Statistical Difference In Response Research Articles

Randomized controlled trial of intravenous immunoglobulin for autoimmune postural orthostatic tachycardia syndrome (iSTAND).

This study assesses response to intravenous immunoglobulin (IVIG) in presumed autoimmune postural orthostatic tachycardia syndrome (POTS). POTS may be associated with autoimmune disorders, serum autoantibodies, or recent infection. Uncontrolled case studies suggest that IVIG is beneficial for treating autoimmune POTS. No previous randomized controlled trials have been conducted. This single-site randomized controlled trial compared IVIG with intravenous albumin infusions. Albumin comparator ensured blinding and control for effects of volume expansion. Eligible patients with POTS had COMPASS-31 total weighted score ≥ 40 and met predetermined criteria suggesting autoimmunity. Over 12weeks, participants received eight infusions (0.4gm/kg each). Four infusions were given weekly followed by four infusions every other week. Primary outcome measure was improvement in COMPASS-31 2weeks after final infusion. A total of 50 participants consented; 30 met inclusion criteria and received study drug (16 IVIG and 14 albumin; 29 female). Group baseline characteristics were well matched; 27 participants completed treatment protocol. Change in COMPASS-31 did not differ between groups (median change [IQR]; IVIG: -5.5 [-23.3, 2.5] versus albumin: -10.6 [-14.1, -4.7]; p-value = 0.629). The IVIG group had a higher response rate (46.7% versus 38.5%), but this was not statistically significant. Adverse events were common but usually mild and did not differ between treatment groups. This small randomized controlled trial of IVIG in POTS found no statistical difference in response compared with albumin infusion. Both groups showed improvement possibly related to volume expansion or other effects obscuring group differences. These findings inform development of future immunomodulatory clinical trials in POTS.

Testing the environmental buffering hypothesis of cooperative breeding in the Seychelles warbler

Species are facing environmental challenges caused by rapidly changing environments. Globally, extreme weather events, like droughts or extreme rainfall, are increasing in frequency. Natural selection usually acts slowly, while adaptations through phenotypic plasticity are limited. Therefore, organisms may utilise other mechanisms to cope with such rapid change. Cooperative breeding is hypothesised to be one such mechanism, as helpers could increase survival probabilities of offspring, especially in harsh years. Rainfall is a cue for onset of breeding in many tropical species, to ensure young are born when food abundance is highest. Using 21 years of data, we investigate the effect of rainfall on social behaviour and life history in the insectivorous Seychelles warbler (Acrocephalus sechellensis), a facultative cooperative breeder. We found that low rainfall is associated with reduced reproductive output and possibly with decreased survival. However, there were no statistical differences in response between groups with helpers, groups with only non-helping subordinates, and breeding pairs without subordinates. With low rainfall, more sons (the sex less likely to help) were produced, and those subordinate males already present were less likely to help. Thus, in contrast to expectations, cooperative breeding does not seem to buffer against harsh environments in Seychelles warblers, indicating that group living may be costly and thus not a mechanism for coping with changing environments. Our study showed that the interaction between the environment and life histories, including social behaviour, is complex, but that this interaction is important to consider when studying the impact of changing environments on species survival.

Difference in Pap test uptake between women who have sex with women and other women in France: A comparative survey of 2032 women

The elimination of cervical cancer has been a priority of the World Health Organization since 2018. The number of these cancers induced by the human papillomavirus (HPV) could be drastically reduced through vaccination and regularly screening by Pap tests. Guidelines for cervical cancer screening apply to all women, including those who have sexual relations with women (WSW), as HPV can be transmitted during sex between two women. As far as we know, our study is the first that compare the Pap test rate between WSW and other women in France. We developed an 18-item questionnaire available on the internet for 15 days and finally analyzed the responses of 2032 women. Based on their responses about their self-definition of their sexual orientation and their sexual behavior, we classified them into three groups of women: exclusive WSW, mixed WSW, and non-WSW. For each question, we tested the statistical differences in responses between these three groups. Our study shows in a large sample representative of the French population that exclusive WSW undergo Pap tests significantly less often than either mixed WSW or non-WSW. Among the exclusive WSW, 28.9 % had never had a Pap test, compared with 9 % of the mixed WSW and 3.1 % of non-WSW (p < 0,001). The responses to our questionnaire contribute to an understanding of this disparity and thus help to envision solutions for better care of all women, regardless of their sexual orientation; this point is crucial for prevention of cervical cancer.

Patient perceptions of a tuberculosis testing program provided in the community pharmacy setting

ObjectivesThis study sought to describe patient experiences and perceptions of a public health initiative designed to improve tuberculosis (TB) testing access using the tuberculin skin test (TST) in a community pharmacy setting. Study designThis was a cross-sectional study. MethodsA telephonic survey of patients who had received a TST at one of twelve participating community pharmacies between August 2014 and July 2016 was conducted. The 26-question survey was developed by two pharmacists with expertise in TB management and one pharmacy student. Before administration the survey was peer-reviewed for clarity. Potential study patients were identified through TST records at the study pharmacies. English-speaking patients older than 18 years were eligible for study inclusion. Statistical differences in responses based on location were identified using chi-squared test for frequency comparisons with a P-value of <0.05 to determine statistical significance. ResultsA total of 1709 patients received a TST during the study period, of whom 431 were contacted and 325 participated, meeting the predetermined representative sample needed of 314 patients. The majority of study patients were female (67.1%) and white (81%). The mean age was 36 years (standard deviation = 14.1). A majority (68.3%) lived <5 miles from the TST pharmacy, while 45.2% of those with a primary care provider (PCP) (61.6% of respondents) lived within 5 miles of the PCP's office. Care was accessible and met patients' testing needs. For most patients (84.6%), the initial and follow-up appointments took < 20 min. Follow-up TST reading rate was 98.5%; 4.3% of tests were positive. Positive TST results were associated with use of a small city pharmacy (P = 0.003). Perception differences based on location were identified. ConclusionsUptake of the TST service in the community pharmacy setting was high and patients reported positive experiences.

Choice of Hypomethylating Agent (HMA) for Initial Treatment Does Not Influence Outcome or Survival for Therapy-Related Myeloid Neoplasms (t-MN)

Introduction: T-MN is a serious complication of prior chemotherapy and/or radiation therapy. In 2008, the World Health Organization created a new category for t-MN due to the distinct variance in etiology when compared to de novo myelodysplastic syndromes (MDS) or acute myelogenous leukemia (AML). Compared to de novo MDS/AML, t-MN characteristically has poor risk cytogenetics and a higher incidence of TP53 mutations which are both associated with inferior survival. Small, retrospective analyses have evaluated the efficacy of front-line HMA therapy for t-AML and t-MDS, with response rates of approximately 38% (Klimek et al. Leukemia Res, 2012 and Bally et al, Leukemia Res, 2013). However, the response duration (RD), progression-free survival (PFS), and overall survival (OS) outcomes are poorly characterized in t-MN treated with HMA. This retrospective study evaluates the efficacy and survival of t-MN patients (pts) treated with azacitidine (AZA) or decitabine (DAC) in the largest cohort analyzed to-date. Methods: Our cohort included pts with t-MN at Memorial Sloan Kettering Cancer Center treated with either AZA or DAC from January 1, 2002 to September 30, 2016. The primary objective was to compare the best overall response rate (ORR) between AZA and DAC, including complete remission (CR), marrow CR (mCR), hematologic improvement (HI), and partial response (PR). The best ORR was then compared to stable disease (SD), treatment failure (TF), and progressive disease (PD). Secondary objectives included OS, PFS, and RD. Responses were assessed using the 2006 MDS International Working Group (IWG) guidelines and 2003 AML IWG guidelines. We also assessed the impact of TP53 mutations on response to HMA and survival outcomes. Results: Of the 118 pts (56% male), 76 pts received DAC and 42 pts received AZA. Median age was 70 years (yrs) (range, 25-90). DAC recipients were younger (median 67 yrs, range, 25-85) compared to AZA (median 73 yrs, range, 42-90). More pts with AML were treated with DAC (n=27, 35.5%) and more pts with MDS were treated with AZA (n=36, 85.7%). Most MDS pts had Poor (19.3%) or Very Poor (42%) risk cytogenetics, resulting in a High (23.9%) or Very High (54.5%) overall IPSS-R risk category. Time to response was faster with DAC (9.4 weeks) versus (vs.) AZA (13.3 weeks) with more pts proceeding to hematopoietic cell transplant (HCT) in the DAC group (n=19, 25%) vs. AZA (n=3, 7.1%). Overall, there were no statistical differences in response between AZA and DAC when we analyzed combined TF/PD (45.2% and 32.9%, respectively), SD (14.3% and 25%, respectively), and combined CR/HI/PR (40.5% and 42.1%, respectively) with a p-value of 0.28 (Table 1). However, more patients receiving DAC achieved CR and mCR (18.4% and 14.5%, respectively) vs. AZA (4.8% and 7.1%, respectively) and AZA had a higher HI rate (28.6%) vs. DAC (5.3%). DAC pts also appeared to have higher TF rates (25%) vs. AZA (19%) with more PD in the AZA group (26.2%) vs. DAC (7.9%). Median OS was 10.9 months (mo) and PFS was 5.3 mo (Figure 1). There was no difference in median OS between AZA (11.2 mo) and DAC (10.9 mo, p=0.61) and no difference in the median PFS between AZA (5.1 mo) and DAC (5.3 mo, p=0.83). Lastly, there was no difference in median RD between AZA (4.5 mo) and DAC (3.4 mo, p=0.39). Of the 58 pts with known TP53 mutation status, 29 (50%) had ≥1 TP53 mutation(s). There was no difference in OS and PFS between mutant and wildtype TP53 pts, and no difference in survival between AZA and DAC recipients in the mutant TP53 cohort (Figure 2). Conclusions: This large, retrospective study showed no difference in the ORR between AZA and DAC. The faster response and higher rates of CR and mCR may favor the use of DAC as a bridge to HCT in eligible pts. Conversely, the higher rates of HI seen with AZA can improve the quality of life in MDS pts who are ineligible for HCT. Our results confirm prior reports of poor OS seen in t-MN. In our cohort, we showed no difference in survival outcomes between AZA and DAC. There was also no statistical difference in OS/PFS between DAC and AZA in mutant TP53 pts, however point estimates may indicate a pattern favoring DAC over AZA that needs to be explored in a larger sample size. Although we confirmed the efficacy of HMA in this difficult to treat population, response duration and survival outcomes remain poor. Development of more effective therapies that specifically target the biology of t-MN are needed to improve survival outcomes.

Utilizing Audience Response to Foster Evidence-based Learning in a Pilot Study: Does It Really Work?

IntroductionRadiology residency programs are increasingly using audience response systems (ARS) in educational lectures. It is imperative that this is investigated to assess if learning outcomes in trainees are actually improved.MethodsThe primary objective of this randomized prospective unblinded pilot study was to assess the effect of ARS on long-term learning outcomes, with a secondary objective of understanding perceptions of ARS amongst radiology residents. Twenty-two radiology residents were randomized into two groups of 11 residents each receiving five identical musculoskeletal (MSK) radiology lectures. One group received lectures through ARS and the other through traditional didactics. A pretest and identical posttest were completed by all residents at baseline and eight months later, respectively. Residents also completed a pre and post five-question Likert scale survey designed to measure perceptions of ARS.ResultsWilcoxon rank sum tests revealed no statistically significant difference between the two groups of residents on the pretest (p = 0.47) or the posttest (p = 0.41). Of the five questions designed to gauge perceptions of ARS, “How often do you study radiology outside of work?” resulted in statistical significance between groups after the lecture series via ordinal logistic regression, with the ARS group six times more likely to study compared to the non-ARS group (Odds ratio = 6.52, P = 0.04, 95% Confidence Interval [1.1, 38.2]). There was no statistical difference in response to this question prior to the lecture series.DiscussionUse of ARS was associated with increased likelihood of studying radiology without significant difference in long-term learning outcomes.

Cadaveric versus Radiology Anatomy: Do we have the right balance to prepare medical students to be physicians?

BackgroundRadiology is one of the cornerstones of modern medicine, playing an important role in patient diagnosis and management. All physicians, regardless of their speciality, are now expected to provide preliminary interpretations of radiological studies throughout their careers. Many medical undergraduate anatomy programs are beginning to teach radiological concepts through their anatomy curricula to improve the clinical relevance of teaching and to better prepare students for clinical practice. However, there has been no research to date assessing the optimal balance between cadaveric and radiological anatomy. The purpose of this study is to assess medical students' comfort level in identifying normal cadaveric and radiological anatomy and to identify areas where curricula can be renewed.MethodsAn anonymous online survey was administered to the second, third and fourth year undergraduate medical students at a large distributed medical school which teaches both cadaveric and radiologic anatomy (N = 850). The survey collected respondents' demographic information as well as prior radiology exposure. Students were asked to rank their comfort level in identifying anatomy in cadavers and on radiology studies on a 4‐point Likert scale. Statistical analysis was carried out to determine if there was any difference in student responses based on year of training (i.e. pre‐clinical vs clinical) and the Copeland score method was used to generate a rank order list of student comfort level across all variables.Results153 students completed the survey yielding a response rate of 18%. 50.3% of respondents were female and most respondents were between 18–24 years old. 51.6% of respondents were in their clinical years (i.e. year 3 and 4) and 48.4% were in their pre‐clinical years. Most (90.8%) students reported receiving no radiology teaching prior to medical school. Most students (65.4%) reported their overall anatomy knowledge as “average.” When Likert data was used to generate a rank‐order list, students reported feeling most comfortable when identifying cadaveric organ anatomy, cadaveric bony anatomy and recognizing spatial relationships in cadavers and least comfortable when identifying radiological pathology, radiological neuroanatomy, and recognizing spatial relationships on imaging studies. There was no statistical difference in response when considering students' level of training.ConclusionsOverall, medical students reported feeling less comfortable when identifying normal anatomy on radiological studies when compared to identifying the same structures in the cadaver. This study suggests medical students would benefit from increased exposure to radiology anatomy during medical school, especially given that most physicians will be primarily examining radiology images throughout their careers.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The feasibility of alcohol screening and interventions in emergency care: a comparison of primary and specialised health care settings

Background: Implementation of alcohol screening and brief intervention in emergency departments is inadequate and the evidence base more mixed than in primary health care (PHC). This comparison study investigates the feasibility of alcohol screening and interventions by nurses in emergency departments, seven based in PHC and two in specialised health care clinics. The aim is to analyse barriers to implementation in these two contexts.Methods: A questionnaire was used among emergency nurses in the Kymenlaakso hospital district in Finland. The response rate was 71% (N = 112; PHC clinics n = 42; specialised clinics n = 38). The statistical differences in responses were analysed using the χ2 test. Open-ended questions were analysed qualitatively.Results: The nurses in specialised clinics treated patients with alcohol-attributable conditions/traumas more often than the nurses in PHC did (p < .001) but were less sure whether it was worthwhile to intervene in the patients’ alcohol use (p < .01). The reasons for reluctance included a lack of time and frustration resulting from discouraging results. The nurses in PHC were more familiar with brief interventions and used AUDIT-C more often than the nurses in specialised clinics (p < .05).Conclusions: The results indicate an intervention paradox in the emergency care setting: compared to nurses in PHC clinics, nurses in specialised health care clinics work more often with intoxicated patients but they are less willing to implement alcohol screening and interventions. The findings highlight the need for institutional-level support in addition to capacity building among nurses.

القیادة الأخلاقیة لدى رؤساء ومشرفات الأقسام الأکادیمیة بجامعة تبوک وعلاقته بسلوک الصمت التنظیمی لدى أعضاء هیئة التدریس

هدفت هذه الدراسة إلى الوقوف على طبيعة العلاقة بين القيادة لدى رؤساء ومشرفات الأقسام الأکاديمية بجامعة تبوک ومستوى الصمت لدى أعضاء هيئة التدريس، واستخدمت الدراسة المنهج الوصفي الارتباطي. حيث تکون مجتمع الدراسة من جميع أعضاء هيئة التدريس بجامعة تبوک، وبلغ حجم عينة الدراسة (111) عضو هيئة تدريس من جامعة تبوک تم اختيارهم باستخدام العينة الطبقية العشوائية من مجمل المجتمع البالغ قوامه (761) عضو هيئة تدريس. ولتحقيق أهداف الدراسة قام الباحثان بإعداد استبانتين لجمع المعلومات الأولى: لقياس القيادة الأخلاقية، والثانية لقياس الصمت التنظيمي، حيث تم تحليل الاستبانة باستخدام الأساليب الوصفية کما استخدمت الدراسة معامل الانحدار وارتباط بيرسون من أجل إظهار طبيعة العلاقة بين متغيرات الدراسة، وتوصلت الدراسة إلى عدد من النتائج وهي: 1-هناک أثر للقيادة لدى رؤساء ومشرفات الأقسام الأکاديمية بجامعة تبوک على الصمت التنظيمي لدى أعضاء هيئة التدريس بنسبة 83%. کما أظهرت نتائج الدراسة أن مستوى القيادة والصمت لتنظيمي لدى رؤساء ومشرفات الأقسام الأکاديمية في جامعة تبوک کانت مرتفعة حيث أظهرت النتائج أن هناک ارتباط بين کل من القيادة الأخلاقية وبين سلوک الصمت التنظيمي حيث جاءت قيمة مستوى الدلالة أقل من (&=0.05) وذلک بحسب ارتباط بيرسون. 2-أظهرت نتائج الدراسة عدم وجود فروق ذات دلالة إحصائية عند استجابات أفراد عينة الدراسة فيما يتعلق بمتغير القيادة لدى رؤساء ومشرفات الأقسام الأکاديمية وسلوک الصمت لدى أعضاء هيئة التدريس تعزى لمتغير الرتبة العلمية. بينما أظهرت نتائج الدراسة وجود فروق ذات دلالة إحصائية عند إجابات أفراد الدراسة على متغير القيادة وسلوک الصمت لدى أعضاء هيئة التدريس تبعا لمتغير الجنس حيث جاءت لصالح فئة (ذکر)، ومتغير التخصص حيث جاءت لصالح فئة (نظري). وأوصت الدراسة بضرورة الاهتمام بممارسة رؤساء ومشرفات الأقسام الأکاديمية في جامعة تبوک للقيادة على مختلف مجالاتها، نظرا لأهميتها في إعطاء الحرية الديمقراطية في العمل وبالتالي خفض درجة ممارسة الصمت لدى أعضاء هيئة التدريس. إضافة إلى عقد دورات تدريبية وندوات وورش عمل من أجل توعية رؤساء ومشرفات الأقسام الأکاديمية ودورها في تعزيز اللامرکزية الإدارية وخفض مستوى الصمت لدى أعضاء هيئة التدريس. This study investigates the relationship between moral leadership for heads and academic supervisors department at Tabuk University and the level of behavior organizational silence for faculty members. The study used Correlative survey approach. The study population was 111 faculty members at Tabuk University were selected by using stratified sample from 761 faculty members of overall society. To achieve the objectives of the study, the researcher designed two questionnaires to gather information. Firstly, to measure moral leadership, secondly, to measure the behavior of organizational silence .The questionnaire was analyzed depending on descriptive approaches (computational, repetitive and percentage).The study also used the regression coefficient and Pearson correlation to clarify the nature of the relationship between the variables of the study. The study showed these results: 1-There is an impact of the moral leadership of the heads and supervisors of the academic department at Tabuk University on the behavior of organizational silence for faculty members. Also, the study showed that the level of leadership and organizational silence for the heads and supervisors of academic departments at Tabuk University was high, the results showed that there is a relationship between moral leadership and organizational silence behavior that the value of the significance level was less than (0.05) according to Pearson correlation. 2-The study showed no statistical differences in responses of the study members to the practice of moral leadership for the heads and supervisors of academic department and the behavior of the organizational silence of faculty members because of variable of scientific rank. And the existence of differences of statistical in the responses of the members of the study on the practice of moral leadership for the heads and supervisors of the academic departments and the behavior of organizational silence in the faculty according to the gender variable for a (male)category and the variable specialization for a(theoretical) category . The study recommended the need to pay attention to the practice of heads and supervisors of academic departments at Tabuk University for moral leadership in different fields. Because of its importance in giving democratic freedom in work so that reducing the degree of practicing of organizational silence for faculty members in addition to holding training courses, seminars and workshop to raise awareness of heads and supervisors of academic department and their role in enhancing administrative centralization and reducing the level of organizational silence between faculty members.

KNOWLEDGE AND ATTITUDES REGARDING CHILD ABUSE AND NEGLECT.

Purpose:The aim of this study was to assess knowledge and attitude of dentists in Bosnia and Herzegovina (BH) regarding signs and symptoms of child abuse and neglect (CAN), reporting procedure and level of education.Methods:Data were collected through a self-administrated structured questionnaire adopted and modified from previous studies. It was administrated to 300 dentists out of which a total number of 210 subjects were in final sample for statistical analyses. Response rate was seventy percent. Descriptive statistics, Chi-square and Kruskal-Wallis H test were used to analyze statistical differences in responses. The level of significance was set at p<0.05.Results:Dentists in BH are very rarely provided (80%) with training related to recognition and reporting of CAN. Sixty six percent of dentists had never suspected CAN in their practice. Only nine percent of dentists would report suspicious of CAN. Prevailing reasons for not reporting suspected case of CAN was lack of knowledge of the reporting procedure (43%), and combination of indicated answers that never had a case and lack of knowledge about the procedure (31%).Conclusion:Results of this study suggest that dentists need an effective education to increase their knowledge and awareness of all aspects of CAN.

Effect of Oral Vitamin E on Atopic Dermatitis

Purpose : To compare the efficacy and satisfaction from vitamin E and common modalities in the treatment of AD. Methods: This clinical trial was performed on 100 patients with AD, presenting to Dermatology Clinic of Tabriz Sina hospital (Mar 2008 until Dec 2010). The patients were divided into two groups by RandList software. In group I, the patients received 400 IU/day Vitamin E orally, while group II patients received topical corticosteroid and oral antihistamines. All of the patients were followed up for 8 months. Results: The results were positive in the 66% of the patients in group I and 62% of the patients in group II. There was no statistical difference in response to therapy in both groups, but satisfaction was higher in patients receiving vitamin E. There was an inverse relationship between age and response to therapy in patients using vitamin E. No side effects were reported from vitamin E uses. Conclusion: Vitamin E may have the same effect as common treatment with topical corticosteroid and oral antihistamines in improving the signs and symptoms of AD and the quality of life.

In vivo evaluation of the protective capacity of sunscreen by monitoring urocanic acid isomer in the stratum corneum using Raman spectroscopy

Urocanic acid (UCA) is a major ultraviolet (UV) ray-absorbing component in the epidermis, and it isomerizes from the trans to the cis form upon exposure to UV radiation. Continuous measurement of UCA isomers in the skin at the same area is not available using conventional methods. This study aimed to evaluate the protective capacity of sunscreen by non-invasively monitoring the trans-UCA (t-UCA) amount in the stratum corneum (SC) by confocal Raman spectroscopy. In vivo Raman spectra of the skin at the cheek or volar forearm were obtained from 27 healthy Japanese volunteers of different ages (age range, 22-53 years) throughout a whole year using confocal Raman spectroscopy. Eighteen healthy male Japanese volunteers (age range, 25-52 years) were enrolled for the evaluation of the protective capacity of sunscreen. The concentration depth profile of t-UCA relative to keratin was calculated from the Raman spectra in the 400-2200 cm(-1) region. Then, the integrated amount within the depth of 0-12 mum was calculated, which represented the total amount of t-UCA in the SC. The integrated amount of t-UCA in the cheek skin was significantly lower than that in the volar forearm skin throughout a year. The amount of it in the volar forearm skin was significantly the lowest in summer, but not in the cheek skin. The amount of t-UCA decreased immediately after UV exposure even below 1 minimal erythema dose, remained low for 1 week, and gradually increased up to the initial level about 2 weeks after UV exposure. The decrease in the t-UCA amount was hindered by the application of sunscreen on the skin surface. There were no statistical differences in response to UV exposure between the erythema-positive and erythema-negative groups. The monitoring of the amount of t-UCA in the SC by confocal Raman spectroscopy is a good method to assess the efficacy of sun protective substances.

A retrospective audit of patients with osteo-arthritic knees treated with prolotherapy in a general practice

Objective: The objective of this study was to assess the effects of dextrose prolotherapy on knee osteoarthritis. Patients and methods: A retrospective audit of treated series using a postal questionnaire and general practitioner (GP) records was conducted in UK National Health Service (NHS) general practice. Participants included 48 men and women with self-reported knee pain, treated by prolotherapy 3–43 months previously. Outcome measures were retrospective numerical visual analogue scale (VAS) scores pre- and post-treatment and self-reported duration of pain relief, reduction in analgesia requirement, severity of osteoarthritis on X-ray and any subsequent knee replacement referral. Results: There were 42 (85%) respondents to the postal questionnaire. Median follow-up was 30 months. Of respondents, 83% reported benefit, 75% for more than 3 months, and 26% for more than 1 year. Mean reduction of VAS score for the population was 3.5 (P < 0.001), suggestive of a significant clinical effect. There was no statistical difference in response of any subgroup examined. Conclusions: These results suggest a genuine effect, but the study is obviously inconclusive. However, it provides a good case for conducting a formal randomised controlled trial against usual care in knee osteoarthritis in an NHS setting.

Idiopathic thrombocytopenic purpura in childhood: a 10-year audit

Objectives: To evaluate clinical course, treatment modalities, complications and referral pattern in paediatric patients treated over a 10-year period.Design: A retrospective, descriptive, hospital based study.Setting and subjects: 123 patients were diagnosed with ITP at Tygerberg Hospital from January 1996 to December 2006. Thirteen were excluded. The information of 106 patients was examined in detail.Outcome measures: Comparison of presenting platelet counts, special investigations, response and complications.Results: The mean age at presentation was 4·9 years (range 2 months – 13 years 3 months). A history of a preceding infection was obtained in 51% of patients. The mean presenting platelet count at diagnosis was 11·5 × 109/L (range 1 × 109 to 104 × 109/L). In 25 patients observation alone was the treatment choice. Specific treatment for ITP was given to 81 patients; steroids were used in 46 patients and intravenous immunoglobulin (IVIG) in seven patients. A combination of steroids and IVIG was used in 28 patients. There was no statistical difference in response to any therapy. Three patients developed an intracranial haemorrhage, two died. Twenty-one patients progressed to chronic ITP (19%). ITP had a benign clinical course with 87% of patients experiencing no major complication and 90% of patients making a complete recovery with or without treatment.Conclusion: ITP in South African children presents similarly to that in other settings, however the rate of intracranial haemorrhage was higher in this series than in literature. There were no statistically significant differences in the effects of various treatments, and observation alone was a successful treatment modality.

A Randomized, Double-Masked, Placebo-Controlled Study of Alicaforsen, an Antisense Inhibitor of Intercellular Adhesion Molecule 1, for the Treatment of Subjects With Active Crohn’s Disease

The aim of this study was to compare the safety and efficacy of alicaforsen, a first-generation antisense inhibitor of intercellular adhesion molecule 1, with placebo in subjects with active Crohn's disease, a disorder in which intercellular adhesion molecule 1 is overexpressed. In 2 identical double-masked, placebo-controlled studies, 331 subjects with active Crohn's disease were treated with either alicaforsen (221 subjects) or placebo (110 subjects) administered via 2-hour intravenous infusion 3 times a week for 4 weeks. Patients then returned for follow-up every 2 weeks. The primary end point was clinical remission by week 12. Secondary end points included clinical response and remission in relation to previous use of other biologics including tumor necrosis factor-alpha antagonists and presence of fistulous disease. The results, whether combined or analyzed individually, failed to demonstrate statistical significance as a measure of its primary outcome (alicaforsen 33.9% vs placebo 34.5%; P = .89). In addition, no statistical differences in response were observed between alicaforsen and placebo in subjects who were previously treated with anti-tumor necrosis factor-alpha therapy or had baseline fistulizing disease. There were no significant differences in adverse events from placebo apart from a higher infusion reaction rate. In the subject population studied, alicaforsen failed to demonstrate efficacy in any of its primary outcome measures. Alicaforsen was well-tolerated.

Lodo de esgoto e produção de palmito em pupunheira

O uso agrícola do lodo de esgoto vem se mostrando como opção para reduzir impactos ambientais e poluição das águas. No entanto, há necessidade de se adequar dose e freqüência de aplicação para cada cultura. Durante 40 meses, foram avaliados, em experimento de campo instalado em Ubatuba (SP), os efeitos de doses de lodo de esgoto sobre a precocidade de colheita e a produção de palmito de pupunheira. Foram testadas quatro doses anuais de lodo, correspondentes a 0, 0,5, 1,0 e 2,0 vezes a quantidade de nitrogênio recomendada para o cultivo, sob delineamento de blocos ao acaso. A primeira aplicação foi efetuada no sulco de plantio durante a instalação do experimento (seis repetições), enquanto as demais foram realizadas anualmente, em superfície ou incorporadas nas entrelinhas da cultura (três repetições cada). Adubações complementares com cloreto de potássio e ácido bórico foram efetuadas trimestralmente, para corrigir deficiências. Utilizaram-se mudas inermes do ecótipo, com 10 meses de idade e densidade de plantio de 5.000 plantas ha-1. As respostas das plantas às doses de lodo foram avaliadas mensalmente, por meio de caracteres diretamente relacionados à precocidade de colheita e à produção de palmito. Houve resposta linear positiva de acordo com as doses empregadas para todos os caracteres avaliados. O uso de lodo de esgoto no sulco de plantio antecipou a primeira colheita de palmito em mais de três meses, quando comparadas dose máxima e testemunha. Não houve diferenças significativas entre as duas formas de aplicação de lodo. O número de hastes colhidas por ano e por planta variou de 0,45 a 1,04, de acordo com as doses aplicadas. A produção média anual de palmito variou de 0,82 a 1,65 t ha-1 ano-1 e de 0,87 a 1,39 t ha-1 ano-1 de resíduo basal, com aumento proporcional ao das doses de lodo de esgoto. Concluiu-se então que o uso de lodo de esgoto no cultivo da pupunheira é viável e atende, em parte, às necessidades da cultura.

Rooting of healthy and CVC-affected 'Valência' sweet orange stem cuttings, through the use of plant regulators

Citrus variegated chlorosis (CVC) is a disease caused by Xylella fastidiosa. Using different concentrations of plant regulators, such as auxins (indole-3-butyric acid) and gibberellic acid biosynthesis-inhibitor (paclobutrazol), physiological rooting capacity of healthy and CVC-affected stem cuttings were evaluated in order to investigate the importance of plant hormone imbalance and xylem occlusion in plants with CVC. The percentages of dead, alive and rooted cuttings, cuttings with callus and mean number of roots per cuttings did not show statistical differences in response to the distinct concentrations of synthetic plant regulators. There were differences only between healthy and CVC-affected cuttings. This showed the importance of xylem occlusion and diffusive disturbances in diseased plants, in relation to root initiation capacity and hormonal translocation in the plant tissue.

Separation filtering using fractional order derivatives

Separation or layer filtering of regional and residual magnetic fields is an important component of magnetic interpretation. Separation filtering depends fundamentally on the concept of random distributions of sources within discrete layers, and assumes that there is no statistical difference in response along each ideal layer and no correlation between the distributions in different layers. Separation filtering becomes very difficult when there is considerable overlap in the spectra of individual depth ensembles. The degree of separation achieved depends on the depth differences and the spectral b/B ratio, the ratio of the amplitudes of the shallow and deep ensembles. A high b/B ratio is needed to separate the effects of shallow sources with minimum contamination by deeper sources. In practice, it is usually impossible to achieve complete separation because the problem is non-linear and spectra have too much overlap, but the results are still a very powerful interpretation aid when used qualitatively (Jacobsen, 1987). Selection of a suitable filter depends both on the magnetic signature of the target source and on the data quality. Both tonal (amplitude) and textural information are needed to recognise type patterns characteristic of the magnetic expression of geological features of interest.It is well known that derivatives of potential fields enhance the field component associated with shallow features and de-emphasise the field from deeper sources. Fractional vertical derivatives provide an objective, flexible approach to shallow-layer separation filtering, as the order of the fractional derivative can be selected to match the data and optimise enhancement of the shallow field component. The method avoids the uncertainties in selecting spectral matched filter parameters. Fractional derivatives of different order can be combined to produce RGB images and this can be a significant aid to the interpretation of the data. Finally, the order of the vertical derivative can be varied across the dataset, based on local statistics, to produce balanced derivative images that show detail in both ‘smooth’ and ‘rough’ regions simultaneously.The application of fractional-derivative separation filtering is illustrated using high-resolution aeromagnetic data covering the Ghanzi-Chobe fold belt in Botswana. Total magnetic intensity data are dominated by crystalline basement anomalies. Progressively increasing the order of fractional vertical derivatives provides rejection of deeper basement anomalies and provides better resolution of subtle supracrustal anomalies than the conventional vertical gradient. Varying the order of the vertical derivative across the dataset provides a local rather than global filtering capability, unlike conventional matched filters.

Separation filtering using fractional order gradients

Separation or layer filtering of regional and residual magnetic fields is an important component of magnetic interpretation. Separation filtering depends fundamentally on the concept of random distributions of sources within discrete layers and assumes that there is no statistical difference in response along each ideal layer and no correlation between the distribution in each layer. Separation filtering becomes very difficult when there is considerable overlap in the spectra of individual depth ensembles. The degree of separation achieved depends on the spectral b/B ratio, the ratio of the amplitudes of the shallow and deep ensembles. A high b/B ratio is needed to deconvolve the effects of shallow sources with minimum contamination by deeper sources. It is well known that derivatives of potential fields enhance the field component associated with shallow features and de-emphasise the field from deeper sources. Fractional vertical derivatives provide an objective, flexible approach to shallow layer separation filtering as the order of the fractional derivative can be selected to match the data and optimise enhancement of the shallow field component. The method avoids the uncertainties in selecting spectral matched filter parameters. Different order fractional derivatives can be combined to produce RGB images and this can be a significant aid to the interpretation of the data. The application of fractional derivative separation filtering is illustrated using high-resolution aeromagnetic data covering the Ghanzi-Chobe fold belt in Botswana. Total magnetic intensity data are dominated by crystalline basement anomalies. Progressively increasing the order of fractional vertical derivatives provides rejection of deeper basement anomalies and provides improved resolution of subtle supracrustal anomalies than the conventional vertical gradient.

Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate.

Vitamin D metabolites alphacalcidol and calcitriol (D-hormones) have been investigated for two decades, but few and conflicting results are available from high-quality randomized controlled trials. Our objectives were to provide an evidence-based update quantitatively summarizing their efficacy on bone mineral density (BMD) and fracture rate. We performed a systematic research of any randomized controlled trial containing relevant data, peer review, data extraction and quality scoring blinded for authors and data sources, and comprehensive meta-analyses of the relevant data. Inclusion criteria were: randomized controlled study, calcitriol or alphacalcidol, BMD or fractures in healthy/osteopenic/osteoporotic patients exposed or not to corticosteroids (CS). Analyses were performed in a conservative fashion using professional dedicated softwares and stratified by outcome, target patients, study quality, and control-group type. Results were expressed as effect size (ES) for bone loss or relative risk (RR) for fracture while allocated to D-hormones vs control. Publication bias and robustness were investigated. Of the trials that were retrieved and subsequently reviewed, 17 papers fitted the inclusion criteria and were assessed. Quality scores ranged from 20 to 100%, the mean (standard deviation) being 72 (22)%. Calcitriol and alphacalcidol were found to have the same efficacy on all outcomes at p>0.13. We globally assessed D-hormones effects in preventing bone loss in patients not exposed to CS, and found positive effect: ES=0.39 ( p<0.001). For lumbar spine, this particular effect was 0.43 ( p<0.001). D-hormones significantly reduced the overall fracture rates: RR=0.52 (0.46; 0.59) and both vertebral and non-vertebral fractures: RR=0.53 (0.47; 0.60) and RR=0.34 (0.16; 0.71), respectively. No statistical difference in response was observed between results from studies on healthy and osteoporotic patients or depending on the fact that controls were allowed to calcium supplementation. Treatment with D-hormones was evaluated for maintaining spinal bone mass in five trials of patients with CS-induced osteoporosis, and provided ES=0.43 at p<0.001. Only two studies specifically addressed the effects of calcitriol on spinal fracture rate. None of them provided significant results, and the global RR did not reach the significance level as well: RR=0.33 (0.07; 1.51). Our data demonstrated efficacy for DH on bone loss and fracture prevention in patients not exposed to CS and on bone loss in patients exposed to CS, in the light of the most reliable scientific evidence. Their efficacy in reducing the number of fractures in patients exposed to CS remains to be determined.