Analysis Of Treatment Effects Research Articles

Analysis of heat treatment effect on fretting fatigue occurrence in Zr-1Nb-1Sn-0.1Fe fuel rods

Nuclear fuel rods prevent the loss of nuclear material to the refrigerant fluid, acting as a first safety barrier. Damage by grid-to-rod fretting remains a significant cause of nuclear fuel element failure in Pressurized Water Reactors (PWR). In this paper fretting-induced friction at the contact interface between springs and samples of nuclear fuel rods of Zr-1.0Nb-1.0Sn-0.1Fe alloy was evaluated. The effect on the fretting resistance of heat treatments applied to the samples of Zr-1.0Nb-1.0Sn-0.1Fe fuel rods was also investigated. It was observed that the increase in the heat treatment temperature decreases the mass loss, indicating a mild fretting wear regime.

27594 Impact of guselkumab on fatigue and mediation analysis of independent treatment effect of guselkumab on fatigue in patients with active psoriatic arthritis: Results from DISCOVER-1&2

Introduction: Guselkumab(GUS) demonstrated efficacy in the Ph3 DISCOVER-1&2 trials in patients with psoriatic arthritis. Here, the effect of GUS on fatigue is evaluated in these trials using Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F).

27078 Mediation analysis of independent treatment effect of guselkumab on health-related quality of life in patients with moderate to severe plaque-type psoriasis: Results from 2 phase 3 studies VOYAGE-1&2

Background: VOYAGE-1&2 were randomized, double-blind, phase-3 studies exploring guselkumab for moderate-to-severe plaque-type psoriasis. Previous analyses demonstrated that among patients with a psoriasis area and severity index (PASI) 100 response, guselkumab-treated patients had greater improvement in dermatology life quality index (DLQI) score than adalimumab-treated patients. Understanding the independent treatment effect on patient-reported outcomes (PROs) beyond clinical assessments would provide insights on the importance of HRQoL in the treatment of psoriasis patients.

Analysis of Clinical Treatment Effect of Acute Cardiovascular Patients

Analysis of Clinical Treatment Effect of Acute Cardiovascular Patients

Reducing Pretrial Detention: A Randomized Intervention with Public Defenders in El Salvador

Approximately one third of the global prison population is in pretrial detention, waiting for trial. Overreliance on pretrial detention exposes defendants to harsh conditions, exacerbates jail overcrowding, increases recidivism, and favors criminal governance. What policies can resource-strapped countries implement to effectively address excessive pretrial detention? Based on a theoretical model focused on institutional-level efforts, we evaluate an experimental intervention implemented in El Salvador intended to increase pretrial release requests and reduce pre-trial detention. The intervention randomly assigned public defenders to receive specialized legal training, an improved interview protocol, material resources, and increased communication channels. We find that this inexpensive, scalable program increased pretrial release requests from public defenders by nearly 10% (0.228 standard deviations) and increased the success in securing pretrial release by 4.4% (0.114 standard deviations). Heterogeneous treatment effect analyses suggest that the program increased strategic litigation among the most experienced public defenders and has distinct effects for those accused of minor and severe crimes. We find no evidence that the mechanism explaining our results involves changes in public defenders’ attitudes or perceptions about their work environments. Criminal justice programs focusing on pretrial detention may help reduce prison overcrowding in high crime countries.

Post-Harvest N2O Emissions Can Be Mitigated With Organic Amendments

After the harvest of winter oilseed rape and faba bean crops, considerable high soil nitrate values may be built up before winter in central to north European regions. High precipitation and a low N uptake by the subsequent crop in fall cause a high risk of N2O emissions and nitrate leaching. Microbial decomposition of crop residues or high carbon amendments may immobilize mineral N temporarily and may prevent losses by direct N2O emissions. Five treatments, including crop residue removal and application of different organic amendments after harvest, were tested in a field trial in Northern Germany to elucidate the potential of this mechanism as a mitigation option. N2O emissions and the soil mineral nitrogen status were monitored from August to March for three consecutive years. Observed emissions ranged from 0.1 to 3.4 kg N ha−1 in 180 days. An empirical model approach was applied to separate the impact of spatially and temporally heterogeneous environmental conditions between the plots of the field experiment from treatment effects in the subsequent statistical analysis of N2O emissions. Results show that the exchange of the initial crop residues with organic amendments with high C:N ratios (i.e., winter wheat straw and sawdust) after the harvest of faba bean or oilseed rape can reduce N2O emission during fall and winter by up to 45%.

The progressive fibrotic phenotype in current clinical practice.

The progressive fibrotic phenotype (PFP), a term that covers large sub-groups of patients with fibrotic lung diseases that clinically progress despite appropriate usual management, is now an everyday problem for patients and clinicians alike. This review covers recent data that are relevant to major clinical uncertainties. The clinical relevance of the PFP is covered by a brief review of data from which this entity was constructed. Estimates of the prevalence of the PFP are cited. The importance of an accurate initial diagnosis is emphasized - with refutation of the belief that diagnosis now matters less because of recent antifibrotic trial data. Pivotal trials are reviewed briefly with emphasis on the range of diseases studied and the efficacy signals. Included in this section are analyses of treatment effects in individual diseases and data that validate the progression criteria that define the PFP. Clinicians can now implement the findings from recent antifibrotic trials in non-idiopathic pulmonary fibrosis lung diseases. However, the appropriate application of recent data requires an understanding of the critical importance of initial diagnosis, key measures of disease progression and knowledge of the strengths and weaknesses of trial data. Important clinical uncertainties not informed by current data include the evaluation of the adequacy of traditional management (before antifibrotic therapy is introduced) and agreement on the exact definition of disease progression that should trigger consideration of antifibrotic therapy.

Rallying in fear? Estimating the effect of the UK COVID‐19 lockdown with a natural experiment

We use a natural experiment to study how the announcement of the UK COVID‐19 lockdown affected citizens' attitudes towards the pandemic and the government's response to it. On the day of the lockdown announcement, YouGov ran a survey that captured responses before and after the announcement. Comparison of these responses suggests that the lockdown announcement made people more supportive of the government's response to the crisis but also (perhaps surprisingly) more concerned about the pandemic. Analysis of heterogeneous treatment effects suggests that the announcement narrowed gaps in perceptions of the crisis, increasing support for the government's response especially among those who had been least supportive and increasing concern about the pandemic especially among those who had been least concerned. Overall, the findings highlight a tension inherent in governing during times of crisis: actions that increase people's confidence in government and induce compliance with government directives may also tend to increase anxiety among the population.

Resource Utilization Using Micro-Costing Method and Cost Effectiveness Analysis of Treatment of Acute Promyelocytic Leukemia with Generic Arsenic-Trioxide

We have previously reported on the challenges of treating AML in India, the major challenge being the cost of treatment (Chepsy et al. BJH 2015). With conventional treatment of AML it is recognized that the major part of this cost is not related to the cost of the individual chemotherapeutic drugs, but rather from the high cost of supportive care to take patients through repeated cycles of prolonged neutropenia induced by conventional chemotherapy. In contrast with arsenic trioxide (ATO) based regimens in acute promyelocytic leukemia (APL), when expensive patented ‘innovator’ ATO was used, the reported 3 year direct pharmacy cost of drugs was higher with an ATO+ATRA regime compared with a conventional ATRA+chemotherapy regimen (Euro 46,700 Vs 6,700), though the cost of supportive care was a third of conventional therapy (Kruse M et al. PLoS One. 2015). There is limited data on the cost effectiveness of using generic ATO, as available in India, in the treatment of APL (10 mg vial costs US $7 in India versus US $ 676 in North America)In a single center, retrospective study, 30 newly diagnosed APL (ND-APL) patients, treated with ATO and 16 relapsed APL (R-APL) patients, treated on a phase II trial with a ATO based regimen followed by an autologous stem cell transplant (regimens as previously reported by us; Mathews et al. Blood 2012 and Mathews et al. Blood 2016 abstract) were evaluated. In the absence of patients being treated at our center with a conventional ATRA+chemotherapy regimen (APL-CT) the cost of treatment for APL with such a regimen was assumed to be similar to the cost that would be incurred to treat a non-M3 AML patient at our center with a conventional AML chemotherapy schedule. Incremental cost effectiveness ratio was calculated using weighted costs with weighing factor obtained from survival data for 60 patients from our database for APL ATO group and from the AIDA 2000 trial for APL-CT group.A three phase micro-costing method (figure 1) used four cost centers involved in providing patient care: (i) chemotherapy administration (ii) supportive care (iii) treatment of complications (iv) laboratory services. For each of these cost centers there were four cost drivers: (i) drugs / reagents (ii) personnel (iii) ward (iv) instruments / overheads. The actual cost of cost drivers was found out by micro-costing and summed up to obtain the unit cost of each cost center (m). Each time a patient used a cost center this unit cost would be incurred. Next, the frequency of utilization (n) of each cost center was found out from the patient database and multiplied by the unit cost of the cost center to obtain the total cost of treatment in each protocol (m x n) (For illustration and international comparison all cost were converted to US$).In ND-APL patients, the mean cost of induction and consolidation was $5078.5±1581 and $902±212 respectively while in APL-CT it was $9812.1±3239 and $11803.1±4872 respectively (exchange rate 1 US$=61.87 Indian rupees). Our data illustrated that APL-CT group incurred higher costs mainly due to the greater duration of in-patient care that was required in this group and since they had higher rate of infectious complications (Table 1). During maintenance phase, in ND-APL, there were no in-patient stays and the entire chemotherapy was given on outpatient basis and the average cost was $2074±146 and the cost of following up these patients for an additional three years was $704.6±289. The mean lifetime cost of treatment of ND-APL using ATO was $8759.2±2078 while using APL-CT was $24393±5528. In R-APL patients, the total cost of re-induction and consolidation was $3498±1220 and $2274±372 respectively. The mean cost of an autologous-SCT was $4318±159. The average lifetime cost of treatment of relapsed APL patients using ATO based regimen followed by an autologous SCT was $12269.7±4915. The weighted cost per living for ATO and CT was estimated to be $12426 and $28330 respectively. The incremental cost effectiveness ratio showed ATO to be cheaper by $13359 for each life saved compared to conventional chemotherapy.ATO based regimen in ND-APL and R-APL are associated with significant reduction in resource utilization and costs of treatment and is also cost-effective as compared to conventional ATRA+chemotherapy. With the world still debating the best treatment for APL, generic ATO based regimen offers a significant opportunity for resource constrained countries to treat all patients with a diagnosis of APL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Do Hermetic Storage Technology Significantly Abate Losses of Rice Over Time? An Economic Evaluation

In Bangladesh, traditional technologies like Dole, Auri, Bamboo Gola, Motka, and Plastic bag are widely used in rice storage. Hot and humid weather of the country favors the growth of insects in these which are not functional for rice storage. Recently, hermetic bag (HB) GrainPro and PICS bags are suggested for rice storage without being subjected to economic analysis in the country. Very few empirical studies on the economic analysis of storage technologies were conducted at laboratory and field conditions. In it, losses of rice storage using traditional technologies and HB were evaluated to judge the economic effects of these. Moreover, determinants of storage benefit were analyzed for different devices and econometric modeling was formulated to have the understanding the benefit of reduced loss by storage over time. These benefits were found to increase with time meaning that a farmer gained more benefit by storing longer period in HB. Results showed that economically feasible and attractive in investing these technologies at a discount rate of 12 percent by using financial analytical tools like net present value (NPV) and benefit-cost ratio (BCR) of different storage technologies. The results also indicate that gain of storage clearly increased over time. Considering BCR, Plastic drum use in rice storage is the most profitable storage technology followed by GrainPro and PICS Bag for consumption. Regression analysis of treatment and time effect of storage indicated that percentage profit per month is found the highest in GrainPro bag followed by PICS bag, Dole, Plastic bag and Motka, respectively. Promotion of PICS and GrainPro bags in rice seed storage would be more cost-effective and economically feasible to farmers.

A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery.

The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P = 0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P = 0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P = 0.042) but mental-component HRQoL and depressive symptoms were unchanged. Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it. NCT03157973 (http://www.clinicaltrials.gov).

Repeat hepatectomy versus radiofrequency ablation in management of recurrent hepatocellular carcinoma: an average treatment effect analysis.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver with high rates of recurrence post-resection. Repeat hepatectomy (RH) and radiofrequency ablation (RFA) are the mainstays for managing recurrent HCC following initial curative resection. This retrospective study aims to determine the average treatment effect of RH and RFA in patients with recurrent HCC. From 2000 to 2016, a total of 219 consecutive patients with recurrent HCC who underwent either RH or RFA were included in the study. The analysis was performed using inverse probability of treatment weighting (IPTW), and propensity score-matched (PSM) methods. The minor and major post-operative morbidity after propensity score-matched analysis for the RH group was 30.0% and 6.0%, respectively, and 19.2% and 0.0% (p = 0.1006), respectively, for the RFA group. After propensity score matching, the median OS for RH and RFA was 85.5 (IQR, 33.5-not reached) and 53.3 months (IQR, 27.5-not reached) (p = 0.8474), respectively. There was no significant difference in 90-day mortality between both groups (p = 0.1287). RH showed improved long-term overall survival over RFA at the third [71.3% versus 65.7% (p = 0.0432)], fifth [59.9% versus 45.4% (p = 0.0271)] and tenth [35.4% versus 32.2% (p = 0.0132)] year follow-up, respectively. Median time to recurrence was 11.1 (IQR, 5.0-33.2) and 28.0 months (IQR, 9.1-not reached) (p = 0.0225) for the RFA and RH group, respectively. RH confers a late survival benefit compared with RFA for patients with recurrent HCC despite a higher morbidity rate.

Using marginal structural models to analyze the impact of subsequent therapy on the treatment effect in survival data: Simulations and clinical trial examples.

We explore the impact of time-varying subsequent therapy on the statistical power and treatment effects in survival analysis. The marginal structural model (MSM) with stabilized inverse probability treatment weights (sIPTW) was used to account for the effects due to the subsequent therapy. Simulations were performed to compare the MSM-sIPTW method with the conventional method without accounting for the time-varying covariate such as subsequent therapy that is dependent on the initial response of the treatment effect. The results of the simulations indicated that the statistical power, thereby the Type I error, of the trials to detect the frontline treatment effect could be inflated if no appropriate adjustment was made for the impact due to the add-on effects of the subsequent therapy. Correspondingly, the hazard ratio between the treatment groups may be overestimated by the conventional analysis methods. In contrast, MSM-sIPTW can maintain the Type I error rate and gave unbiased estimates of the hazard ratio for the treatment. Two real examples were used to discuss the potential clinical implications. The study demonstrated the importance of accounting for time-varying subsequent therapy for obtaining unbiased interpretation of data.

Comparison of treatment modalities for selected advanced laryngeal squamous cell carcinoma.

The authors aimed to clarify the optimal treatment strategy and the indication of different treatments in managing advanced laryngeal squamous cell carcinoma (LSCC). A total of 9700 patients with advanced (T3-4aN0-3M0) LSCC who treated with (1) surgery alone, (2) surgery plus adjuvant radiation with or without chemotherapy (aCRT/RT), or (3) definitive CRT/RT was retrieved from the SEER database. The propensity score matching (PSM) was applied to balance confounding factors. Kaplan-Meier method and Cox proportional hazards regression were used to comparing the overall survival (OS) of patients. After optimal matching, 907 patients were screened from each treatment cohort. Kaplan-Meier and multivariate analyses presented that patients treated with surgery plus aCRT/CT had significantly longer OS than those treated with either surgery alone or CRT/RT, even after PSM. However, significant interactions were tested in treatment effects in stratified analyses of the primary subsite, T stage, N stage, and insurance status (PInteraction < 0.05 for all). Specifically, surgery plus aCRT/CT significantly improved the OS of patients with supraglottic, T4a, and N + tumors (P < 0.001 for all), while three treatment modalities achieved equal OS rates for patients with glottic, T3, and N0 tumors (P > 0.05 for all). Besides, supraglottic tumors presented a poorer prognosis than glottic subsite. Current study suggests that surgery with aCRT/RT is the preferred initial therapy for patients with T4a tumors, whereas patients with T3 tumors could be treated with either surgery (followed by aCRT/RT if it presents N +) or definitive CRT/RT for achieving laryngeal preservation. More-intense treatment should be emphasized for advanced supraglottic cancer.

2D fracture mechanics analysis of HFMI treatment effects on the fatigue behaviour of structural steel welds

The purpose of this paper is to present the extension of a previously developed strain-based fracture mechanics (SBFM) model from one to two dimensions for simulating fatigue crack growth in steel arc welds. The one-dimensional (1D) SBFM model is first briefly reviewed. Steps for extending it to simulate 2D growth of a semi-elliptical surface crack in a weld are then described. An application of the new model is lastly presented, which consists of analysing the behaviour of structural steel weld specimens from a previously published fatigue test program, in which the fatigue performance of weld specimens was enhanced by high frequency mechanical impact (HFMI) treatment. In this application, the effect of the treatment-induced compressive residual stress on the crack shape is simulated, and it is shown how the extended 2D SBFM model can be used to establish probabilistic design stress-life (S-N) curves for various loading conditions.

Semiparametric estimation of the nonmixture cure model with auxiliary survival information.

With rapidly increasing data sources, statistical methods that make use of external information are gradually becoming popular tools in medical research. In this article, we efficiently synthesize the auxiliary survival information and propose a semiparametric estimation method for the combined empirical likelihood in the framework of the nonmixture cure model, to enhance inference about the associations between exposures and disease outcomes. The auxiliary survival probabilities from external sources are first summarized as unbiased estimation equations, which help produce more efficient estimates of the effects of interest and improve the prediction accuracy for the risk of the event. Then we develop a Bernstein-based sieve empirical likelihood method to estimate the parametric and nonparametric components simultaneously. Such an estimation procedure allows us to reduce the computation burden while preserving the shape constraint on the baseline distribution function. The resulting estimators for the true associations are strongly consistent and asymptotically normal. Instead of collecting substantial exposure data, the auxiliary survival information at multiple time points is incorporated, which further reduces the mean squared error of the estimators. This contributes to biomarker evaluation and treatment effect analysis within smaller studies. We show how to choose the number of auxiliary survival probabilities appropriately and provide a guideline for practical applications. Simulation studies demonstrate that the estimators enjoy large gains in efficiency. A melanoma dataset is analyzed for illustrating themethodology.

The Impact of the COVID-19 Pandemic on Ambient Air Quality in China: A Quasi-Difference-in-Difference Approach.

The novel coronavirus (COVID-19) pandemic has provided a distinct opportunity to explore the mechanisms by which human activities affect air quality and pollution emissions. We conduct a quasi-difference-in-differences (DID) analysis of the impacts of lockdown measures on air pollution during the first wave of the COVID-19 pandemic in China. Our study covers 367 cities from the beginning of the lockdown on 23 January 2020 until April 22, two weeks after the lockdown in the epicenter was lifted. Static and dynamic analysis of the average treatment effects on the treated is conducted for the air quality index (AQI) and six criteria pollutants. The results indicate that, first, on average, the AQI decreased by about 7%. However, it was still over the threshold set by the World Health Organization. Second, we detect heterogeneous changes in the level of different pollutants, which suggests heterogeneous impacts of the lockdown on human activities: carbon monoxide (CO) had the biggest drop, about 30%, and nitrogen dioxide (NO2) had the second-biggest drop, 20%. In contrast, ozone (O3) increased by 3.74% due to the changes in the NOx/VOCs caused by the decrease in NOx, the decrease of O3 titration, and particulate matter concentration. Third, air pollution levels rebounded immediately after the number of infections dropped, which indicates a swift recovery of human activities. This study provides insights into the implementation of environmental policies in China and other developing countries.

Homeland Political Trust Among Emigrants: The Case of Finland-Swedes

How does emigrating affect one's political trust for their native country's political and state institutions? This question is increasingly relevant as a result of growing migration in the wake of globalization and the willingness to widen electoral laws and channels for participation to also include emigrated citizens in homeland politics. Despite the research conducted on homeland politics and voting from abroad in political science, the question of homeland political trust among emigrants has not been given sufficient attention. This could be seen as surprising from the perspective of trust research, which has exhaustively analyzed political and social trust. This paper seeks to map the effect of migration on political trust by comparing the trust in Finnish political and state institutions of emigrated Swedish-speaking Finns, also known as Finland-Swedes, and Finland-Swedes living in Finland. The Finland-Swedes are a resourceful minority with a sizeable diaspora, which in relative terms is comparable to nations with a renowned diaspora. The paper analyzes the political trust of migrants and residents with two high quality random surveys and using two methods, linear regression and propensity score matching, with analysis of average treatment effects to counter potential endogeneity of political trust and migrating citizens. The analyses show emigrants have on average significantly higher homeland political trust. Comparing the linear regression analysis and the average treatment effects after matching we get similar results, although the linear regression analysis that controls for potentially endogenous factors seems to somewhat exaggerate the effect of migration.

High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants.

Human milk is the best enteral nutrition for preterm infants. However, human milk, given at standard recommended volumes, is not adequate to meet the protein, energy, and other nutrient requirements of preterm or low birth weight infants. One strategy that may be used to address the potential nutrient deficits is to give a higher volume of enteral feeds. High volume feeds may improve nutrient accretion and growth, and in turn may improve neurodevelopmental outcomes. However, there are concerns that high volume feeds may cause feed intolerance, necrotising enterocolitis, or complications related to fluid overload such as patent ductus arteriosus and chronic lung disease. This is an update of a review published in 2017. To assess the effect on growth and safety of high versus standard volume enteral feeds in preterm or low birth weight infants. In infants who were fed fortified human milk or preterm formula, high and standard volume feeds were defined as > 180 mL/kg/day and ≤ 180 mL/kg/day, respectively. In infants who were fed unfortified human milk or term formula, high and standard volume feeds were defined as > 200 mL/kg/day and ≤ 200 mL/kg/day, respectively. We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 6) in the Cochrane Library; Ovid MEDLINE (1946 to June 2020); Embase (1974 to June 2020); and CINAHL (inception to June 2020); Maternity & Infant Care Database (MIDIRS) (1971 to April 2020); as well as previous reviews, and trial registries. We included randomised controlled trials (RCTs) that compared high versus standard volume enteral feeds for preterm or low birth weight infants. Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported risk ratio (RR) and risk difference for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. The primary outcomes were weight gain, linear and head growth during hospital stay, and extrauterine growth restriction at discharge. We included two new RCTs (283 infants) in this update. In total, we included three trials (347 infants) in this updated review. High versus standard volume feeds with fortified human milk or preterm formula Two trials (283 infants) met the inclusion criteria for this comparison. Both were of good methodological quality, except for lack of masking. Both trials were performed in infants born at < 32 weeks' gestation. Meta-analysis of data from both trials showed high volume feeds probably improves weight gain during hospital stay (MD 2.58 g/kg/day, 95% CI 1.41 to 3.76; participants = 271; moderate-certainty evidence). High volume feeds may have little or no effect on linear growth (MD 0.05 cm/week, 95% CI -0.02 to 0.13; participants = 271; low-certainty evidence), head growth (MD 0.02 cm/week, 95% CI -0.04 to 0.09; participants = 271; low-certainty evidence), and extrauterine growth restriction at discharge (RR 0.71, 95% CI 0.50 to 1.02; participants = 271; low-certainty evidence). We are uncertain of the effect of high volume feeds with fortified human milk or preterm formula on the risk of necrotising enterocolitis (RR 0.74, 95% CI 0.12 to 4.51; participants = 283; very-low certainty evidence). High versus standard volume feeds with unfortified human milk or term formula One trial with 64 very low birth weight infants met the inclusion criteria for this comparison. This trial was unmasked but otherwise of good methodological quality. High volume feeds probably improves weight gain during hospital stay (MD 6.2 g/kg/day, 95% CI 2.71 to 9.69; participants = 61; moderate-certainty evidence). The trial did not provide data on linear and head growth, and extrauterine growth restriction at discharge. We are uncertain as to the effect of high volume feeds with unfortified human milk or term formula on the risk of necrotising enterocolitis (RR 1.03, 95% CI 0.07 to 15.78; participants = 61; very low-certainty evidence). High volume feeds (≥ 180 mL/kg/day of fortified human milk or preterm formula, or ≥ 200 mL/kg/day of unfortified human milk or term formula) probably improves weight gain during hospital stay. The available data is inadequate to draw conclusions on the effect of high volume feeds on other growth and clinical outcomes. A large RCT is needed to provide data of sufficient quality and precision to inform policy and practice.

Greater trochanteric pain syndrome: predicting who will respond to a local glucocorticoid injection

Objectives: This study aimed to explore whether certain clinical tests or a rapid improvement in lateral hip pain following periarticular injection are predictive of subsequent efficacy of local glucocorticoid (GC) injection in greater trochanteric pain syndrome (GTPS). Method: This secondary analysis of a randomized controlled trial of an injection of GC and local anaesthetic (LA) versus placebo included 44 patients with GTPS. Two subgroups of patients were defined: (i) 30 min responders, reporting a decrease of ≥ 50% of the initial pain at 30 min post-injection; and (ii) positive triple test, presenting a combination of three positive clinical tests (30-second single-leg stance, FABER, and Lequesne). Median level of numeric rating scale for pain at 1 month was the primary outcome. Interaction analysis of treatment effect in the subgroups was performed using a linear regression adjusting for pain at baseline. Results: Sixteen patients (36%) were 30 min responders. In this group, GC treatment was associated with a significant improvement in pain at 1 month compared to non-responders (p = 0.03). The 30 min response was not associated with the use of LA. Positive triple test (22% of patients) was associated with higher pain scores at baseline (p = 0.03). In this group, patients who received placebo had significantly more pain at 1 month than those with the cortisone injection (p = 0.04). Conclusion: Patients with GTPS who present a rapid decrease in pain after periarticular injection, and those who display a combination of three specific clinical tests, are more likely to benefit from an injection with GC and anaesthetic.