Efficacy Of Different Treatments Research Articles

Evaluation of bioherbicide for controlling weedy rice and enhancing the yield of rice in Malaysia

Aim: Rice (Oryza sativa L.) is the second most important food crop in Malaysia, and weedy rice is the severe constraint in the Malaysian rice field. An experiment was conducted in Shadehouse at Field 2, Universiti Putra Malaysia to assess the performance of Agroplus BioDcomposer as a bioherbicide to control weedy rice and to select appropriate dosage of Agroplus BioDcomposer for effective control of weedy rice in the rice field. Methodology: Ten treatments of herbicides were applied in the experiment viz., control (0 ml), Agroplus BioDcomposer® (150 ml 20 l-1 water, 300 ml 20 l-1 water and 450 ml 20 l-1 water), Paraquat (125 ml 20 l-1 water, 250 ml 20 l-1 water and 375 ml 20 l-1 water) and the combination of Agroplus BioDcomposer® with Paraquat @150 ml 20 l-1 water + @125 ml 20 l-1 water, 300 ml 20 l-1 water + 250 ml 20 l-1 water and 450 ml 20 l-1 water+375 ml 20 l-1 water). Data on the percentage of weedy rice killed three days after treatments and percentage of weedy rice emergence 7 and 14 days after soil application of treatments were recorded to evaluate the efficacy of different treatments. Results: The results revealed significant differences among treatments in the percentage of weedy rice killed, weedy rice emergence after treatments application and the ultimate yield of rice. Paraquat, @ 375 ml 20 l-1 water and a combination of Agroplus BioDcomposer® and Paraquat (300 ml 20 l-1 water + 250 ml 20 l-1 water) performed better over other treatments to kill the weedy rice, to control the emergence of weedy rice from the seed bank and produced the highest rice yield. Interpretation: The overall result revealed that the recommended rate of Agroplus BioDcomposer® + Paraquat (300 ml 20 l-1 water + 250 ml 20 l-1 water) is more appropriate and suitable for environmental friendly control of weedy rice in Malaysia.

Comparison of crystalloid resuscitation fluids for treatment of acute brain injury: a clinical and pre-clinical systematic review and network meta-analysis protocol

BackgroundCurrent guidelines identify the choice of fluid resuscitation as important in minimizing the incidence of secondary brain injury from cerebral edema. It is widely accepted that isotonic crystalloid resuscitation fluids, specifically normal saline (NS), are optimal for resuscitation and that other relatively hypotonic fluids, such as Ringer’s lactate (RL), should be avoided in this patient population. The aim of this review is to systematically compare the use of relatively hypotonic versus isotonic crystalloid resuscitation fluids in clinical and pre-clinical models of acute brain injury and their effect on outcomes. In recognition of the potential need for a network meta-analysis (NMA), we have also included all other relevant crystalloid resuscitation fluids as interventions of relevance to potentially inform indirect comparisons.MethodsSystematic searches of MEDLINE, Embase, and Web of Science BIOSIS Previews® will be used to identify eligible clinical and pre-clinical studies, which included studies examining acute brain injury (human and in vivo animal brain injury models) within the first 7 days of therapy. The intervention of interest is the intravenous use of relatively hypotonic crystalloid resuscitation fluids (e.g., Ringer’s lactate, Hartmann’s or Plasma Lyte® fluids). The main comparator of interest is an isotonic crystalloid resuscitation fluid, specifically normal saline (0.9%). Other crystalloid resuscitation fluids (e.g., hypertonic saline (3–23.4%)) will also be included as an additional intervention of interest. The primary outcome measures of interest are intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Secondary outcomes include the effect of resuscitation on cerebral edema, brain and serum osmolarity, and electrolyte concentrations and clinical outcomes including modified Rankin Scale (mRS), (extended) Glasgow Outcome Scale (GOS/eGOS), and mortality. Separate meta-analyses will be conducted to quantify the effects of the different fluid resuscitation on acute brain injury outcomes in clinical and pre-clinical populations. Network meta-analyses to compare interventions will also be performed to compare the effects of different interventions.DiscussionThis systematic review will comprehensively summarize the difference in treatment efficacy of various crystalloid resuscitation fluids in acute brain injury. This review is essential to underscore the evidence, or lack thereof, present in the literature to date to support current preference-driven practice and to direct future study.Systematic review registrationPROSPERO #CRD42016042960

Individual patient data meta-analysis of randomized controlled trials of dual therapy with a boosted PI plus lamivudine for maintenance of virological suppression: GeSIDA study 9717

Dual therapy (DT) with a ritonavir-boosted PI (PI/r) plus lamivudine has proven non-inferior (12% margin) to triple therapy (TT) with PI/r plus two nucleos(t)ide reverse transcriptase inhibitors [N(t)RTIs] in four clinical trials. It remains unclear whether DT is non-inferior based on the US FDA endpoint (virological failure with a margin of 4%) or in specific subgroups. We performed a systematic search (January 1990 to March 2017) of randomized controlled trials that compared switching of maintenance ART from TT to DT. The principal investigators were contacted and agreed to share study databases. The primary endpoint was non-inferiority of DT to TT based on the current FDA endpoint (4% non-inferiority margin for virological failure at week 48). We also analysed whether efficacy was modified by gender, active HCV infection and type of PI. Effect estimates and 95% CIs were calculated using generalized estimating equation-based models. We found 881 references that yielded eight articles corresponding to four clinical trials (1051 patients). At week 48, 4% of patients on DT versus 3.04% on TT had experienced virological failure (difference 0.9%; 95% CI -1.2% to 3.1%), and 84.7% of patients on DT versus 83.2% on TT had <50 copies of HIV RNA/mL (FDA snapshot algorithm) (difference 1.4%; 95% CI -2.8% to 5.8%). Gender, active HCV infection and type of PI had no effect on differences in treatment efficacy between DT and TT. DT was non-inferior to TT using both current and past FDA endpoints. The efficacy of DT was not influenced by gender, active HCV infection status, or type of PI.

Reliability of posturographic measures obtained during instrumental assessment of trunk control using inertial sensors in individuals with spinal cord injury

The seated position is the most frequent and fundamental for patients with Spinal Cord Injury (SCI). There are tests for clinically assessing seated postural control in SCI, most of them rely on distance related parameters. However, clinical assessment of trunk control in SCI is not enough sensitive to detect and/or describe a possible improvement. Hence, there is a need for practical, objective and reliable assessment tools to demonstrate the efficacy of different interventions in clinical practice. Therefore our objective was to establish the reliability of distance related measures obtained from inertial sensors (IMUs) to assess trunk control in SCI subjects. A cross-cutting study was performed where 15 non SCI subjects and 22 SCI subjects who fulfilled inclusion criteria were recruited. After signature of informed consent, there was held a concurrent application of the trunk control test (TCT) and the instrumental assessment (using IMUs attached to head and trunk of subjects) with repeated measures three times of static and dynamic control selected items, in an interleaved and random manner. IMUs 3D orientation was obtained during all time. Distance related parameters on transverse plane were obtained after applying IMUs 3D orientation to a biomechanical model of head and trunk segments. Dimensions were normalized to body segments. One hundred twenty-four distance related measures were calculated. Test-retest reliability was measured by intraclass correlation coefficients (ICC) of items with repeated measures. High reliability (ICC > 0.5) was found on 10 distance related measures in both areas of static and dynamic equilibrium of TCT, measured on both the head and the trunk of SCI and non SCI subjects. It was demonstrated that the IMU usage has high reliability when measuring distance related parameters of static and dynamic control of the trunk.

Improving genomics-based predictions for precision medicine through active elicitation of expert knowledge.

MotivationPrecision medicine requires the ability to predict the efficacies of different treatments for a given individual using high-dimensional genomic measurements. However, identifying predictive features remains a challenge when the sample size is small. Incorporating expert knowledge offers a promising approach to improve predictions, but collecting such knowledge is laborious if the number of candidate features is very large.ResultsWe introduce a probabilistic framework to incorporate expert feedback about the impact of genomic measurements on the outcome of interest and present a novel approach to collect the feedback efficiently, based on Bayesian experimental design. The new approach outperformed other recent alternatives in two medical applications: prediction of metabolic traits and prediction of sensitivity of cancer cells to different drugs, both using genomic features as predictors. Furthermore, the intelligent approach to collect feedback reduced the workload of the expert to approximately 11%, compared to a baseline approach.Availability and implementationSource code implementing the introduced computational methods is freely available at https://github.com/AaltoPML/knowledge-elicitation-for-precision-medicine.Supplementary information Supplementary data are available at Bioinformatics online.

Cement Distribution Patterns Are Associated with Recompression in Cemented Vertebrae After Percutaneous Vertebroplasty: A Retrospective Study

To reevaluate the cement distribution patterns and further investigate associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Two hundred twenty-four patients with a mean age of 71.9 years were enrolled and treated with single-level PVP between June 2012 and July 2015. The mean follow-up time was 16.5 months. Data from medical records and radiographs were collected and analyzed. Cement distribution patterns were divided into 4 cement distribution patterns extending from the traditional 2 patterns: interlocked solid pattern (LS) and uninterlocked solid pattern (ULS); contiguous trabecular pattern (CT) and discontiguous trabecular pattern (DCT). Differences in treatment efficacy and the occurrence rates of recompression in cemented vertebrae were compared for both groups using the Wilcoxon rank sum test and chi-squared test. Thirty-seven patients who underwent PVP developed recompression in cemented vertebrae. Recompression in cemented vertebrae was significantly more frequent in the ULS and DCT groups than in the LS and CT groups (P < 0.05 or 0.001), with the Visual Analogue Scale score at the time of final follow-up was also significantly higher in the ULS and DCT groups (P < 0.001). Significant associations were found between cement distribution patterns and recompression in cemented vertebrae, which affected the clinical outcome in patients after PVP. A higher incidence of recompression in cemented vertebrae was seen in patients with treated vertebrae exhibiting ULS pattern or DCT pattern.

Effectiveness of Vocal Therapy for the Elderly When Applying Conventional and Intensive Approaches: A Randomized Clinical Trial

The aim of this study was to verify the effects of the method Vocal Therapy for the Elderly and the differences in treatment efficacy when it was administered intensively or in the conventional way. Twenty-seven elderly individuals were randomized into two groups and referred for 16 sessions of vocal therapy. The Intensive Group (IG) had therapy four times a week, whereas the Conventional Group had it twice a week. The effects of the therapy were assessed by auditory-perceptual analysis, the Voice-Related Quality of Life protocol, and visual-perceptive analysis of laryngoscopy examinations. The first stage consisted of evaluating the vocal quality and self-assessment of 15 subjects before and after a time period equal to that which they would undergo in vocal therapy. The second stage consisted of comparing the assessments of all participants in the week preceding the beginning of treatment, in the week following the end of treatment, and 1 month after that. There was no difference between perceptual voice parameters and self-assessment when the subjects were not undergoing therapy. When comparing the periods immediately before and after therapy, there was improvement in vocal quality and Voice-Related Quality of Life. One month later, the benefits that had been revealed through the self-assessment protocol, and some of the improvements in vocal parameters were maintained. There was no difference between the IG and Conventional Group with the exception of vocal fold bowing, which decreased in the IG group. The Vocal Therapy for the Elderly program is effective for treating voice presbyphonia. An intensive approach may be superior with regard to vocal fold bowing.

Impact of body mass index on the efficacy of endocrine therapy in patients with metastatic breast cancer - A retrospective two-center cohort study

BakgroundThe aim of this study was to investigate the impact of body mass index (BMI) on the efficacy of endocrine therapy in postmenopausal women with metastatic hormone receptor breast cancer (HR+BC) as well as to identify if the potential difference in efficacy was associated with Fulvestrant only or both aromatase inhibitors (AIs) and Fulvestrant. MethodsA consecutive cohort of postmenopausal women with HR+metastatic breast cancer that have received endocrine therapy including Fulvestrant as a metastatic treatment strategy at the Departments of Oncology in Eskilstuna and Uppsala, Sweden, between 2008 and 2016 were identified. The primary outcome of the study was time to disease progression (TTP) during the treatment with Fulvestrant in overweight and obese women compared to patient with normal BMI. ResultsIn total, 173 patients were enrolled in the study cohort, amongst these, 141 patients received both Fulvestrant and AIs and 32 received only Fulvestrant. No statistical significant association was observed between the three BMI categories and TTP, during Fulvestrant treatment (p = 0.136). The rates of objective response and clinical benefit due to Fulvestrant were similar among patients with normal weight, overweight and obesity, respectively. ConclusionsNo difference in treatment efficacy was seen between normal, overweight and obese women with metastatic HR+BC, when treated with Fulvestrant. Until further research with prospective studies is available, there is no evidence to support any modification in how Fulvestrant treatment is used in patients with metastatic breast cancer in regard to BMI.

Randomized, Double-Blinded, Sham-Controlled, Split-Hand Trial Evaluating the Safety and Efficacy of Triamcinolone Acetate Injection After Calcium Hydroxylapatite Volume Restoration of the Dorsal Hand.

Calcium hydroxylapatite (CaHA) is currently the only FDA-approved soft-tissue filler indicated for augmentation of the dorsal hand. Although the treatment is generally safe and effective, adverse side effects such as swelling and edema postinjection are common and can sometimes be debilitating. In this study, the authors explore the utility of triamcinolone acetate coinjection with CaHA to the dorsal hands to mitigate adverse effects and improve patient experience. After obtaining informed consent, 20 subjects were enrolled in this double-blind, randomized, split-hand, sham-controlled clinical trial. Subject hands were randomized to receive either CaHA with triamcinolone acetate or CaHA with sham saline coinjection. Follow-up evaluations were performed by a blinded investigator at Days 7, 14, 30, 90, 180, 270, and 360 and consisted of the validated Merz Hand Grading Scale and assessments of erythema, edema, modules, bruising, and skin atrophy. Subjects also kept a daily diary for the first 30 days postinjection documenting bruising, itching, pain, redness, swelling, difficulty in performing activities with hands, and sensory alteration in hands. There were no significant differences in treatment efficacy between the 2 groups. Post-treatment swelling was significantly reduced between Days 6 and 19 in the triamcinolone acetate coinjection group. The addition of triamcinolone acetate coinjection with CaHA for dorsal hand augmentation did not negatively impact treatment efficacy but significantly reduced adverse side effects. This strategy represents a safe and effective way to improve patient experience and treatment tolerability.

Minimal residual disease analysis in chronic lymphocytic leukemia: a way for achieving more personalized treatments.

Therapeutic approaches for chronic lymphocytic leukemia (CLL) have dramatically changed over the recent past. In parallel, quantification of minimal residual disease (MRD) proved to be an independent prognostic factor forprogression-free and overall survival. The European Research Initiative on CLL (ERIC) in collaboration with American and Australasian partners developed harmonised assays that could be applied reproducibly to compare the efficacy of different treatments. The potential for MRD analysis to identify the most effective treatments prior to reaching survival endpoints was recognised by regulatory agencies and approved as an intermediate endpoint for licensure in randomized studies, in Europe. More recently treatment approaches have evolved, in particular with BCL2-pathway inhibitors, so that MRD analysis may be informative for most patients and clinical trials, potentially becoming atool for managing CLL patients in clinical practice. In the recent past the importance of the type of MRD assay used, the most appropriate timing and compartment to assess for different treatment types have been learnt as we move towards eradicating residual disease beyond the guideline threshold of one cell in ten thousand. Nowadays, MRD assessment in CLL has quickly become an indispensable tool for clinical research and development that promise to change the way we manage our patients in the future.

Efficacy of different methods of treatment for macular edema secondary to branch retinal vein occlusion

Objective To compare the efficacy of different treatments for macular edema secondary to branch retinal vein occlusion. Methods The data of 64 eyes of 64 cases of macular edema secondary to branch retinal vein occlusion from Jun. 2015 to Feb. 2017 were analyzed prospectively. Group A, 32 eyes of 32 patients, received intravitreal injection of Triamcinolone acetonide and retinal photocoagulation. Group B, 32 eyes of 32 patients, underwent intravitreal Lucentis injection and retinal photocoagulation. The follow-up time was 6 months. The visual acuity, central macular retinal thickness (CMT), the recurrence and complications were compared between the two groups. Results The BCVA (LogMAR) of group A and group B were (0.72±0.19) and (0.74±0.23) before surgery. The difference in BCVA before operation was not significant between the two groups (P>0.05). Six months after operation, BCVA of group A and group B were (0.53±0.27) and (0.36±0.26). The BCVA of two groups were improved after operation (P=0.002, 0.000). BCVA of group B was better than that of group A (P=0.013). The difference in CMT was not significant between the two groups (P>0.05). The recurrence rate of group A was 25.0% after operation, which was higher than that of group B (3.1%) (P=0.031). No obvious adverse reaction during treatment occurred. Conclusion Intravitreal injection of Ranibizumab combined with retinal photocoagulation for the treatment of macular edema secondary to branch retinal vein occlusion is effective. Key words: Edema, macular; Occlusion, retinal vein, branch; Ranibizumab, intravitreal injection; Photocoagulation, retinal; Visual acuity

Treatment of experimental necrotizing enterocolitis with stem cell-derived exosomes

PurposeNecrotizing enterocolitis (NEC) remains a devastating disease in premature infants. We previously showed that four stem cell (SC) types equivalently improve experimental NEC. Exosomes are intercellular nanovesicles containing RNA, miRNA, DNA, and protein. Because SC therapy faces challenges, our aim was to determine if the beneficial effects of SC are achievable with cell-free exosomes. MethodsExosomes from four SC types were compared: (1) amniotic fluid-derived mesenchymal SC (AF-MSC); (2) bone marrow-derived MSC (BM-MSC); (3) amniotic fluid-derived neural SC (AF-NSC); and (4) neonatal enteric NSC (E-NSC). Rat pups exposed to NEC received a varying concentration of a single type of exosome with control pups receiving PBS only. Intestinal damage was graded histologically. ResultsThe incidence of NEC was 0% in unstressed pups and 60.7% in control pups subjected to NEC. Exosomes (4.0×108) reduced NEC incidence to: AF-MSC 25.0%; BM-MSC 23.1%; AF-NSC 11.1%; E-NSC 27.3%. When administered at a concentration of at least 4.0×108, all groups demonstrated a significant reduction in NEC compared to untreated pups. At this minimum concentration, there was no difference in treatment efficacy between exosomes and the SC from which they were derived. ConclusionStem cell-derived exosomes reduce the incidence and severity of experimental NEC as effectively as the stem cells from which they are derived, supporting the potential for novel cell-free exosome therapy for NEC. Type of studyBasic science.

A qualitative study on older primary care patients\u2019 perspectives on depression and its treatments - potential barriers to and opportunities for managing depression

BackgroundDepression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare.MethodsQualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis.ResultsThe study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression.ConclusionsThis study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder.

Randomized Controlled Trial of a Novel Device for Tinnitus Sound Therapy During Sleep.

The aim of this study was to determine if a customized stimulus from the Otoharmonics Levo System reduces tinnitus perceptions and reactions for people with bothersome tinnitus. Sixty participants were randomized to 1 of 3 groups that used sound therapy devices during sleep that differed in their acoustic stimulus: (a) tinnitus-matched (TM), (b) noise stimulus (NS), and (c) bedside sound generator (BSG). Outcome measures were the Tinnitus Functional Index (TFI), numeric rating scale of tinnitus loudness, and tinnitus loudness match. A Bayesian hierarchical model was fit to estimate the differences in treatment efficacy among groups. Average tinnitus reactions and perceptions improved across treatment groups. We are at least 87% certain that treatment with TM or NS reduces mean TFI compared to treatment with BSG, with an estimated relative efficacy of 4.5-5 points greater reduction. We are at least 95% certain that treatment with TM results in greater reduction in mean numeric rating scale (NRS) of tinnitus loudness compared to the other groups, with an estimated relative efficacy of about 0.75 points greater reduction. This study offers some support for greater average improvement in reactions to tinnitus with TM or NS devices compared to the BSG device. The TM group, compared to the BSG and NS groups, showed a greater reduction in ratings of tinnitus loudness on the NRS on average. https://doi.org/10.23641/asha.5545759.

Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder: A Meta-analysis of Randomized Controlled Trials.

Background:Practice guidelines have recommended cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) as the treatment of choice for major depression disorder (MDD). However, whether one therapy is better than the other remains inconclusive. The aim of this study was to compare the treatment efficacy of the two treatment approaches for MDD.Methods:Using the terms “cognitive behavior therapy or cognitive therapy or CBT or CT or cognitive behavioral therapy” and “interpersonal psychotherapy or IPT,” we systematically searched PubMed, Psyclnfo and Chinese National Knowledge Infrastructure databases up to February 2017. The language was restricted to be English and Chinese. Therapeutic outcomes, characteristics, and research quality were then extracted and analyzed independently. In accessing the included studies, we followed the criteria suggested by the Cochrane Handbook for Systematic Reviews of Interventions.Results:Data for 946 patients from 10 randomized controlled trials were included in the study. Methodological quality was not optimal in most trials. Meta-analysis showed a mean difference (MD) of −1.31, 95% confidence interval (CI) (−2.49, −0.12) (P < 0.05) in favor of CBT according to the Beck Depression Inventory (BDI), and however, we did not found any statistically significant difference between CBT and IPT on the Hamilton Rating Scale for depression (HRSD) (MD −0.90, 95% CI [−2.18, 0.38]). Subgroup analyses for the studies in which patients were treated only by psychotherapy (MD −1.26, 95% CI [−2.78, 0.35]) and for those which offered more sessions of therapies (MD −0.82, 95% CI [−2.23, 0.59]) showed there was no significant difference between CBT and IPT according to BDI.Conclusions:Differences in treatment efficacy seem to vary according to different outcome measures. CBT shows an advantage over IPT for MDD according to BDI, and there is no significant difference between the two according to HRSD. These results should be interpreted with caution.

Methodological Challenges to the Evaluation of Interventions for Foster/Kinship Carers and Children: A Systematic Review.

Caregivers of children in alternative care face a complex range of challenges that can result in placement disruption and poor long-term outcomes. Interventions designed to help carers meet these challenges report positive outcomes. Nevertheless, several reviewers have reported these positive results may be mitigated by limitations in trial methodology. This review aims to systematically review these methodological challenges and limitations, to provide an analysis of the current state of the evidence base for these interventions. A systematic review was conducted into the methods used to evaluate the effectiveness of psychosocial interventions for foster and kinship carers. Limitations relating to internal validity, external validity and clinical heterogeneity were identified and synthesised. Seventeen studies met inclusion criteria. The quality of methods used in the included studies is mixed, with high and unknown levels of bias in the majority of trials. Heterogeneity in participant characteristics, intervention aims and outcome measures across interventions reflect the diversity of carer and child needs and make it difficult to generalise results or compare and synthesise the efficacy of different interventions. These factors limit the application of trial results to evidence-based clinical practice. The diverse and complex needs of this population present significant challenges to robustly evaluating interventions for foster/kinship families. Participant needs, theoretical approaches, intervention aims and outcome measures need to be better coordinated, both within trials and across the field. Exploratory research should be used to generate focussed and concrete hypotheses that can be robustly tested in high-quality randomised controlled trials. Protocol registration number: CRD 42017048415.

Griseofulvin vs. Terbinafine in the Treatment of Tinea Capitis

Background: Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. Purpose: The purposes of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25–12.5 mg⁄kg⁄day) to 4 weeks of terbinafine (3.125–6.25 mg⁄kg⁄day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel–Haenszel method and random effects model; results were expressed as odds ratios with 95%. Results: Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporumspp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Conclusion:Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.

Dysfunctional Cognitions in Online Gaming and Internet Gaming Disorder: a Narrative Review and New Classification

Purpose of Review Over the last two decades, Internet gaming disorder (IGD) has emerged as a potential clinical entity. Dysfunctional cognitions relating to IGD have been the object of debate by scholars in the field. The aim of the current paper is to provide a narrative review and new classification of dysfunctional cognitions involved in IGD. Recent Findings A wide range of dysfunctional cognitions have been investigated in online gaming. Recent research has indicated the importance and value of distinguishing dysfunctional cognitions from dysfunctional metacognitions in IGD. Summary We propose a new classification which distinguishes between dysfunctional cognitions and metacognitions in IGD. Future studies should compare these two forms of cognitive constructs using longitudinal and experimental designs and examine their relative contribution in predicting IGD and efficacy of different treatments.

Tracking Skill Acquisition With Cognitive Diagnosis Models: A Higher-Order, Hidden Markov Model With Covariates

A family of learning models that integrates a cognitive diagnostic model and a higher-order, hidden Markov model in one framework is proposed. This new framework includes covariates to model skill transition in the learning environment. A Bayesian formulation is adopted to estimate parameters from a learning model. The developed methods are applied to a computer-based assessment with a learning intervention. The results show the potential application of the proposed model to track the change of students’ skills directly and provide immediate remediation as well as to evaluate the efficacy of different interventions by investigating how different types of learning interventions impact the transitions from nonmastery to mastery.

Candidates for inclusion in a universal antiretroviral regimen: tenofovir alafenamide.

Tenofovir disoproxil fumarate (TDF) is a standard first-line therapy for HIV. Recently, tenofovir alafenamide (TAF), a different prodrug for the same active moiety, has been approved. In this review, we have conducted a meta-analysis comparing efficacy and safety data for TDF and TAF, to inform a discussion of which drug would be best for a proposed 'universal antiretroviral (ARV) regimen'. We identified 10 randomized controlled trials comparing TDF with TAF (6969 patients, 8043 patient-years of follow-up). Meta-analysis found no difference in treatment efficacy, resistance, or adverse events. There were significant differences favouring TAF in bone mineral density measures and renal function measures, but no significant difference in bone fracture events or discontinuations because of bone toxicity or renal toxicity. TAF arms showed higher lipid levels, and were associated with a slightly greater risk of being started on lipid-lowering therapy. TAF has lesser detrimental effects on renal and bone markers, but no difference in adverse events. Data are unavailable for TAF safety in pregnancy, tuberculosis coinfection, and low CD4 count. Data for these groups, and an affordable price, will be required before it can be recommended as part of a 'universal ARV regimen'.