Evidence For Other Types Research Articles

Sticky Platelet Syndrome: 35 Years of Growing Evidence.

Since the identification of antithrombin deficiency by Egeberg in 1956, ongoing research in prothrombotic defects continues to progress. Interestingly, past research has predominantly focused on coagulation factors and not on other components of the hemostatic system. The possible role of platelet function defects in the development of thrombotic events was suggested for the first time in the late 1970s, when an increased platelet adhesiveness and aggregation after epinephrine (EPI) and adenosine diphosphate (ADP) was found in a group of patients with unexplained transient ischemic attack. Clinical evidence for other types of thrombotic events (e. g. myocardial infarction, ischemic stroke, optic neuropathy, and pregnancy-related complications) with similar laboratory findings was provided by several authors in the 1980s and 1990s, with Drs. Mammen and Bick undertaking key research. The familial occurrence was noted as well, and the term sticky platelet syndrome was introduced by Holliday in 1983 to describe the defect. The term in our present understanding describes a thrombophilic qualitative platelet disorder characterized by increased in vitro platelet aggregation after the addition of very low concentrations of ADP and/or EPI and an increased risk of thromboembolic (predominantly arterial) events. Although now recognized for 35 years, significant issues, namely its etiology, inheritance, epidemiology, and diagnostics, remain a matter of vigorous debate. The aim of this review is to summarize the history, key works, and present understanding of the syndrome and to outline present-day diagnostic and clinical problems and controversies.

PP159 Is Community Paramedicine A Safe/Effective Alternative To Usual Care?

IntroductionDue to an aging population, shortage of healthcare staff, and escalating healthcare costs, there has been a recent shift in the professional roles and responsibilities in acute care settings to help bridge the care gap. Paramedics, whose primary responsibilities have been in emergency/transportation services, are increasingly involved in the management of chronic diseases in the community setting. However, even with additional training, there are concerns about the safety and effectiveness of this expanded role. The objective of this presentation is to highlight some of the key findings from a health technology assessment report on the safety and effectiveness of community paramedicine in assessing and managing conditions/diseases with low acuity.MethodsA systematic review was conducted to identify studies that evaluated the safety and effectiveness of different community paramedicine programs.ResultsFour systematic reviews and 20 primary studies (one randomized controlled trial (RCT) and 19 observational studies) were identified. Of these, two systematic reviews and 14 primary studies focused on the safety and effectiveness of Emergency Care Practitioner (ECP) programs ̶ widely implemented programs whereby a paramedic or nurse undertakes activities traditionally performed by physicians, such as the initial assessment of patients, provision of simple treatment, or referral of patients to other clinical care. Limited evidence showed that ECP programs are promising in reducing repeated emergency calls, emergency department visits, hospital admissions/readmissions, and emergency transport charges. While the majority of included studies did not report any safety outcomes, no significant safety issues were identified from the cluster RCT. Evidence for other types of community paramedicine is limited.ConclusionsEvaluation of the impact of community paramedicine programs remains methodologically challenging. Additional cluster RCTs may help determine the effectiveness of community paramedicine programs; safety outcomes should be a key element of future observational studies.

Acupuncture and Related Therapies for Treatment of Postoperative Ileus in Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Delays in recovery of intestinal function following abdominal surgery are associated with longer hospital stays, increased postoperative complications, and higher costs to the health care system. Studies of acupuncture for postoperative ileus and other postoperative issues have reported improvements. This systematic review and meta-analysis aimed to assess whether acupuncture assisted recovery following surgery for colorectal cancer (CRC). Randomized controlled trials (RCTs) were identified from major English and Chinese language biomedical databases. Participants (aged 18 years plus) had received surgical resection for CRC. 22 studies (1,628 participants) were included. Five were sham-controlled. Outcomes included gastrointestinal function recovery (21 studies), recovery of urinary function (1 study), postoperative abdominal distension (3 studies), and quality of life (1 study). Meta-analyses found significant reductions in time to first bowel sounds, first flatus, and first defecation in both the sham-controlled and nonblinded studies. These results suggested that the addition of acupuncture following CRC surgery improved recovery of gastrointestinal function based on four blinded good quality RCTs (281 participants) and 17 nonblinded lower quality RCTs (1,265 participants). The best available evidence was for interventions that included electroacupuncture at the point ST36 Zusanli and there is supporting evidence for other types of acupuncture therapies that involve stimulation of this point. This review is registered with the following: systematic review registration in PROSPERO: CRD42017079590.

Syrena, ciecòla, monocordum and clavicembalum: the case for stringed keyboards in late Trecento and early Quattrocento Italy

It is now generally assumed that stringed keyboards were widespread throughout Europe from the start of the 15th century onwards and that they represented a viable performance option for surviving intabulations and instrumental music from this time. The current article challenges this notion by re-examining one specific case where several sources of ‘keyboard’ music survive: that of late Trecento and early Quattrocento Italy. A close examination of Italian sources in fact strongly suggests that only one type of stringed keyboard—the clavichord—may have been widely known in Italy before 1450. Yet this instrument is repeatedly connected to the science of music and organ practice. Evidence for other types of stringed keyboards, by comparison, is not only very sparse but is also either too late, of dubious authority, or documents non-Italian practices. Collectively, this suggests that the surviving early Quattrocento ‘keyboard’ music was unlikely to have been intended for performance on stringed keyboards. Finally, the article invites a re-examination of the stringed-keyboard evidence and ‘keyboard’ manuscripts from other European countries in order to gain a more accurate picture of these instruments, their function and possible repertory.

Dissociation of item and source memory in rhesus monkeys

Source memory, or memory for the context in which a memory was formed, is a defining characteristic of human episodic memory and source memory errors are a debilitating symptom of memory dysfunction. Evidence for source memory in nonhuman primates is sparse despite considerable evidence for other types of sophisticated memory and the practical need for good models of episodic memory in nonhuman primates. A previous study showed that rhesus monkeys confused the identity of a monkey they saw with a monkey they heard, but only after an extended memory delay. This suggests that they initially remembered the source – visual or auditory – of the information but forgot the source as time passed. Here, we present a monkey model of source memory that is based on this previous study. In each trial, monkeys studied two images, one that they simply viewed and touched and the other that they classified as a bird, fish, flower, or person. In a subsequent memory test, they were required to select the image from one source but avoid the other. With training, monkeys learned to suppress responding to images from the to-be-avoided source. After longer memory intervals, monkeys continued to show reliable item memory, discriminating studied images from distractors, but made many source memory errors. Monkeys discriminated source based on study method, not study order, providing preliminary evidence that our manipulation of retention interval caused errors due to source forgetting instead of source confusion. Finally, some monkeys learned to select remembered images from either source on cue, showing that they did indeed remember both items and both sources. This paradigm potentially provides a new model to study a critical aspect of episodic memory in nonhuman primates.

Gabapentin for chronic neuropathic pain in adults.

Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage). This review updates a review published in 2014, and previous reviews published in 2011, 2005 and 2000. To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain in adults. For this update we searched CENTRAL), MEDLINE, and Embase for randomised controlled trials from January 2014 to January 2017. We also searched the reference lists of retrieved studies and reviews, and online clinical trials registries. We included randomised, double-blind trials of two weeks' duration or longer, comparing gabapentin (any route of administration) with placebo or another active treatment for neuropathic pain, with participant-reported pain assessment. Two review authors independently extracted data and assessed trial quality and potential bias. Primary outcomes were participants with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)), or moderate pain relief (at least 30% pain relief over baseline or much or very much improved on PGIC). We performed a pooled analysis for any substantial or moderate benefit. Where pooled analysis was possible, we used dichotomous data to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH). We assessed the quality of the evidence using GRADE and created 'Summary of findings' tables. We included four new studies (530 participants), and excluded three previously included studies (126 participants). In all, 37 studies provided information on 5914 participants. Most studies used oral gabapentin or gabapentin encarbil at doses of 1200 mg or more daily in different neuropathic pain conditions, predominantly postherpetic neuralgia and painful diabetic neuropathy. Study duration was typically four to 12 weeks. Not all studies reported important outcomes of interest. High risk of bias occurred mainly due to small size (especially in cross-over studies), and handling of data after study withdrawal.In postherpetic neuralgia, more participants (32%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (17%) (RR 1.8 (95% CI 1.5 to 2.1); NNT 6.7 (5.4 to 8.7); 8 studies, 2260 participants, moderate-quality evidence). More participants (46%) had moderate benefit (at least 30% pain relief or PGIC much or very much improved) with gabapentin at 1200 mg daily or greater than with placebo (25%) (RR 1.8 (95% CI 1.6 to 2.0); NNT 4.8 (4.1 to 6.0); 8 studies, 2260 participants, moderate-quality evidence).In painful diabetic neuropathy, more participants (38%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (21%) (RR 1.9 (95% CI 1.5 to 2.3); NNT 5.9 (4.6 to 8.3); 6 studies, 1277 participants, moderate-quality evidence). More participants (52%) had moderate benefit (at least 30% pain relief or PGIC much or very much improved) with gabapentin at 1200 mg daily or greater than with placebo (37%) (RR 1.4 (95% CI 1.3 to 1.6); NNT 6.6 (4.9 to 9.9); 7 studies, 1439 participants, moderate-quality evidence).For all conditions combined, adverse event withdrawals were more common with gabapentin (11%) than with placebo (8.2%) (RR 1.4 (95% CI 1.1 to 1.7); NNH 30 (20 to 65); 22 studies, 4346 participants, high-quality evidence). Serious adverse events were no more common with gabapentin (3.2%) than with placebo (2.8%) (RR 1.2 (95% CI 0.8 to 1.7); 19 studies, 3948 participants, moderate-quality evidence); there were eight deaths (very low-quality evidence). Participants experiencing at least one adverse event were more common with gabapentin (63%) than with placebo (49%) (RR 1.3 (95% CI 1.2 to 1.4); NNH 7.5 (6.1 to 9.6); 18 studies, 4279 participants, moderate-quality evidence). Individual adverse events occurred significantly more often with gabapentin. Participants taking gabapentin experienced dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (14%). Gabapentin at doses of 1800 mg to 3600 mg daily (1200 mg to 3600 mg gabapentin encarbil) can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. Around 3 or 4 out of 10 participants achieved this degree of pain relief with gabapentin, compared with 1 or 2 out of 10 for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief but may experience adverse events. Conclusions have not changed since the previous update of this review.

Are wikipedia citations important evidence of the impact of scholarly articles and books?

Individual academics and research evaluators often need to assess the value of published research. Although citation counts are a recognized indicator of scholarly impact, alternative data is needed to provide evidence of other types of impact, including within education and wider society. Wikipedia is a logical choice for both of these because the role of a general encyclopaedia is to be an understandable repository of facts about a diverse array of topics and hence it may cite research to support its claims. To test whether Wikipedia could provide new evidence about the impact of scholarly research, this article counted citations to 302,328 articles and 18,735 monographs in English indexed by Scopus in the period 2005 to 2012. The results show that citations from Wikipedia to articles are too rare for most research evaluation purposes, with only 5% of articles being cited in all fields. In contrast, a third of monographs have at least one citation from Wikipedia, with the most in the arts and humanities. Hence, Wikipedia citations can provide extra impact evidence for academic monographs. Nevertheless, the results may be relatively easily manipulated and so Wikipedia is not recommended for evaluations affecting stakeholder interests.

Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults.

Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults.

Documentary Evidence and the Construction of Narratives in Legal and Historical Contexts.

Based on her experiences as an expert witness in Canadian litigation related to Aboriginal peoples, the author shares some personal reflections on the use of the written record as "evidence" in a legal context. As end users in a litigation context will be constructing their own narratives, a historian can add value in the courtroom by sharing skills in analyzing and providing context for written materials as well as providing a narrative based on their content. This process of simultaneously constructing and deconstructing a narrative can support the legitimacy of multiple narratives and provide space for evidence of other types, particularly oral evidence.

Insights into the Motif Preference of APOBEC3 Enzymes

We used a multivariate data analysis approach to identify motifs associated with HIV hypermutation by different APOBEC3 enzymes. The analysis showed that APOBEC3G targets G mainly within GG, TG, TGG, GGG, TGGG and also GGGT. The G nucleotides flanked by a C at the 3′ end (in +1 and +2 positions) were indicated as disfavoured targets by APOBEC3G. The G nucleotides within GGGG were found to be targeted at a frequency much less than what is expected. We found that the infrequent G-to-A mutation within GGGG is not limited to the inaccessibility, to APOBEC3, of poly Gs in the central and 3′polypurine tracts (PPTs) which remain double stranded during the HIV reverse transcription. GGGG motifs outside the PPTs were also disfavoured. The motifs GGAG and GAGG were also found to be disfavoured targets for APOBEC3. The motif-dependent mutation of G within the HIV genome by members of the APOBEC3 family other than APOBEC3G was limited to GA→AA changes. The results did not show evidence of other types of context dependent G-to-A changes in the HIV genome.

Intergovernmental Responsibility for Social Policy: An Analysis of Public Preferences in Spain

Although a considerable amount is known about public preferences for multilevel government in the United States, there is less empirical evidence for other types of federations. Moreover, prior studies have neglected regional differences in intergovernmental policy preferences, despite the relevance of regional variation in places where territorial claims for autonomy exist. This article analyzes citizen preferences for the assignment of responsibility for social policies in Spain. Using data from a survey conducted in 2005 (prior to the European economic crisis), we find distinct patterns across regions in the strength of assignment preferences for health services, pensions, education, and social services. We also find that education, age, gender, social class, political ideology, preferences for lower taxes, and regional political identity are also independent determinants of assignment preferences.

Comprehensive analysis of RNA-Seq data reveals extensive RNA editing in a human transcriptome

RNA editing is a post-transcriptional event that recodes hereditary information. Here we describe a comprehensive profile of the RNA editome of a male Han Chinese individual based on analysis of ∼767 million sequencing reads from poly(A)(+), poly(A)(-) and small RNA samples. We developed a computational pipeline that carefully controls for false positives while calling RNA editing events from genome and whole-transcriptome data of the same individual. We identified 22,688 RNA editing events in noncoding genes and introns, untranslated regions and coding sequences of protein-coding genes. Most changes (∼93%) converted A to I(G), consistent with known editing mechanisms based on adenosine deaminase acting on RNA (ADAR). We also found evidence of other types of nucleotide changes; however, these were validated at lower rates. We found 44 editing sites in microRNAs (miRNAs), suggesting a potential link between RNA editing and miRNA-mediated regulation. Our approach facilitates large-scale studies to profile and compare editomes across a wide range of samples.

Indoleamine 2,3-dioxygenase (IDO) and tryptophan dioxygenase (TDO) mRNA expression in oral squamous cell carcinoma cells is actively and differentially modulated

Objective: Oral cancers are slow developing tumors that affect thousands of individuals in the US annually. Evidence has shown that these cancers can create microenvironments to enhance their progression, survival and metastasis characteristics. Cancer cells will compete for extracellular nutrients with normal tissue cells, which can cause irregularities in immune regulation of progressive cancers. Recent evidence in other types of cancers have suggested that tumor cells may actually upregulate the consumption of extracellular L-tryptophan and increase the export of cytosolic kynurenine byproduct. These kynurenines have been linked to suppression of local immune response of T-cells. The primary goal of this study was to evaluate oral cancer cell lines for tryptophan dioxygenase (TDO) and Indolamine 2,3-dioxygenase (IDO) expression and elucidate whether or not other flavonoids inhibit enzyme expression and cancer growth. Methods: Oral cancer cell lines SCC25, SCC15, and CAL27 were screened for enzyme expression using mRNA specific primers and RT-PCR. The three cell lines were then subjected to proanthocyanidin (PAC) administration to determine potential growth and enzyme inhibition. Results: This study found that IDO and TDO are expressed in the SCC25, SCC15, and CAL27 oral cancer cell lines and enzyme expression is correlated with tumor growth. Additionally, it was observed that IDO and TDO expression, along with tumor growth, can be inhibited by flavonoid administration. Conclusions: With no real treatment advances in many years and survival rates remaining relatively unchanged, these results provide further knowledge in the understanding of oral cancer mechanisms and function that may lead to future treatment modalities. Our demonstration of enzyme down regulation and growth inhibition induced by flavonoids may also contribute to further research in future novel treatments.

The influence of corporate and political interests on models of illness in the evolution of the DSM

The diagnostic and statistical manual of mental disorders (DSM) is an evolving document that serves the many mental health care disciplines as the primary reference guide for classifying mental disorders. While the successive framers of the DSM have attempted to base it on scientific evidence, political and economic factors have also shaped the conceptualization of mental illness. These economic and institutional forces have reinforced the DSM's use of a medical model in understanding psychopathology. Though the scientific evidence for a medical model is mixed and evidence for other types of conceptualizations have been given less attention, the medical model provides for reliable diagnoses that allot diverse benefits to treatment providers and researchers, as well as to the pharmaceutical and healthcare industries. This article will outline the development of a medical model of mental illness, highlighting connections between this model and corporate and political interests, and will show how this model relates to the various revisions of, and developments within, the DSM. Such an analysis is especially relevant today as the field looks towards the publication of the newest revision of the DSM and attempts to understand and integrate its proposed changes into current treatment, theory, and research.

Settlement at Policy Limits and the Duty to Settle: Evidence from Texas

All liability insurance policies have coverage limits, and insurers usually control whether a case is settled or tried. If the insurer rejects a within-limits settlement offer, the insured bears the risk of an above-limits verdict. In response, virtually every state has imposed a “duty to settle” on insurers, which creates incentives for plaintiffs to make at-limits offers and for insurers to accept those offers when expected damages exceed limits. We study the association between the duty to settle, settlement at limits, claim duration, and defense costs using detailed data from Texas for 1988–2005 on closed, commercially insured personal injury claims. We focus principally on medical malpractice suits against physicians, but find consistent evidence for other types of cases. We find strong evidence that the duty to settle affects settlement dynamics. Essentially, all physician-defendant cases that settle at limits are preceded by an at-limits demand. Roughly 20 percent of physician-defendant cases settle at 90–100 percent of policy limits (broad at-limits) and 13 percent settle exactly at limits (exact at-limits). Broad- and exact-at-limits cases close about five months faster than similar “below-limits” cases—a roughly 20 percent shorter time from suit to settlement, controlling for payout and type of harm. Broad- and exact-at-limits cases also have substantially lower defense costs, controlling for case duration and complexity. More broadly, as the payout/limits ratio approaches 1 from below, duration declines (controlling for payout) and defense costs decline (controlling for payout and duration). Payouts above limits are uncommon; when they occur, insurers are the primary payers. Policy limits alone cannot explain these results; most likely they reflect a combination of policy limits and the duty to settle.

Settlement at Policy Limits and the Duty to Settle: Evidence From Texas

All insurance has coverage limits, and insurers usually control whether a case is settled or tried. If the insurer rejects a within-limits settlement offer, the insured bears the risk of an above-limits verdict. In response, virtually every state has imposed a “duty to settle” on insurers, which creates incentives for plaintiffs to make at-limits offers and for insurers to accept those offers when expected damages exceed limits. We study the association between the duty to settle, settlement at limits, claim duration, and defense costs using detailed data from Texas for 1988-2005 on closed, commercially insured personal injury claims. We focus principally on medical malpractice suits against physicians, but find consistent evidence for other types of cases. We find strong evidence that the duty to settle affects settlement dynamics. Essentially all physician-defendant cases that settle at-limits are preceded by an at-limits demand. Roughly 20% of physician-defendant cases settle at 90-100% of policy limits (“broad at-limits”) and 13% settle exactly at limits (“exact at-limits”). Broad- and exact-at-limits cases close about five months faster than similar “below-limits” cases -- a roughly 20% shorter time from suit to settlement, controlling for payout and type of harm. Broad- and exact-at-limits cases also have substantially lower defense costs, controlling for case duration and complexity. More broadly, as the payout/limits ratio approaches 1 from below, duration declines (controlling for payout) and defense costs decline (controlling for payout and duration). Payouts above-limits are uncommon; when they occur, insurers are the primary payers. Policy limits alone cannot explain these results; most likely reflect a combination of policy limits and the duty to settle.

Health Canada Approaches and Activities With Respect to Bioavailability of Contaminants in Soil

MS1-06 Abstract: Under the Canadian Federal Contaminated Sites Action Plan (FCSAP), Health Canada is responsible for the provision of guidance, training, and advice on human health risk assessment (and related topics) to federal departments with custodial responsibilities for contaminated sites. This presentation provides an overview of Health Canada-funded research into the relevance and applicability of in vitro simulated lung fluid solubility assays, in vitro dermal penetration of various soil-borne contaminants using viable human skin, and factors affecting oral bioavailability. One way to improve human health exposure estimates is to apply an increasingly realistic understanding of the fate of particulates and the substances they carry. A review of in vitro studies for the pulmonary tract indicated that given the complexity of particulate distribution, clearance, dissolution, and interaction with macrophages in the pulmonary tract, there is insufficient experimental evidence for other types of solubility assessments to allow for the confident use of in vitro assays as estimates of in vivo contaminant bioavailability. Based on the currently available studies, any arguments for decreased bioavailability of substances derived from inhaled particulates are necessarily accompanied by a very low level of confidence. Ongoing in vitro studies are being conducted at Health Canada to examine bioavailability through viable excised skin. It is anticipated that this will provide more relevant data for human exposures than studies with cadaver skin or animal studies. Contaminated soils are applied to the tissue for various durations as well as soils spiked with chemicals. A database of these results will be compiled for a variety of chemicals that are commonly found at contaminated sites. With regard to oral bioavailability, Health Canada has funded numerous studies to evaluate oral bioavailability of soil-borne contaminants. Health Canada is working toward having a standardized in vitro test that can be used to evaluate site-specific bioaccessibility of metals in soils because the soil characteristics and chemical speciation can have a significant impact on the bioavailability. Each of these pathways can have significant influence in the estimates of exposures in human health risk assessment, including childhood exposures to metals in soils and house dust in residential environments. This presentation provides information on these studies and recommendations toward regulatory approaches with respect to bioavailability of contaminants in soils and housedust.

Molecular-dynamics simulations of dimethylsulfoxide-methanol mixtures

We present molecular-dynamics (MD) computer simulation results for the local structures, hydrogen (H)-bond distribution, and dynamical properties of methanol (MeOH) and dimethylsulfoxide (DMSO) binary mixtures at ambient conditions over the entire composition range. The simulated heat of mixing and site-site pair distribution functions suggest that the intermolecular structures of the pure liquids are not markedly altered upon mixing. Nevertheless, H-bonding statistics show that aggregates of the type 1DMSO:1MeOH are formed and represent the predominant form of molecular association in these mixtures. Only a small fraction (10%) of DMSO molecules in MeOH-rich mixtures (85% in mole) forms H-bonding trimers of type 1DMSO:2MeOH. No evidence of other types of interspecies association is found. The self-diffusion coefficient for DMSO (MeOH) increases (decreases) upon mixing. The characteristic reorientation time tau1 of both species increases in the mixture, but the composition dependence is weak. The frequency spectrum of MeOH reorientational time-correlation function shows significant redshifts of the principal librational band as DMSO is added to the system, whereas the librational band of DMSO shows small alterations upon mixing. Our results are discussed in the light of previous simulation analyses for a similar system, DMSO-water mixtures, and compared with available experimental results.

Baseline and Modulated Acoustic Startle Responses in Adolescent Girls With Posttraumatic Stress Disorder

To assess baseline and modulated acoustic startle responses in adolescent girls with posttraumatic stress disorder (PTSD). Twenty-eight adolescent girls with PTSD and 23 healthy control girls were recruited for participation in the study. Acoustic stimuli were bursts of white noise of 104 dB presented biaurally through headphones. Baseline startle responses as well as prepulse inhibition, a 1,000-Hz prestimulation tone presented 120 milliseconds before the startle stimulus for 30 milliseconds, and prepulse facilitation, a 1000-Hz prestimulation tone presented continuously for 2, 000 milliseconds before the startle stimulus, were compared in these two groups of girls. At baseline and under neutral testing conditions, the magnitude of the startle response (eye blink) did not differ significantly between girls with PTSD and healthy control girls. There were no significant differences in the degree of prepulse inhibition or facilitation between the two groups of girls. Unlike combat veterans with PTSD, adolescent girls with PTSD who report exaggerated startle may not have exaggerated baseline acoustic startle responses in the laboratory. Further research should explore whether girls with PTSD demonstrate altered startle responses under stress and/or evidence of other types of psychophysiological abnormalities.

Exercise therapy for treatment of non-specific low back pain.

Exercise therapy is widely used as an intervention in low-back pain. To evaluate the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic low-back pain versus no treatment and other conservative treatments. The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE, EMBASE, PsychInfo, CINAHL databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized controlled trials evaluating exercise therapy for adult non-specific low-back pain and measuring pain, function, return-to-work/absenteeism, and/or global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short, intermediate, and long-term follow-up. Sixty-one randomized controlled trials (6390 participants) met inclusion criteria: acute (11), subacute (6) and chronic (43) low-back pain (1 unclear). Evidence was found of effectiveness in chronic populations relative to comparisons at all follow-up periods; pooled mean improvement was 7.3 points (95% CI, 3.7 to 10.9) for pain (out of 100), 2.5 points (1.0 to 3.9) for function (out of 100) at earliest follow-up. In studies investigating patients (i.e. presenting to healthcare providers) mean improvement was 13.3 points (5.5 to 21.1) for pain, 6.9 (2.2 to 11.7) for function, representing significantly greater improvement over studies where participants included those recruited from a general population (e.g. with advertisements). There is some evidence of effectiveness of graded-activity exercise program in subacute low-back pain in occupational settings, though the evidence for other types of exercise therapy in other populations is inconsistent. There was evidence of equal effectiveness relative to comparisons in acute populations [pain: 0.03 points (95% CI, -1.3 to 1.4)]. This review largely reflects limitations of the literature, including low quality studies with heterogeneous outcome measures, inconsistent and poor reporting, and possibility of publication bias. Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations. In subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. In acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.