ISIPTA'07: Proceedings of the Fifth International Symposium on Imprecise Probability: Theories and Applications

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Pediatric Fractures

This reprint contains original research and review chapters concerning the latest advancements in various topics related to pediatric fractures. Topics include fractures of the face, clavicle, shoulder, elbow, forearm, wrist, pelvis, femur, and tibia; special considerations focus on osteogenesis imperfecta patients; and consideration is also given to general pediatric fracture topics, such as the influence of the COVID-19 pandemic, mortality after pediatric trauma, the effects of NSAID and electronic cigarette use, and chapters on epidemiology and physical activity

Studies in acute liver failure

Acute liver failure (ALF) is a devastating condition with a high associated mortality rate. Paracetamol hepatotoxicity remains the leading cause of ALF in the developed world. The studies outlined in this thesis explore the current management of ALF, and systematically review the prognostic tests currently used in paracetamol-induced ALF. Using a database of over 900 acute liver injury patients, the impact of unintentional paracetamol overdose is retrospectively analysed, demonstrating a strong association between this mode of paracetamol overdose and adverse clinical outcomes, including the requirement for emergency orthotopic liver transplantation.Current prognostic tests for severe paracetamol-induced hepatotoxicity have been criticised for their relatively low sensitivity, with the result that not all patients who might benefit from tertiary level care are identified. This thesis demonstrates that the development of the Systemic Inflammatory Response Syndrome (SIRS) or extrahepatic organ failure is strongly associated with death following paracetamol overdose. Due to their very high sensitivity in this condition, both the SIRS and Sequential Organ Failure Assessment scores have potential as future gatekeepers to improve the triage of paracetamol overdose patients, thereby delivering tertiary level care to those most likely to require emergency transplantation.A greater understanding of the pathophysiological links between the initial hepatic injury and development of the SIRS could help to identify novel biomarkers for ALF, and help guide future therapeutic avenues. Using serum samples from a prospectively collected cohort of acute liver injury patients, this thesis identifies two novel biomarkers, serum ferritin and the long pentraxin PTX3, which show a strong association with outcome following paracetamol hepatotoxicity. These biomarkers illustrate the importance that the innate immune system plays in the pathogenesis of paracetamol-induced ALF, and identifies several exciting areas for future cellular and animal-based studies

Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer

PMID: 23127367 [PubMed - indexed for MEDLINE] Free full text Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.Peer reviewedPublisher PD

The trials of homeopathy : a critical historical account of the origins, structure and development of Hahnemann's scientific therapeutics and two systematic reviews of homeopathic clinical trials, 1821-1953 and 1940-1998

The controversial discipline of homeopathy is examined from three original perspectives. Conceptual background The structure and presentation of Hahnemann's research programme is contrasted with philosophical assumptions about medical science and emerging theoretical structures in German academic medicine circa 1800, and the subsequent rift between homeopathy and alfopathy is explained at this level. The sources of homeopathic theory and method are located in mainstream eighteenth-century experiment. Alleged relationships to alchemical medicine are discounted, with the exception of certain pharmacy techniques introduced after 1816. Divergent schools and approaches within homeopathy are traced to their sources, and mapped onto a unified therapeutic field. Historical importance A systematic review of prospective clinical evaluations of homeopathy, 1821-1953, contends that these played an important but neglected part in the evolution of the clinical trial. Placebocontrolled trials by sceptics most probably originated in prior Hahnemannian use of within-patient placebo controls. Pragmatic trials of homeopathy versus allopathy in the mid nineteenth century show that judgements of homeopathic inefficacy made by influential nineteenth-century opponents, which have coloured debate ever since, were not evidence-based. Early twentieth-century clinical trials by homeopaths were methodologically in advance of biomedical trials in some respects. Clinical relevance A systematic review of 205 prospective controlled clinical trials published since 1940 found evidence of homeopathy's safety, and specific and global efficacy in trials of high internal validity. Implications for clinical research and practice are considered, founded on analysis of intrahomeopathic differences and trends. On the basis of trial evidence, the relative merits of placebo-controlled and pragmatic evaluations of homeopathy are discussed. Clinical relevance was found particularly in areas that pose problems for biomedicine, and proposals for pragmatic trials of homeopathy versus standard treatment are made in the following conditions: unexplained female infertility; postviral fatigue syndrome; influenza; atopy

Infertility: Medical and Social Choices

This report illustrates a range of options for congressional action in nine principal areas of public policy related to infertility: collecting data on reproductive health; preventing infertility; information to inform and protect consumers; providing access to infertility services; reproductive health of veterans; transfer of human eggs, sperm, and embryos; recordkeeping; surrogate motherhood; and reproductive research