Evidence In Research Literature Research Articles

Emerging Therapies for the Management of Pain and Vaso-Occlusive Crises in Patients With Sickle Cell Disease: A Systematic Review of Randomized Controlled Trials.

Sickle cell disease (SCD) is an inherited disorder that impairs red blood cells (RBCs) and disrupts the delivery of oxygen to tissues. There is currently no cure. Symptoms can appear as early as six months of age and include anemia, acute episodes of pain, swelling, infections, delayed growth, and vision problems. A growing number of therapies are being investigated for reducing these episodes of pain, also known as vaso-occlusive crises (VOCs). The research literature evidence, however, currently includes far more approaches that have not shown superiority versus placebo than ones that have been proven effective. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of a variety of current and emerging therapies for treading SCD VOCs. Several important new papers have emerged since previous systematic reviews with similar objectives were published. This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and focused on PubMed exclusively. Only RCTs were sought, and no other filters, except for a five-year historical timeline cut-off, were used. Of the 46 publications that were returned in response to the query, 18 were ultimately accepted as meeting the pre-established inclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, five out of 18 featured positive results with superiority and statistical significance versus placebo for either reduction in pain score or number/duration of VOCs. The approaches featured therapies ranging from de novo molecules to currently available drugs approved for other indications to naturally occurring metabolites such as amino acids and vitamins. A single therapy, arginine, was supported for both clinical endpoints: pain score reduction and shortened VOC duration. Currently, two therapies are approved by the United States Food and Drug Administration (FDA) and are commercially available (crizanlizumab, ADAKVEO and L-glutamine, Endari). All other therapies are investigational only in nature. Several studies included measurement of biomarker endpoints as well as clinical outcomes. Generally, beneficial outcomes related to improving biomarker levels did not also translate into statistically significant reduction of pain scores or number/duration of VOCs. While measuring biomarkers may contribute to the understanding of pathophysiology, it does not appear to directly offer predictive value toward treatment success clinically. It can be concluded that there exists a specific opportunity to design, fund, and execute investigations that both compare emerging and existing therapies versus one another and compare combinational therapies versus placebo.

A study on ski groups size and their relationship to the risk of injury

This paper addresses a novel topic in ski injury research - how a ski group size indicates the risk of ski injury. There is evidence in research literature that people ski in groups. However, the relationship between group size and the risk of injury has remained unexplored. Based on ski lift entrance data, we use the density-based clustering algorithm OPTICS to identify groups of skiers and discuss the advantages of using this algorithm. We show that the ski group size can be used to improve the identification of skiers who experience ski injury. The results of the identification of ski groups at Mt. Kopaonik Ski Resort in Serbia show that skiing alone is most susceptible to ski injury, while skiing in couples or in bigger groups reduces the risk of injury by 46%. In addition, it is confirmed that ski injuries are an early failure event phenomena. Based on the CHAID decision tree analysis, spending a small amount of time at the ski resort and skiing alone are associated with the: 6 times greater ski injury risk than the average ski injury risk.

Urgent wake up call for the National Basketball Association.

Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) team during the season, often results in accompanying sleep disturbances related to sleep length, sleep quality, and sleep timing (with highly harmful impacts on health, both physical and mental). These issues are not only problematic for NBA players, but also the coaches, training staff, and management support. In this narrative review, we summarize the detrimental effects that this travel and game schedule could have on NBA team members' sleep, as well as their physical and mental health. Multiple peer-reviewed articles address the role of sleep in athletic performance and health; however, to date, the literature focused on sleep-related issues that are unique to the NBA schedule is scarce. Firstly, this review addresses the impact of the NBA schedule, outlining the number of games and the travel involved (number of flights, the timing of flights, timings of arrival at destination and hotel); we also outline a typical daily NBA travel schedule, providing the reader a glimpse of what this encompasses. Secondly, we provide a brief overview of sleep science and discuss specific applications related to the NBA. Finally, we provide comment on the unique current situation of the NBA "bubble". Based on this review, there appears to be considerable scope for further investigation of the acute and chronic effects of sleep disturbances concerning the NBA travel and game schedule. Sleep science recommendations need to inform practice, target sleep interventions, and personalized protocols designed to enhance sleep health that can be incorporated at the organizational level.

Reading Comprehension and Tolerance against Comprehension Ambiguities: An Empirical Study of Iranian GFL-Learners in Communicative Education

The present study examines the influence of ambiguity tolerance on the performance of Iranian GFL-learners (Note 1) at level B1 in the processing of gap-filling-text tests. It is assumed that learners with more tolerance of ambiguity achieve better results in the reading comprehension or in the contextual guessing of the omitted words. 34 GFL learners at Level B1 in Iran Language Institute in Mashhad have completed a three-part pilot gap-filling test as well as the pilot questionnaire called SLTAS (Note 2) to assess their ambiguity tolerance. In order to examine the hypothesis and to answer the research question, the total score of the subjects who participated in the pilot and the main study were analyzed by SPSS program version 18.0. The quantitative-correlative analysis did not demonstrate a statistically significant relationship between the tolerance of ambiguity and reading comprehension. In conclusion, with regard to the multi-dimensionality of reading comprehension, and despite the divergent empirical evidence in research literature, it is still advisable to take into account the affective, cognitive, and extra-linguistic determinants of reading comprehension in further empirical studies from various aspects and to greater extents. This study provides suggestions for the recognition of the interaction between different affective, and cognitive influential factors in the multidimensional reading process, as well as a basis for the teachers’ and linguists’ methodology with respect to learners in terms of their individual differences while instructing reading comprehension in German as a foreign language.

Using consensus methods to develop clinical practice guidelines for intensive care: The Intensive Care Collaborative project

Clinical practices or procedures based on the best available evidence are an essential resource within an intensive care unit (ICU). Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of staff with relevant skills to interrogate the literature. The aim of the Intensive Care Collaborative (ICC) project was to use the synergism of group processes to develop state-based clinical guidelines for six common intensive care practices - eye care, oral care, endotracheal tube management, suctioning, arterial line management, and central venous catheter (CVC) management. Participants were 55 senior nurse clinicians from all nine area health services in NSW, seven academic facilitators, and staff from the Intensive Care Coordination and Monitoring Unit (ICCMU). A range of approaches were used to develop the six clinical practice guidelines (CPG) and related systematic literature reviews, including a preparatory educational seminar for participants, formation of working groups of clinicians, with subsequent teleconferences, e-mail and online forums to identify the scope of each guideline and review the literature. A consensus development conference (CDC) was conducted to finalise the reviews with a nominal group technique (NGT) used to develop recommendations for practice. External Validation Panels (EVP) verified the recommendations in each clinical practice guideline. Group voting was undertaken using a Likert scale (1-3 disagree, 4-6 neutral, 7-9 agree) with consensus agreement set as a median of at least seven. Eighty-three recommendations for practice were developed for the six Clinical Practice Guidelines; 50% were based on research literature evidence (23% with high levels of evidence). The balance were based on consensus opinion of the panel members. Only five recommendations were not validated by external validation. This project has demonstrated a method for guideline development that is robust, incorporating evidence from research and clinical expertise utilising an objective egalitarian framework.

Could a new Mental Health Act distort clinical judgement? A Bayesian justification of naturalistic reasoning about risk

Background: The proposed new Mental Health Act for England and Wales places a premium on identifying substantial clinical risk. This raises the question of how justifiable judgements about risk can be made when the evidence in this area is based upon frequentist statistical analysis which is of limited value in clinical practice. Aims: To develop a model of judgement about risk that articulates the relationship between the results of classical statistical research and the real-time reasoning of professionals in clinical practice. Methods: We use a Bayesian framework to explore the respective roles of frequentist quantities relating to classes and qualitative data idiosyncratic to individuals in real-time reasoning about risk. Results: We develop a model of naturalistic reasoning about risk within which clinical judgement is central. Conclusions: Data that stands as evidence in research literature recedes to become background knowledge in clinical practice, while difficult-to-quantify information idiosyncratic to individuals actually determines clinical judgement. This process is relatively neglected in the literature. We therefore advocate greater research into the reasoning process underlying judgements about clinical risk and advance some suggestions about how that reasoning might be better supported. It should be a matter of concern that legislation such as the proposed Mental Health Act could impair such reasoning. Declaration of Interest: None.

Seedling growth on Mulga soils and the ameliorating effects of lime, phosphate fertilizer and surface soil from beneath poplar box trees.

Phosphate fertilizer, lime (CaCO3), and soil from beneath poplar box trees (Eucalyptus populnea) were incorporated into the surface of an acid sandy red earth (mulga soil) in pots. The effect of these treatments was studied on the growth rate and yield of seedlings of 7 exotic pasture species, Cenchrus ciliaris cv. Biloela, C. ciliaris Q10087, C. ciliaris Q10077. Schmidtia pappophoroides, Eragrostis curvula CPI 30379, Anthephora pubescens and Stylosanthes fruticosa, plus 3 native species Monachather paradoxa, Digitaria ammophila and Aristida armata. Phosphate fertilizer significantly increased growth rates and yields on all soils of all species except E. curvula, S. fruticosa, M. paradoxa and A. armata. Lime, sufficient to raise the pH from 4.8 to 7.7, only slightly improved plant growth overall, although the effect was significant on the three C. ciliaris lines in the absence of added phosphorus. Box surface soil significantly increased growth rate and size of C. ciliaris, especially the cultivar Biloela, and to a lesser extent that of A. pubescens, M. paradoxa and .T. pappophoroides. This improvement in seedling growth on soil from beneath box trees could be at least matched by the addition of phosphorus to mulga soil. Yet the shoots of seedlings growing in box surface soil appeared deficient in phosphorus, indicating a lower availability to plants of such phosphorus than chemical tests would indicate. Evidence in research literature indicates that the results obtained point to aluminium toxicity as being a major factor limiting seedling growth of C. ciliaris on mulga soils.