AUC = 0.870) and sensitivity (76.67 %) for predicting tumor response compared to MRI tumor regression grading (mrTRG) scores (AUC = 0.722; sensitivity = 90.0 %). DiscussionThe use of FROC alongside comprehensive tumor histogram analysis was found to be practical and effective in evaluating the tumor response to nCRT in LARC patients.

Water cycle changes in Czechia: a multi-source water budget perspective

Abstract. The water cycle in Czechia has been observed to be changing in recent years, with precipitation and evapotranspiration rates exhibiting a trend of acceleration. However, the spatial patterns of such changes remain poorly understood due to the heterogeneous network of ground observations. This study relied on multiple state-of-the-art reanalyses and hydrological modeling. Herein, we propose a novel method for benchmarking hydroclimatic data fusion based on water cycle budget closure. We ranked water cycle budget closure of 96 different combinations for precipitation, evapotranspiration, and runoff using CRU TS v4.06, E-OBS, ERA5-Land, mHM, NCEP/NCAR R1, PREC/L, and TerraClimate. Then, we used the best-ranked data to describe changes in the water cycle in Czechia over the last 60 years. We determined that Czechia is undergoing water cycle acceleration, evinced by increased atmospheric water fluxes. However, the increase in annual total precipitation is not as pronounced nor as consistent as evapotranspiration, resulting in an overall decrease in the runoff. Furthermore, non-parametric bootstrapping revealed that only evapotranspiration changes are statistically significant at the annual scale. At higher frequencies, we identified significant spatial heterogeneity when assessing the water cycle budget at a seasonal scale. Interestingly, the most significant temporal changes in Czechia occur during spring, while the spatial pattern of the change in median values stems from summer changes in the water cycle, which are the seasons within the months with statistically significant changes.

Agronomic and environmental performance of dairy farms in a warmer, wetter climate

The northeast United States has experienced higher temperatures, more annual precipitation, and more frequent heavy rain events in recent decades. These trends appear likely to continue, and they may depress crop yields and exacerbate environmental problems associated with the region’s dairy farms. To investigate these possibilities, we used the Agricultural Policy/Environmental eXtender (APEX) model to simulate runoff, erosion, nutrient losses, and crop yields on two Vermont farms in a small set of possible future climates. Raising temperatures by 2°C, combined with increasing total precipitation or changing the seasonality of precipitation, had relatively modest effects on any outcome (less than 10% change in median values). However, a combination of higher temperatures and more intense precipitation led to increased runoff volumes and larger soil and nutrient losses. Median values of runoff, sediment, and nutrient losses increased by 2% to 15% at one site and by 36% to 58% at the other (although the changes at the latter site were relative to very low baseline values), while the 95th percentile rose by 6% to 19% and 53% to 65%. This suggests that management practices adapted to reducing runoff etc. in extreme precipitation events will be increasingly valuable in the coming years. Corn (<i>Zea mays</i> L.) silage yields changed by less than 10% in all simulations, and in some cases increased slightly. However, modeling that includes many additional factors that can reduce yields (such as new pests, or delays to farm operations in wet conditions) is needed for a more complete understanding of how climate change may affect the viability of forage production on dairy farms in this region.

Quantitative Imaging of Patients Undergoing Radiotherapy for Primary Gliomas Using A 1.5 Tesla MR Linac

The introduction of a 1.5 Tesla MR-Linac (MRL) allows for the acquisition of diagnostic quality MR images, either as ancillary studies during treatment on a conventional Linac (cLinac) or seamlessly during treatment on the MRL. We present the first in human experience imaging and treating primary brain tumors using a 1.5 Tesla MRL. Between February of 2019 and January of 2020 a total of 4 patients with gliomas have been treated using the MRL, with daily quantitative MR (qMR) and 3 patients had weekly acquisition of qMR images while undergoing treatment on a cLinac in a prospective imaging trial (NCT03500081). A detailed log during each treatment was obtained for the duration and changes in treatment time. Quantitative MR sequences (IVIM, T1 and T2 mapping) were acquired for patients treated on the MRL while adaptive planning was performed and during beam delivery. Patients treated on the MRL had daily acquisition of qMR sequences. Patients treated on cLinac were scheduled for weekly qMR imaging. qMR sequences obtained are in Table 1. Independent, FDA approved, commercially available software was used for qMRI processing and radiomic feature extraction. Six patients with WHO Grade IV tumors were treated with 60 Gy, while one WHO Grade II tumor of the brainstem was treated to 59.4Gy. The median patient age was 60. Median follow up is 4.7 months, four patients have progressed. Patients treated on the MRL had a median table time of 28 minutes including daily adaptation and optimization of IMRT plan, physician review, treatment and all qMR imaging. Weekly imaging sessions for patients treated on cLinac ranged from 15-33 minutes. Analysis of the qMR data demonstrated variable % change in median values within the Gross Target Volume (Table 1). ADC, T1, and T2 parameters ranged from (-0.2 – 25%), (-1 – 36%), and (3-22%) within the GTV, respectively. Changes in quantitative T1 (14-36%) and T2 (15-22%) within the GTV over the course of treatment were observed in the recurring patients. We present a first in human experience of imaging and treating primary gliomas with a 1.5 Tesla MR. It was feasible to treat patients on the MRL and obtain qMR imaging without additional table time. It was also feasible to integrate weekly imaging into a standard clinical work flow without increasing time. While entirely exploratory and hypothesis generating, highly unique changes in qMRI parameters were seen in those patients who developed progression. This presents an unparalleled opportunity for collection, validation, and future interventional trial integration of MR biomarkers of radiation response in primary glioma. Table 1: % Change Median Value for GTV.Tabled 1Abstract 2641; TablePatientMachineIVIMADCDSLOWDFASTFMAPT1MapT2Map1MRL7-0.25-0.2-10-132-17252415-258153-21141311-536154151812313314225conventional2761167-7-3 Open table in a new tab

Ediacaran reorganization of the marine phosphorus cycle

The Ediacaran Period (635 to 541 Ma) marks the global transition to a more productive biosphere, evidenced by increased availability of food and oxidants, the appearance of macroscopic animals, significant populations of eukaryotic phytoplankton, and the onset of massive phosphorite deposition. We propose this entire suite of changes results from an increase in the size of the deep-water marine phosphorus reservoir, associated with rising sulfate concentrations and increased remineralization of organic P by sulfate-reducing bacteria. Simple mass balance calculations, constrained by modern anoxic basins, suggest that deep-water phosphate concentrations may have increased by an order of magnitude without any increase in the rate of P input from the continents. Strikingly, despite a major shift in phosphorite deposition, a new compilation of the phosphorus content of Neoproterozoic and early Paleozoic shows little secular change in median values, supporting the view that changes in remineralization and not erosional P fluxes were the principal drivers of observed shifts in phosphorite accumulation. The trigger for these changes may have been transient Neoproterozoic weathering events whose biogeochemical consequences were sustained by a set of positive feedbacks, mediated by the oxygen and sulfur cycles, that led to permanent state change in biogeochemical cycling, primary production, and biological diversity by the end of the Ediacaran Period.

Multivariate Analysis of Plasma Metabolites in Children with Autism Spectrum Disorder and Gastrointestinal Symptoms Before and After Microbiota Transfer Therapy

Current diagnosis of autism spectrum disorder (ASD) is based on assessment of behavioral symptoms, although there is strong evidence that ASD affects multiple organ systems including the gastrointestinal (GI) tract. This study used Fisher discriminant analysis (FDA) to evaluate plasma metabolites from 18 children with ASD and chronic GI problems (ASD + GI cohort) and 20 typically developing (TD) children without GI problems (TD − GI cohort). Using three plasma metabolites that may represent three general groups of metabolic abnormalities, it was possible to distinguish the ASD + GI cohort from the TD − GI cohort with 94% sensitivity and 100% specificity after leave-one-out cross-validation. After the ASD + GI participants underwent Microbiota Transfer Therapy with significant improvement in GI and ASD-related symptoms, their metabolic profiles shifted significantly to become more similar to the TD − GI group, indicating potential utility of this combination of plasma metabolites as a biomarker for treatment efficacy. Two of the metabolites, sarcosine and inosine 5′-monophosphate, improved greatly after treatment. The third metabolite, tyramine O-sulfate, showed no change in median value, suggesting it and correlated metabolites to be a possible target for future therapies. Since it is unclear whether the observed differences are due to metabolic abnormalities associated with ASD or with GI symptoms (or contributions from both), future studies aiming to classify ASD should feature TD participants with GI symptoms and have larger sample sizes to improve confidence in the results.

In Patients with Severe Peripheral Arterial Disease, Revascularization-Induced Improvement in Lower Extremity Ischemia Can Be Detected by Laser Speckle Contrast Imaging of the Fluctuation in Blood Perfusion after Local Heating

We previously reported the utility of the perfusion value (PV) fluctuation slope for detecting severe ischemia in the lower limb. Our approach was based on a thermal load test mimicking the well-known physiological reaction termed "cold-induced vasodilation," which is known to occur as a 3-phase phenomenon. The slope parameter quantifies the decrease in PVs accompanying the relative cooling (third phase) following the transient increase in blood flow (second phase) induced by the applied thermal load. This phenomenon of "relative" cold-induced vasodilation (rCIVD) can be monitored using laser speckle contrast imaging (LSCI) after applying the thermal load (LTL test). Here, we aimed to determine whether the slope parameter obtained via the LTL test also reflects the improvement in hemodynamics after revascularization. The study enrolled 16 patients (18 limbs), who underwent revascularization for peripheral arterial disease (PAD). The measurements were performed at 2 sites in each limb (in total, 34 sites; 2 sites in one patient were excluded because of significant movement during the measurement). For each site, we recorded the slope describing the behavior of PVs (decrease or plateau) in the third phase of rCIVD, following the initial, heating-induced increase in perfusion (second phase of rCIVD). The plateau group (group P), which included patients with an abnormal rCIVD, and the decrease group (group D), which included patients with a normal rCIVD, were defined based on perfusion slope values of <0.20 and≥0.20 perfusion units/min, respectively. We also quantified the transient increase in perfusion (from baseline to peak) as a descriptor of perfusion behavior during the second phase of rCIVD. In group P, the change in median values (25-75%) of the slope, transcutaneous oxygen tension, and ankle-brachial index (ABI) from before to after operation was (-0.02 [-0.04 to 0.02]; 4 [1-11]; and 0.08 [0-0.27]) to (0.39 [0.32-0.59]; 46 [37-54]; and 0.81 [0.72-0.90]). Conversely, in group D, the change in the median values of the slope, transcutaneous oxygen tension, and ABI between before and after operation was (0.38 [0.32-0.49]; 40.5 [35-45]; and0.58 [0.57-0.65]) to (0.44 [0.30-0.64]; 52 [43-56]; and 0.92 [0.81-0.99]). Sites exhibiting perfusion pattern of group D in the third phase of rCIVD showed no significant change in slope after revascularization (P=0.21), whereas the slope in group P increased significantly after revascularization, becoming similar to the postoperative slopes in group D (P=0.81). The amount of transient increase in perfusion, which quantified the behavior in the second phase of rCIVD, showed a similar behavior. Preoperatively, all patients in group P had rest pain and/or ulcer of the foot, whereas only few patients in group D had such symptoms. Normal rCIVD response in the LTL test indicates less-than-severe ischemia, while abnormal rCIVD response measured via the LTL test indicates severe ischemic symptoms, such as critical limb ischemia. Notably, patients with an abnormal rCIVD response can develop a normal rCIVD response following revascularization, thereby reflecting an improvement in blood flow. The LTL test assessing rCIVD response can be useful for detecting severe limb ischemia, such as critical limb ischemia (CLI), and determining the departure from severe limb ischemia by revascularization.

DCE-MRI and IVIM-MRI of rabbit Vx2 tumors treated with MR-HIFU-induced mild hyperthermia.

BackgroundThe purpose of this study is to investigate whether changes could be detected in dynamic contrast-enhanced (DCE) and intra-voxel incoherent motion (IVIM) MR parameters upon MR-guided high-intensity focused ultrasound (MR-HIFU)-induced hyperthermia in a rabbit Vx2 tumor model.MethodsFive Vx2 tumor-bearing New Zealand white rabbits were treated with hyperthermia using a clinical MR-HIFU system. Data were acquired before and after hyperthermia. For the DCE analysis, the extended Tofts model was used. For the IVIM analysis, a Bayesian approach was used. Maps were reconstructed of the DCE parameters (Ktrans, kep, and vp) and IVIM parameters (Dt, fp, and Dp). Individual parameter histograms and two-dimensional cross-correlation histograms were constructed to analyze changes in the parameters after hyperthermia. Changes in median values were tested for statistical significance with the Mann-Whitney U test.ResultsThe MR temperature measurements confirmed that mild hyperthermia (40 to 42 °C) was successfully achieved in all rabbits. One rabbit died during treatment and was excluded from the analysis. In the remaining four rabbits, an increase in Dt was observed. In three rabbits, an increase in Ktrans was observed, while in the other rabbits, all three DCE parameter values decreased. Mixed changes were seen for vp and fp.ConclusionsChanges in DCE and IVIM parameters were detected after hyperthermia and were variable between the rabbits. DCE- and IVIM-MRI may be promising tools to assess tumor responses to hyperthermia. Further research in a larger number of subjects is necessary in order to assess their value for treatment response monitoring.

Contemporary neighborhood housing dynamics in a mid-sized US city: the policy consequences of mismeasuring the dependent variable

This paper analyzes median assessed residential property values using three different operationalizations of a tract-level dependent variable for a mid-sized US city: Louisville, Kentucky. We estimated the impacts of accessibility, socio-demographics, and housing characteristics as well as three policy interventions (HOPE VI, historic preservation districts, and university–community partnerships) on median assessed values and changes to them over the 2000–2006 housing bubble. Our interpretation of models employing the three different operationalizations leads to different conclusions about neighborhood health and the efficacy of policy programs. Conventional operationalizations employed by advocates, such as looking at medians or raw dollar changes in median values, are likely to find that policy interventions have less of an impact compared to measuring recent percent changes in property values. Thus, we provide a methodological contribution that shows that percent changes should accompany traditional analysis in capturing the effects of contemporary policy interventions. Mismeasuring neighborhood housing markets has played a role in prematurely concluding that targeted policy programs in neighborhoods are ineffective. Based on our analysis, we invite academics and policy-makers to rethink contemporary neighborhood housing dynamics.

Chemical composition and sources of coastal marine aerosol particles during the 2008 VOCALS-REx campaign

Abstract. The chemical composition of aerosol particles (Dp ≤ 1.5 μm) was measured over the southeast Pacific Ocean during the VAMOS (Variability of the American Monsoon Systems) Ocean-Cloud-Atmosphere-Land Study Regional Experiment (VOCALS-Rex) between 16 October and 15 November 2008 using the US Department of Energy (DOE) G-1 aircraft. The objective of these flights was to gain an understanding of the sources and evolution of these aerosols, and of how they interact with the marine stratus cloud layer that prevails in this region of the globe. Our measurements showed that the marine boundary layer (MBL) aerosol mass was dominated by non-sea-salt SO42−, followed by Na+, Cl−, Org (total organics), NH4+, and NO3−, in decreasing order of importance; CH3SO3− (MSA), Ca2+, and K+ rarely exceeded their limits of detection. Aerosols were strongly acidic with a NH4+ to SO42− equivalents ratio typically &lt; 0.3. Sea-salt aerosol (SSA) particles, represented by NaCl, exhibited Cl− deficits caused by both HNO3 and H2SO4, but for the most part were externally mixed with particles, mainly SO42−. SSA contributed only a small fraction of the total accumulation mode particle number concentration. It was inferred that all aerosol species (except SSA) were of predominantly continental origin because of their strong land-to-sea concentration gradient. Comparison of relative changes in median values suggests that (1) an oceanic source of NH3 is present between 72° W and 76° W, (2) additional organic aerosols from biomass burns or biogenic precursors were emitted from coastal regions south of 31° S, with possible cloud processing, and (3) free tropospheric (FT) contributions to MBL gas and aerosol concentrations were negligible. The very low levels of CH3SO3− observed as well as the correlation between SO42− and NO3− (which is thought primarily anthropogenic) suggest a limited contribution of DMS to SO42− aerosol production during VOCALS.

Temporal Trends in the Characteristics of Children at Antiretroviral Therapy Initiation in Southern Africa: The IeDEA-SA Collaboration

BackgroundSince 2005, increasing numbers of children have started antiretroviral therapy (ART) in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined temporal changes in patient and regimen characteristics at ART start using data from 12 cohorts in 4 countries participating in the IeDEA-SA collaboration.Methodology/Principal FindingsData from 30,300 ART-naïve children aged <16 years at ART initiation who started therapy between 2005 and 2010 were analysed. We examined changes in median values for continuous variables using the Cuzick's test for trend over time. We also examined changes in the proportions of patients with particular disease severity characteristics (expressed as a binary variable e.g. WHO Stage III/IV vs I/II) using logistic regression. Between 2005 and 2010 the number of children starting ART each year increased and median age declined from 63 months (2006) to 56 months (2010). Both the proportion of children <1 year and ≥10 years of age increased from 12 to 19% and 18 to 22% respectively. Children had less severe disease at ART initiation in later years with significant declines in the percentage with severe immunosuppression (81 to 63%), WHO Stage III/IV disease (75 to 62%), severe anemia (12 to 7%) and weight-for-age z-score<−3 (31 to 28%). Similar results were seen when restricting to infants with significant declines in the proportion with severe immunodeficiency (98 to 82%) and Stage III/IV disease (81 to 63%). First-line regimen use followed country guidelines.Conclusions/SignificanceBetween 2005 and 2010 increasing numbers of children have initiated ART with a decline in disease severity at start of therapy. However, even in 2010, a substantial number of infants and children started ART with advanced disease. These results highlight the importance of efforts to improve access to HIV diagnostic testing and ART in children.

Mo1917 The Prague Classification Underestimates the True Maximal Extent and Dysplasia Grade of Barrett's Esophagus

Background: Endoscopic treatment by either radiofrequency (RFA) ablation or endoscopic mucosal resection (EMR) has become first line treatment for Barrett's esophagus (BE) with high grade dysplasia, while focal EMR and subsequent elimination of the residual segment by RFA or EMR is accepted therapy for intramucosal cancer (IMC). RFA and EMR are known to be clinically effective but the effect on the mRNA expression of molecular markers of disease stage, which may inform the long term risk of progression to adenocarcinoma, is unknown. We compared the mRNA expression profile in pre-treatment BE tissues biopsies and post-treatment neo-squamous tissues from the same level to provide a surrogatemolecular estimate of treatment effect. Methods: Paired pre-treatment BE tissues and post-treatment neosquamous biopsies were obtained from 38 patients treated by RFA (20 patients (3 IMC (prior EMR), 5 HGD, 12 LGD) or EMR (18 patients, 6 IMC, 12 HGD). mRNA expression of 16 genes significantly associated with different BE stages was measured using a multiplex tandem RT-PCR method with preand post-treatment tissues assessed simultaneously. Distal esophageal tissues from 12 patients with no history of GERD or BE were used as controls. Results: Endoscopic therapy resulted in a highly significant change in median values towards the squamous mucosa expression profile for all 16 genes on unpaired analysis. This change remained significant for 12 genes by paired analysis (t test). The only significant treatment differences in pre-post mean difference in gene expression were greater changes for RFA compared to EMR for 5 genes. The neosquamous expression profile was significantly different to the control profile for 9 of 16 genes. Conclusions: Both RFA and EMR result in marked changes in mRNA expression, with replacement of the highly disordered Barrett's dysplasia or IMC expression profile with a more normal expression profile. The neosquamous mucosa was significantly different to the control squamous mucosa for most genes but the significance of this finding is uncertain and may reflect confounding factors.

Mo1916 Gene Expression Pre- and Post-Endoscopic RFA or EMR Treatment for Dysplastic Barrett's Esophagus or Intramucosal Adenocarcinoma

Background: Endoscopic treatment by either radiofrequency (RFA) ablation or endoscopic mucosal resection (EMR) has become first line treatment for Barrett's esophagus (BE) with high grade dysplasia, while focal EMR and subsequent elimination of the residual segment by RFA or EMR is accepted therapy for intramucosal cancer (IMC). RFA and EMR are known to be clinically effective but the effect on the mRNA expression of molecular markers of disease stage, which may inform the long term risk of progression to adenocarcinoma, is unknown. We compared the mRNA expression profile in pre-treatment BE tissues biopsies and post-treatment neo-squamous tissues from the same level to provide a surrogatemolecular estimate of treatment effect. Methods: Paired pre-treatment BE tissues and post-treatment neosquamous biopsies were obtained from 38 patients treated by RFA (20 patients (3 IMC (prior EMR), 5 HGD, 12 LGD) or EMR (18 patients, 6 IMC, 12 HGD). mRNA expression of 16 genes significantly associated with different BE stages was measured using a multiplex tandem RT-PCR method with preand post-treatment tissues assessed simultaneously. Distal esophageal tissues from 12 patients with no history of GERD or BE were used as controls. Results: Endoscopic therapy resulted in a highly significant change in median values towards the squamous mucosa expression profile for all 16 genes on unpaired analysis. This change remained significant for 12 genes by paired analysis (t test). The only significant treatment differences in pre-post mean difference in gene expression were greater changes for RFA compared to EMR for 5 genes. The neosquamous expression profile was significantly different to the control profile for 9 of 16 genes. Conclusions: Both RFA and EMR result in marked changes in mRNA expression, with replacement of the highly disordered Barrett's dysplasia or IMC expression profile with a more normal expression profile. The neosquamous mucosa was significantly different to the control squamous mucosa for most genes but the significance of this finding is uncertain and may reflect confounding factors.

Mo1918 Adherence to the 2011 AGA Medical Position Statement for the Treatment of Barrett's Esophagus

Background: Endoscopic treatment by either radiofrequency (RFA) ablation or endoscopic mucosal resection (EMR) has become first line treatment for Barrett's esophagus (BE) with high grade dysplasia, while focal EMR and subsequent elimination of the residual segment by RFA or EMR is accepted therapy for intramucosal cancer (IMC). RFA and EMR are known to be clinically effective but the effect on the mRNA expression of molecular markers of disease stage, which may inform the long term risk of progression to adenocarcinoma, is unknown. We compared the mRNA expression profile in pre-treatment BE tissues biopsies and post-treatment neo-squamous tissues from the same level to provide a surrogatemolecular estimate of treatment effect. Methods: Paired pre-treatment BE tissues and post-treatment neosquamous biopsies were obtained from 38 patients treated by RFA (20 patients (3 IMC (prior EMR), 5 HGD, 12 LGD) or EMR (18 patients, 6 IMC, 12 HGD). mRNA expression of 16 genes significantly associated with different BE stages was measured using a multiplex tandem RT-PCR method with preand post-treatment tissues assessed simultaneously. Distal esophageal tissues from 12 patients with no history of GERD or BE were used as controls. Results: Endoscopic therapy resulted in a highly significant change in median values towards the squamous mucosa expression profile for all 16 genes on unpaired analysis. This change remained significant for 12 genes by paired analysis (t test). The only significant treatment differences in pre-post mean difference in gene expression were greater changes for RFA compared to EMR for 5 genes. The neosquamous expression profile was significantly different to the control profile for 9 of 16 genes. Conclusions: Both RFA and EMR result in marked changes in mRNA expression, with replacement of the highly disordered Barrett's dysplasia or IMC expression profile with a more normal expression profile. The neosquamous mucosa was significantly different to the control squamous mucosa for most genes but the significance of this finding is uncertain and may reflect confounding factors.

Promoting childbirth companions in South Africa: a randomised pilot study.

BackgroundMost women delivering in South African State Maternity Hospitals do not have a childbirth companion; in addition, the quality of care could be better, and at times women are treated inhumanely. We piloted a multi-faceted intervention to encourage uptake of childbirth companions in state hospitals, and hypothesised that lay carers would improve the behaviour of health professionals.MethodsWe conducted a pilot randomised controlled trial of an intervention to promote childbirth companions in hospital deliveries. We promoted evidence-based information for maternity staff at 10 hospitals through access to the World Health Organization Reproductive Health Library (RHL), computer hardware and training to all ten hospitals. We surveyed 200 women at each site, measuring companionship, and indicators of good obstetric practice and humanity of care. Five hospitals were then randomly allocated to receive an educational intervention to promote childbirth companions, and we surveyed all hospitals again at eight months through a repeat survey of postnatal women. Changes in median values between intervention and control hospitals were examined.ResultsAt baseline, the majority of hospitals did not allow a companion, or access to food or fluids. A third of women were given an episiotomy. Some women were shouted at (17.7%, N = 2085), and a few reported being slapped or struck (4.3%, N = 2080). Despite an initial positive response from staff to the childbirth companion intervention, we detected no difference between intervention and control hospitals in relation to whether a companion was allowed by nursing staff, good obstetric practice or humanity of care.ConclusionThe quality and humanity of care in these state hospitals needs to improve. Introducing childbirth companions was more difficult than we anticipated, particularly in under-resourced health care systems with frequent staff changes. We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals. Trial registration: Current Controlled Trials ISRCTN33728802

Liver haemodynamics and function in alcoholic cirrhosis: Relation to testosterone treatment and ethanol consumption

Liver haemodynamics and liver function were measured in 34 alcoholic cirrhotic men before entry and after 12 months (median) in a double-blind, placebo-controlled study on the effect of oral testosterone treatment (200 mg t.i.d.). Comparing data at entry with those at follow-up in the total patient group, a significant change in median values of portal pressure (-23%, n = 34, P less than 0.005), hepatic blood flow (-22%, n = 28, P less than 0.001), indocyanine green clearance (+16%, n = 29, P less than 0.01), and galactose elimination capacity (+8%, n = 31, P less than 0.05) was observed. However, testosterone-treated patients did not differ significantly from placebo-treated patients regarding any of the measured variables. No significant relationships could be demonstrated between ethanol consumption and liver haemodynamics and liver function, but the number of patients consuming more than 100 g ethanol per day decreased significantly (P less than 0.001) from 22 (65%) before entry to one (3%) during follow-up. In conclusion, oral testosterone treatment of men with alcoholic cirrhosis does not explain the significant improvement of liver haemodynamics and function observed in this study. However, the improvement may be due to reduced ethanol consumption.