Lack Of Treatment Effect Research Articles

Surgery for small asymptomatic abdominal aortic aneurysms.

An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but an important one is the size of the aneurysm, as risk of rupture increases with aneurysm size. Large asymptomatic AAAs (greater than 5.5 cm in diameter) are usually repaired surgically; very small AAAs (less than 4.0 cm diameter) are monitored with ultrasonography. Debate continues over the appropriate roles of immediate repair and surveillance with repair on subsequent enlargement in people presenting with asymptomatic AAAs of 4.0 cm to 5.5 cm diameter. This is the third update of the review first published in 1999. To compare mortality, quality of life, and cost effectiveness of immediate surgical repair versus routine ultrasound surveillance in people with asymptomatic AAAs between 4.0 cm and 5.5 cm in diameter. For this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1). We checked reference lists of relevant articles for additional studies. Randomised controlled trials in which men and women with asymptomatic AAAs of diameter 4.0 cm to 5.5 cm were randomly allocated to immediate repair or imaging-based surveillance at least every six months. Outcomes had to include mortality or survival. Three members of the review team independently extracted the data, which were cross-checked by other team members. Risk ratios (RR) (endovascular aneurysm repair only), hazard ratios (HR) (open repair only), and 95% confidence intervals based on Mantel-Haenszel Chi(2) statistic were estimated at one and six years (open repair only) following randomisation. We included all relevant published studies in this review. For this update, four trials with a combined total of 3314 participants fulfilled the inclusion criteria. Two trials compared surveillance with immediate open repair; two trials compared surveillance with immediate endovascular repair. Overall, the risk of bias within the included studies was low and the quality of the evidence high. The four trials showed an early survival benefit in the surveillance group (due to 30-day operative mortality with surgery) but no significant differences in long-term survival (adjusted HR 0.88, 95% confidence interval (CI) 0.75 to 1.02, mean follow-up 10 years; HR 1.21, 95% CI 0.95 to 1.54, mean follow-up 4.9 years; HR 0.76, 95% CI 0.30 to 1.93, median follow-up 32.4 months; HR 1.01, 95% CI 0.49 to 2.07, mean follow-up 20 months). A pooled analysis of participant-level data from two trials (with a maximum follow-up of seven to eight years) showed no statistically significant difference in survival between immediate open repair and surveillance (propensity score-adjusted HR 0.99; 95% CI 0.83 to 1.18), and that this lack of treatment effect did not vary by AAA diameter (P = 0.39) or participant age (P = 0.61). The meta-analysis of mortality at one year for the endovascular trials likewise showed no significant association (RR at one year 1.15, 95% CI 0.60 to 2.17). Quality-of-life results among trials were conflicting. The results from the four trials to date demonstrate no advantage to immediate repair for small AAA (4.0 cm to 5.5 cm), regardless of whether open or endovascular repair is used and, at least for open repair, regardless of patient age and AAA diameter. Thus, neither immediate open nor immediate endovascular repair of small AAAs is supported by currently available evidence.

Bread wheat performance, fusarium head blight incidence and weed infestation response to low-input conservation tillage systems in eastern Canada

Munger, H., Vanasse, A., Rioux, S. and Légère, A. 2014. Bread wheat performance, fusarium head blight incidence and weed infestation response to low-input conservation tillage systems in eastern Canada. Can. J. Plant Sci. 94: 193–201. Bread wheat performance, the incidence of diseases like fusarium head blight (FHB) and weed infestations may be affected by low-input systems and conservation tillage practices. This 2-yr study assessed the effects of three 24-yr-old tillage treatments (MP: moldboard plow; CP: chisel plow; NT: no-till) and two cropping systems (high-input: herbicide and mineral fertilizer; low-input: mechanical weed control and organic fertilizer) on wheat productivity, deoxynivalenol (DON) content, Fusarium graminearum inoculum production, and weed infestation in hard red spring wheat. In 2009, low-input CP and NT yields were 13 and 31% lower, respectively, than low-input MP yield, which was comparable with all of the high-input treatment yields. In 2010, yields were 23% lower in CP and NT compared with MP, and 32% lower in low-input than in high-input systems. Optimum wheat yield in low-input systems appeared conditional to adequate weed control, which was achieved with MP and CP tillage. Protein content, test weight, and 1000-kernel weight were higher in the high-input system than in the low-input system, except for test weight in 2009. DON content was not affected by tillage in either year, and was lower in low-input system than in high-input system in 2009. Fusarium graminearum inoculum measured in 2009 was similar across tillage treatments in the high-input system, whereas in the low-input system, the inoculum was lower in NT than in MP. In 2010, DON content was not affected by any treatment. Hot and dry conditions were not conducive to pathogen development, and may explain the low level of DON and the lack of treatment effect.

Prey size increases with nestling age: are provisioning parents programmed or responding to cues from offspring?

As offspring grow, parents often feed them with different sizes or taxa of prey to suit the changing nutritional or energetic demands. We investigated whether such changes in prey types were innate and inflexible or whether they were based on the proximate cue of offspring size. We created experimental broods in which parent blue tits Cyanistes caeruleus and pied flycatchers Ficedula hypoleuca received either older nestlings simulating rapid development or younger nestlings simulating delayed development. The size of prey increased over time in all brood types, suggesting a strong programmed pattern of foraging by parents. However, delayed broods were provisioned with smaller prey than control or advanced broods indicating some plasticity in the response by the parents to the size of nestlings. Although female birds brought smaller prey than male birds, both sexes showed the same rate of increase of prey size with time and brought similar types of prey items. The proportion of soft, digestible larva prey in the nestling diet decreased over time in pied flycatchers but increased in blue tits. Counter to the hypothesis that spiders provide unique and preferred nutrients for young nestlings, the proportion of arachnids in the diet did not change with nestling age for either species. The lack of treatment effect on the taxa of prey delivered suggests that temporal shifts in diet composition are not driven by the proximate cues of nestling age or size but that the feeding patterns are fairly innate and fixed in these altricial birds.

Medication adherence: the critical step towards better patient outcome

Medication adherence is defined as patient’s adherence to take their medications as prescribed and continue to take the prescribed medication for stipulated time frame. Medication non-adherence is a growing concern to physicians, healthcare systems, and other stakeholders (e.g., payers) and there is an increasing evidence of its prevalence and is associated with adverse clinical outcomes eventually resulting into higher costs of care. The cost of non-adherence has been estimated at $100 billion to $300 billion annually, including costs from avoidable hospitalizations, nursing home admissions, and premature deaths. Improving adherence to medication is critical to improve the quality of health care, to encourage better chronic care management, and promote better health outcomes. Reasons for non-adherence are multiple and complex. Studies have reported that poor adherence to drug dosage is due to patient perception that the disease is non-significant, adverse drug effects, lack of treatment effectiveness, and the patient’s poor or incomplete knowledge of the disease and (cost). A multifactorial approach is required to tackle this complex problem as a single approach will be ineffective for all patients. The most effective intervention is to use a combination of approaches and address literacy, behavior, and organizational issues. There are challenges as well as opportunities in addressing the public health issue of medication adherence. Changing healthcare reforms, advances in digital health media, social media and modern technologies can now provide alternatives to tackle this issue.

Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis

Upper limb impairments can occur in patients with multiple sclerosis, affecting daily living activities; however there is at present no definite agreement on the best rehabilitation treatment strategy to pursue. Moreover, motor training has been shown to induce changes in white matter architecture in healthy subjects.This study aimed at evaluating the motor behavioral and white matter microstructural changes following a 2-month upper limb motor rehabilitation treatment based on task-oriented exercises in patients with multiple sclerosis.Thirty patients (18 females and 12 males; age=43.3±8.7years) in a stable phase of the disease presenting with mild or moderate upper limb sensorimotor deficits were randomized into two groups of 15 patients each. Both groups underwent twenty 1-hour treatment sessions, three times a week. The “treatment group” received an active motor rehabilitation treatment, based on voluntary exercises including task-oriented exercises, while the “control group” underwent passive mobilization of the shoulder, elbow, wrist and fingers.Before and after the rehabilitation protocols, motor performance was evaluated in all patients with standard tests. Additionally, finger motor performance accuracy was assessed by an engineered glove.In the same sessions, every patient underwent diffusion tensor imaging to obtain parametric maps of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. The mean value of each parameter was separately calculated within regions of interest including the fiber bundles connecting brain areas involved in voluntary movement control: the corpus callosum, the corticospinal tracts and the superior longitudinal fasciculi.The two rehabilitation protocols induced similar effects on unimanual motor performance, but the bimanual coordination task revealed that the residual coordination abilities were maintained in the treated patients while they significantly worsened in the control group (p=0.002). Further, in the treatment group white matter integrity in the corpus callosum and corticospinal tracts was preserved while a microstructural integrity worsening was found in the control group (fractional anisotropy of the corpus callosum and corticospinal tracts: p=0.033 and p=0.022; radial diffusivity of the corpus callosum and corticospinal tracts: p=0.004 and p=0.008). Conversely, a significant increase of radial diffusivity was observed in the superior longitudinal fasciculi in both groups (p=0.02), indicating lack of treatment effects on this structure, showing damage progression likely due to a demyelination process.All these findings indicate the importance of administering, when possible, a rehabilitation treatment consisting of voluntary movements. We also demonstrated that the beneficial effects of a rehabilitation treatment are task-dependent and selective in their target; this becomes crucial towards the implementation of tailored rehabilitative approaches.

Abstract LB-146: A phase II randomized placebo-controlled study of AZD8931, an inhibitor of EGFR, HER2, and HER3 signaling, plus paclitaxel (P) vs P alone in patients (pts) with low HER2-expressing advanced breast cancer (BC) (THYME).

Abstract Background: AZD8931 is an oral, equipotent inhibitor of EGFR, HER2, and HER3 signaling. Preclinical evidence indicates that AZD8931 may be particularly potent when HER signaling is ligand driven, which is thought to be the signaling mechanism that is more prevalent in low HER2-expressing BC. Methods: In this double-blind multicenter phase II study, women with low HER2- expressing locally advanced or metastatic BC (ineligible by HER2 status for either trastuzumab or lapatinib) were randomized 1:1 to AZD8931 40mg bid + P (90mg/m2; d1, 8 and 15, q4 weeks) or matched placebo + P (NCT00900627). The primary objective was prolonged progression-free survival (PFS; assessed by RECIST v1.1); secondary endpoints included objective response rate (ORR), overall survival (OS), and safety. Results: Between July 2010 and April 2011, 190 pts (median age, 55 years [range, 32-80]; 83% metastatic disease) were randomized to AZD8931 + P (n=94) or placebo + P (n=96). No significant difference in PFS was observed with AZD8931 + P vs P alone (HR=1.08, 95% CI [0.76, 1.52], P=0.679; median PFS, 8.7 vs 9.1 months); this lack of treatment effect was consistent across subgroups. A significant increase in ORR (59% vs 41%; OR=2.02, 95% CI [1.09, 3.75], P=0.026) and in mean % change in tumor size at week 8 vs baseline (difference, -9.9%, 95% CI [-18.4%, -1.4%], P=0.023; exploratory objective) was observed with AZD8931 + P vs P alone. At data cut-off (April 2012), OS data were immature (52 [27%] pts had died), with no difference between treatment arms (HR=1.15, 95% CI [0.67, 2.01], P=0.607). The hazard ratio for the time to deterioration of health-related quality of life (assessed by FACT-B TOI; exploratory objective) was 1.46 (95% CI [1.04, 2.05], P=0.028). The most common adverse events (AEs) were rashes and acne (grouped term; 91% [AZD8931 + P] vs 26% [P alone]) and diarrhea (83% vs 35%). Grade ≥3 AEs were reported for 65% and 41% of pts in the AZD8931 + P and the P alone arm, respectively, the most common being rashes and acne (grouped term; 19% vs 2%), diarrhea (12% vs 4%), neutropenia (7% vs 15%) and peripheral neuropathy (7% vs 2%). Discontinuation of AZD8931 or placebo treatment due to AEs was reported for 12 (13%) and 8 (9%) pts, respectively. Fatal AEs were reported in two pts in the AZD8931 + P arm (neither considered AZD8931 treatment-related) and three pts in the P alone arm. No new or unexpected safety concerns were reported with this treatment combination. Paclitaxel delivery was not compromised by combination with AZD8931. Conclusion: The THYME study did not meet its primary objective of prolonging PFS when AZD8931 was added to weekly P in pts with low HER2-expressing advanced BC. AZD8931 40mg bid can be administered in combination with weekly P with a manageable toxicity profile. Exploratory biomarker analyses are ongoing and will be presented. Citation Format: José Baselga, Roberto Hegg, Maria Vidal Losada, Tatiana Vidaurre, Ana Lluch, Katerina Petrakova, Helen Mann, Serban Ghiorghiu, Mary Stuart, Dónal Landers, Kenneth Thress, Teresa Klinowska, Javier Cortes. A phase II randomized placebo-controlled study of AZD8931, an inhibitor of EGFR, HER2, and HER3 signaling, plus paclitaxel (P) vs P alone in patients (pts) with low HER2-expressing advanced breast cancer (BC) (THYME). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-146. doi:10.1158/1538-7445.AM2013-LB-146

Medium-term impact of tillage and residue management on soil aggregate stability, soil carbon and crop productivity

Conservation agriculture is widely promoted for soil conservation and crop productivity increase, although rigorous empirical evidence from sub-Saharan Africa is still limited. This study aimed to quantify the medium-term impact of tillage (conventional and reduced) and crop residue management (retention and removal) on soil and crop performance in a maize–soybean rotation. A replicated field trial was started in sub-humid Western Kenya in 2003, and measurements were taken from 2005 to 2008. Conventional tillage negatively affected soil aggregate stability when compared to reduced tillage, as indicated by lower mean weight diameter values upon wet sieving at 0–15cm (PT<0.001). This suggests increased susceptibility to slaking and soil erosion. Tillage and residue management alone did not affect soil C contents after 11 cropping seasons, but when residue was incorporated by tillage, soil C was higher at 15–30cm (PT*R=0.037). Lack of treatment effects on the C content of different aggregate fractions indicated that reduced tillage and/or residue retention did not increase physical C protection. The weak residue effect on aggregate stability and soil C may be attributed to insufficient residue retention. Soybean grain yields tended to be suppressed under reduced tillage without residue retention, especially in wet seasons (PT*R=0.070). Consequently, future research should establish, for different climatic zones and soil types, the critical minimum residue retention levels for soil conservation and crop productivity.

Effects of supplemental energy and protein on forage digestion and urea kinetics in growing beef cattle1

Effects of supplemental energy sources on nutrient digestion and urea kinetics at 2 levels of degradable intake protein were evaluated in cattle (Bos taurus). Six ruminally and duodenally cannulated steers (208 ± 17 kg) were used in a 6 × 6 Latin square with treatments arranged as a 3 × 2 factorial. Energy treatments included a control, 600 g glucose dosed ruminally once daily, and 480 g VFA infused ruminally over 8 h daily. Casein (120 or 240 g) was dosed ruminally once daily. Steers had ad libitum access to prairie hay (5.8% CP). Jugular infusion of (15)N(15)N-urea with measurement of enrichment in urine was used to measure urea kinetics. Infusing VFA decreased (P < 0.01) forage intake by 27%. Supplementing glucose decreased (P < 0.01) total tract NDF digestibility and tended to decrease ruminal NDF digestibility; depressions in response to glucose tended to be greater at the lower level of casein. Increasing casein decreased (P < 0.02) ruminal pH. Infusing VFA decreased pH only during infusions, whereas glucose decreased pH 2 h after dosing. Ruminal concentrations of NH(3), acetate, and propionate decreased and butyrate concentration increased when glucose was supplemented. Increasing casein supplementation increased (P < 0.01) ruminal concentrations of NH(3), acetate, and propionate. Supplemental energy decreased (P = 0.03) plasma urea-N concentration, but casein level did not affect it (P = 0.16). Microbial N flow was greater (P < 0.04) for 240 than for 120 g/d casein but was not affected by supplemental energy (P = 0.23). Urea-N entry rate and gut entry of urea-N were not affected (P ≥ 0.12) by supplemental energy or casein, but the proportion of urea production that was recycled to the gut was less (P = 0.01) when 240 g/d rather than 120 g/d casein was provided. Compared with VFA, glucose tended (P = 0.07) to increase the proportion of urea-N entry rate that was recycled to the gut. Supplementation with glucose led to more (P = 0.01) microbial uptake of recycled urea than did supplementation with VFA. Urea recycling did not differ greatly among treatments despite impacts on ruminal pH and NH(3) and on plasma urea-N that were expected to alter urea transport across ruminal epithelium. Lack of treatment effects on urea production indicate that the complete diets did not provide excessive amounts of N and that increases of intestinally available AA were used efficiently by cattle for protein deposition.

Variation in monsoon precipitation drives spatial and temporal patterns of Larrea tridentata growth in the Sonoran Desert

Summary 1. Broad-scale patterns of above-ground net primary production (ANPP) are closely coupled to climate features, particularly the distribution and magnitude of rainfall. In arid and semi-arid regions, however, the precipitation regime, together with local geomorphology and plant life history traits, combine to regulate soil water availability and patterns of growth, complicating simple correlations with climatic variables. 2. To better understand the drivers of plant growth in desert ecosystems, we characterized the rates and spatial heterogeneity of stem elongation by the dominant perennial shrub, creosote bush (Larrea tridentata) in the northern Sonoran Desert of Arizona (USA). Estimates of stem growth were made over a 5-year period (2006–2010) from 60 plots at 15 sites spanning c. 120 km across the Central Arizona–Phoenix (CAP) Long-term Ecological Research (LTER) area. 3. We observed both the highest and lowest rates of stem growth during summer, and these patterns were related to the amount of monsoon rainfall and local rates of water infiltration. The relationship between growth and precipitation in the summer was nonlinear, with rates increasing more than eightfold at plots receiving more than 100 mm of seasonal rainfall. Conversely, growth during the winter/spring was intermediate in magnitude, similar among years and poorly correlated with seasonal precipitation. 4. The spatial heterogeneity of stem growth also differed markedly between seasons and was greater both within and among sites during summer compared to winter/spring growing periods. At broad scales, spatial heterogeneity of shrub growth was correlated with seasonal changes in the spatial variability of rainfall across the study area. At small spatial scales, greater heterogeneity during the summer appears linked to local soil properties that influence infiltration and water availability following monsoon storms. 5. Overall, the strong, nonlinear growth response by L. tridentata to monsoon rainfall suggests that the recurrence interval of wet summer seasons is an important driver of ANPP for this long-lived shrub. More generally, our results illustrate how regional climate variability and local soil properties can interact to influence the rates and heterogeneity of desert plant growth at multiple scales.

In vitro rumen methane output of perennial ryegrass varieties and perennial grass species harvested throughout the growing season

AbstractThe selection and feeding of perennial ryegrass (Lolium perenne L.) varieties (PRV) or perennial grass species (PGS) may affect enteric methane (CH4) output because of changes in the fermentation dynamics in the rumen as a result of differences in herbage chemical composition. The objective of this study was to determine the effects of PRV and PGS harvested throughout the growing season on herbage chemical composition, and in vitro rumen fermentation variables and CH4 output per unit of feed using a batch culture technique. Seven PRV (Experiment 1: Alto, Arrow, Bealey, Dunluce, Greengold, Malone, Tyrella) and six perennial grasses [Experiment 2: perennial ryegrass (Navan), perennial ryegrass (Portstewart), cocksfoot, meadow fescue, tall fescue, timothy; defined as PGS], managed under a simulated grazing regime, were incubated for 24 h with buffered rumen fluid in two separate experiments. The CH4 output per unit of feed dry‐matter (DM) incubated was not affected (P &gt; 0·05) by PRV (range of mean values across PRV of 23·9–25·3 (SEM 0·41) mL g−1 DM) or by PGS (25·6–26·6 (SEM 0·37) mL g−1 DM). The CH4 output per unit feed DM disappearing during the in vitro rumen incubation was not affected by PRV (33·9–35·1 (SEM 0·70) mL g−1 DM), and although there was an overall PGS effect (P &lt; 0·05; 37·2–40·3 (SEM 0·71) mL g−1 DM), none of the paired contrasts between PGS were significant when analysed using Tukey adjusted comparisons. This outcome reflected either small‐scale or a lack of treatment effects on individual herbage chemical composition (e.g. 454–483 g NDF kg−1 DM, 215–224 g CP kg−1 DM and 94–122 g water‐soluble carbohydrate (WSC) kg−1 DM across PRV; 452–506 g NDF kg−1 DM, 208–243 g CP kg−1 DM and 73–131 g WSC kg−1 DM across PGS) and in vitro rumen fermentation variables. Hence, these results provide no encouragement that choices among the grasses examined, produced within the management regimes operated, would reduce enteric CH4 output per unit of feed in vivo. However, the technique utilized did not take account of animal × PRV or PGS interactions, such as potential differences in intake between animals, that may occur under farm conditions.

Effects of vitamin E supplementation on and the association of body condition score with changes in peroxidative biomarkers and antioxidants around calving in dairy heifers

The objective of this study was to investigate the effect of vitamin E supplementation on oxidative status in blood, liver, milk, and ovarian follicular fluid in periparturient heifers. Vitamin E supplementation started 8 wk before calving and continued until 8 wk postpartum. Grass silage was the main forage fed during the experiment. In addition, supplemented heifers (n=9) received 3,000IU of vitamin E daily on a carrier food; control heifers (n=9) consumed only the carrier food. Blood samples and liver biopsies were taken frequently throughout the study and ovarian follicular fluid was sampled at 8 wk postpartum. Body condition score was scored weekly and milk yield was measured daily. A marker of oxidative damage, determinable reactive oxygen metabolites (d-ROM), and a set of antioxidants were measured in blood, liver, milk, and ovarian follicular fluid. Control heifers had a low vitamin E status, and selenium status was marginal in control and supplemented heifers. Vitamin E supplementation increased vitamin E concentrations in blood, liver, and ovarian follicular fluid and increased triacylglycerol in liver. Serum d-ROM were not reduced by vitamin E supplementation. Superoxide dismutase and glutathione peroxidase activity in red blood cells and liver and glutathione peroxidase activity in ovarian follicular fluid were not affected by vitamin E supplementation and they were not increased around calving. Protein thiol groups and ratio of reduced glutathione to oxidized glutathione were also not increased around calving. These results suggest that heifers around calving experience a low level of oxidative processes. This might be caused by lower than expected milk production attributed to a low forage intake. Serum d-ROM were negatively correlated with protein thiol groups and positively correlated with the activity of glutathione peroxidase in red blood cells, oxidized glutathione, and the ratio of reduced glutathione and oxidized glutathione in serum. The lack of treatment effects allowed estimation of the effects of body condition 4 wk before calving and the loss of body condition on markers of lipid peroxidation and antioxidants. A trend that a body condition of ≥3 might result in more oxidative damage measured by serum d-ROM was observed, but fatter heifers had a significantly higher ratio of reduced glutathione to oxidized glutathione.

Multisystemic therapy with conductdisordered young people: stability of treatment outcomes two years after intake

The transfer of successful interventions between different contexts is of increasing interest to policy makers, practitioners and researchers. This study considers the findings of a Swedish trial of multisystemic therapy (MST) in relation to the findings of other such trials in the US and Norway. The trial assessed treatment outcomes two years after referral to MST or treatment as usual (TAU) for 156 young people meeting the diagnostic criteria for conduct disorder. A mixed factorial design was used. With an intent-to-treat approach, the results showed a general decrease in psychiatric problems and antisocial behaviours among participants across treatments. There were no significant differences between the two groups, and the lack of treatment effect did not appear to be caused by site differences or variations in programme maturity.

Measurement of meaningful treatment effects in CADASIL

I read with interest Martin Dichgans and colleagues' study of donepezil in CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy), in the April issue of The Lancet Neurology. 1 Dichgans M Markus HS Salloway S et al. Donepezil in patients with subcortical vascular cognitive impairment: a randomized double-blind trial in CADASIL. Lancet Neurol. 2008; 7: 310-318 Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar The researchers found significant effects on two measures of executive control function, including the executive interview (EXIT25). 2 Royall DR Mahurin RK Gray K Bedside assessment of executive cognitive impairment: the executive interview (EXIT). J Am Geriatr Soc. 1992; 40: 1221-1226 PubMed Google Scholar The EXIT25 effect of −1·5 points out of 50 was comparable to that in an earlier study by Auchus and co-workers 3 Auchus AP, Brashear HR, Salloway S, et al. Results of a trial of galantamine in subjects with vascular dementia confirmed by central MRI reading. American Academy of Neurology Meeting, San Francisco, CA, USA. April 27, 2004. Google Scholar of galantamine in patients with vascular dementia as defined by the National Institute of Neurological Disorders and Stroke (NINDS). Measurement of meaningful treatment effects in CADASIL – Authors' replyWe appreciate Dr Royall's comments on the EXIT25. We agree that the beneficial effect of donepezil on the EXIT25 scores, albeit statistically significant, might not be clinically meaningful. In fact, the lack of treatment effects on instrumental activities of daily living and global dementia rating, as assessed by the disability assessment for dementia and the sum of boxes of the clinical dementia rating scale seems to support this view. We also agree that, on average, patients in the current trial were mildly affected and that this might have limited our ability to detect clinically meaningful improvements in both executive function and instrumental activities of daily living. Full-Text PDF

The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths.

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Rats on the run: removal of alien terrestrial predators affects bush rat behaviour

Predators can strongly influence the microhabitat use and foraging behaviour of prey. In a large-scale replicated field experiment in East Gippsland, Australia, we tested the effects of reduced alien red fox (Vulpes vulpes) and alien wild dog (Canis lupus familiaris) abundance (treatment) on native bush rat (Rattus fuscipes) behaviour. Bush rats are exposed to two main guilds of predators, namely mammalian carnivores and birds of prey. Tracking rat movements using the spool-and-line technique revealed that, in treatment sites, rats used ground cover, which provides shelter from predators, less often than at unmanipulated fox and wild dog abundance (non-treatment sites). In treatment sites, rats more frequently moved on logs where they would have been exposed to hunting foxes and dogs than in non-treatment sites. Furthermore, in treatments, rats showed a preference for understorey but not in non-treatments. Hence, bush rats adapted their behaviour to removal of alien terrestrial predators. Giving-up densities (GUDs) indicated no treatment effects on the marginal feeding rate of bush rats. Interestingly, GUDs were higher in open patches than in sheltered patches, suggesting higher perceived predation risk of bush rats during foraging at low versus high cover. The lack of treatment effects on GUDs but the clear response of bush rats to cover may be explained by the impact of predators other than foxes and wild dogs.

Analgesic effectiveness of celecoxib and diclofenac in patients with osteoarthritis of the hip requiring joint replacement surgery: a 12-week, multicenter, randomized, double-blind, parallel-group, double-dummy, noninferiority study

Background: The hip is the second most common large joint that is affected by osteoarthritis (OA), with prevalence ranging from 3% to 11% in patients aged ≥35 years. OA is often associated with significant pain, disability, and impaired quality of life. Treatment should be tailored according to the level of pain, disability, and handicap. Pharmacologic treatment options for hip OA include acetaminophen (recommended by the European League Against Rheumatism as a first-line treatment), NSAIDs such as diclofenac, and cyclooxygenase-2-selective NSAIDs such as celecoxib. Objective: The purpose of this study was to determine whether celecoxib 200 mg QD is noninferior to diclofenac 50 mg TID in the treatment of OA of the hip. Methods: This was a 12-week, randomized, double-blind, parallel-group, double-dummy, noninferiority study conducted at 40 centers in the United Kingdom. Patients with OA flare at baseline (determined by visual analog scale [VAS] measurement of ≥40 to <90 mm and patient's and physician's global assessments of arthritis ratings of “poor” or “very poor”) and awaiting joint replacement surgery were randomized to receive celecoxib QD or diclofenac TID. Patients were excluded if surgery was anticipated within 8 weeks. The United Kingdom National Health Service initiatives on waiting-list times caused a reduction in the number of potential patients available for participation. Therefore, the study protocol was amended such that change from baseline to week 6 (as opposed to week 12) in the patient's assessment of arthritis pain on walking, measured by VAS (0-100 mm), was the primary outcome. Primary analysis was carried out on the evaluable population (subjects with baseline and week 6 arthritis pain on walking VAS scores and no major protocol deviations). Celecoxib was declared noninferior to diclofenac if the upper limit of the 2-sided 95% CI of the treatment difference (celecoxib vs diclofenac) in the mean change from baseline in VAS did not exceed 10 mm. Tolerability was assessed by the documentation of observed and volunteered adverse events (AEs), physical examination findings, sitting blood pressure, and pulse at screening and at the end of the study (week 12 or early withdrawal). Results: A total of 249 patients aged ≥45 years were randomized to treatment. There were 126 patients in the celecoxib group and 123 patients in the diclofenac group. One patient in the celecoxib group did not receive any treatment and was excluded from analysis. Additionally, 54 patients in the celecoxib group and 45 patients in the diclofenac group discontinued treatment due to AEs and/or lack of treatment effectiveness. Therefore, 71 patients in the celecoxib group and 78 patients in the diclofenac group completed the study. No significant differences in demographic characteristics were observed between treatment groups. The mean (SD) age was 64.0 (9.0) years, 53.9% (76/141) of the patients were men and 46.1% (65/141) were women, and 99.3% (140/141) were white. At weeks 6 and 12, the patient's assessment of arthritis pain on walking (VAS) improved in both groups (-20.0 [23.6] mm in the celecoxib group and This work was presented in poster form at the European Federation of the International Association for the Study of Pain Chapters 5th Congress, September 13-16, 2006, Istanbul, Turkey. Accepted for publication November 28, 2007. -35 [27.0] mm in the diclofenac group [mean treatment difference, 14.4 mm; 95% CI, 6.1 to 22.7]). However, treatment differences in change from baseline favored diclofenac at week 6 (14.4 mm; 95% CI, 6.1 to 22.7) and week 12 (12.2 mm; 95% CI, 2.2 to 22.1). A post hoc analysis, performed after unblinding due to an imbalance in the numbers of patients previously receiving NSAIDs, found a greater treatment difference at week 6 between celecoxib and diclofenac in arthritis pain, favoring diclofenac, in previous nonusers of NSAIDs (n = 49, 18.6 mm; 95% CI, 4.5 to 32.8) compared with previous NSAID users (n = 92, 9.5 mm; 95% CI, -0.4 to 19.3). Celecoxib and diclofenac were generally well tolerated. A similar proportion of patients in both treatment groups experienced AEs (all causality): 67/125 of celecoxib-treated patients (53.6%) compared with 66/123 of diclofenac-treated patients (53.7%). Conclusion: This study did not demonstrate nonin-feriority of celecoxib 200 mg QD to diclofenac 50 mg TID in treating arthritis pain in patients with OA of the hip requiring joint replacement.

Water relations of seedlings of three Quercus species: variations across and within species grown in contrasting light and water regimes

We compared seedling water relations of three Mediterranean Quercus species (the evergreen shrub Q. coccifera L., the evergreen tree Q. ilex L. subsp. ballota (Desf.) Samp. and the deciduous or marcescent tree Q. faginea L.). We also explored seedling potential for acclimation to contrasting growing conditions. In March, 1-year-old seedlings of the three species were planted in pots and grown outdoors in a factorial combination of two irrigation regimes (daily (HW) and alternate day watering (LW)) and two irradiances (43 and 100% of full sunlight). At the end of July, predawn and midday water potentials (Psi(pd), Psi(md)) were measured, and pressure-volume (P-V) curves were obtained for mature current-year shoots. Species exhibited similar Psi(pd) and Psi(md) values, but differed in leaf morphology and water relations. The evergreens possessed larger leaf mass per area (LMA) and were able to maintain positive turgor pressure at lower water potentials than the deciduous species because of their lower osmotic potential at full turgor. However, the three species had similar relative water contents at the turgor loss point because Q. faginea compensated for its higher osmotic potential with greater cell wall elasticity. Values of Psi(pd) had a mean of -1.12 MPa in LW and -0.63 MPa in HW, and Psi(md) had a mean of -1.13 MPa in full sunlight and -1.64 MPa in shade, where seedlings exhibited lower LMA. However, the P-V curve traits were unaffected by the treatments. Our results suggest that Q. faginea seedlings combine the water-use characteristics of mesic deciduous oak and the drought-tolerance of xeric evergreen oak. The ability of Q. coccifera to colonize drier sites than Q. ilex was not a result of higher drought tolerance, but rather may be associated with other dehydration postponement mechanisms including drought-induced leaf shedding. The lack of treatment effects may reflect a relatively low contrast between treatment regimes, or a low inherent responsiveness of these traits in the study species, or both.

Influence of regrouping strategy on performance, behaviour and carcass parameters in pigs

One thousand two hundred pigs were weaned at 4 weeks of age and mixed to form groups of ten animals that were balanced for gender. The groups consisted of uniform weight groups (i.e. separate groups of small, medium or large pigs), or mixed weight groups (i.e. groups containing small, medium and large pigs). Half of the groups were retained from weaning until slaughter at 21 weeks of age, and half were regrouped at the start of the finishing period at 10 weeks of age. In this regrouping, uniform weight groups were regrouped to form mixed weight groups, and mixed weight groups were regrouped to form uniform weight groups. In addition, some mixed weight groups were regrouped to form mixed weight groups in order to assess the effect of regrouping at 10 weeks of age on performance and aggressive behaviour. The formation of uniform weight groups at 4 weeks of age did not significantly reduce within-group coefficient of variation in 21-week weight or carcass weight relative to mixed weight groups formed at this stage. It is suggested that the lack of treatment effect was due to high variability in growth during the growing period. Forming uniform rather than mixed weight groups at 10 weeks of age led to significant reductions in within-group coefficient of variation in 21-week weight and carcass weight ( P < 0.05). However, regrouping at the start of the finishing period was associated with significant increases in aggressive behaviour during the 2-day post regrouping period ( P < 0.001), and thus has negative welfare implications. Mean feed intake, growth rate and food conversion ratio during the growing and finishing periods were not significantly affected by forming either uniform or mixed weight groups. In addition, aggression during the post regrouping period at 10 weeks of age was not significantly affected by forming either uniform or mixed weight groups. The results of the present study show that there are benefits in forming uniform weight groups at 10 weeks of age, in terms of reducing within-group variability in weight at slaughter. However, regrouping at the start of the finishing period has negative welfare implications in terms of leading to increased aggression. It is suggested that future research should concentrate on reducing variability in growth during the growing period so that forming uniform weight groups at weaning reduces variability in weight at slaughter.

Mating system and pollination biology of the spring‐flowering shrub, Dirca palustris

Abstract Dirca palustris L., eastern leatherwood or wicopy (Thymelaeaceae), a widely distributed shrub of eastern North America, flowers in early spring and so may face some of the same constraints faced by ephemeral vernal herbs of the eastern deciduous forest, most notably the influence of low temperature on pollinator activity. I studied the mating system of D. palustris and the influence of temperature on pollinator visitation of flowers, during three field seasons in a small stream valley in north‐western Pennsylvania, USA. Specifically, I was interested in how a species with apparently specialized floral morphology, like D. palustris, may ensure reproductive success in a thermally unpredictable vernal environment. Pollinator visitation of flowers of D. palustris was strongly regulated by temperature, with no visits occurring below 14.9°C. Lack of treatment effects in mating system studies, especially the lack of significant differences in fruit set between the bagged, self‐pollination treatment and various cross‐pollination treatments accessible to pollinators, suggests that D. palustris is self‐compatible or perhaps apomictic. Thus, like other spring‐flowering species faced with pollinator unpredictability, D. palustris may rely on a mixed mating system to ensure reproductive success during cool temperate springs.

Colony growth responses of the Caribbean octocoral, Pseudopterogorgia elisabethae, to harvesting

Abstract. Colonies of the branching Caribbean gorgonian Pseudopterogorgia elisabethae were subjected to partial mortality at 2 sites in the Bahamas to study how colony growth responds to disturbances such as harvesting, grazing, and storm damage. Colonies were clipped so that either 4 branches or 10 branches remained. Growth rates of branches were then monitored over 1 year and compared with nearby unclipped colonies. No significant differences were found between branch extension rates among the 3 treatments. Extension rates of newly formed branches were significantly greater in all treatments than among branches present at the start of the experiment. Per capita branching rates were greater on the more severely clipped colonies and were smallest on control colonies. The absolute number of branches that became mother branches did not differ among treatments. Colonies clipped so that 4 and 10 branches remained had the same average number of mother branches per colony, and there was no significant difference between treatments in the average number of new branches formed on the colonies. Per capita branching rates were significantly different among treatments only because the relative proportion of branches that became mother branches was higher in colonies with four branches than in treatments with more initial branches. Total growth (cumulative growth on all branches) was not significantly different between the 2 clipped treatments. Many of the control colonies suffered extensive damage, which may have obscured the comparison of clipped and unclipped treatments; however, within the range of these clipping treatments, differing levels of partial mortality did not lead to different recovery rates. The lack of treatment effects is particularly relevant to assessing the effects of harvest techniques on the recovery and productivity of harvested, naturally occurring, colonies.