Treatments for spasticity and pain in multiple sclerosis: a systematic review

Objectives: To identify the drug treatments currently available for the management of spasticity and pain in multiple sclerosis (MS), and to evaluate their clinical and cost-effectiveness. Data sources: Electronic bibliographic databases, National Research Register, MRC Clinical Trials Register and the US National Institutes of Health Clinical Trials Register. Review methods: Systematic searches identified 15 interventions for the treatment of spasticity and 15 interventions for treatment of pain. The quality and outcomes of the studies were evaluated. Reviews of the treatment of spasticity and pain when due to other aetiologies were also sought. Results: There is limited evidence of the effectiveness of four oral drugs for spasticity: baclofen, dantrolene, diazepam and tizanidine. Tizanidine appears to be no more effective than comparator drugs such as baclofen and has a slightly different side-effects profile. Despite claims that it causes less muscle weakness, there was very little evidence that tizanidine performed any better in this respect than other drugs, although it is more expensive. The findings of this review are consistent with reviews of the same treatments for spasticity derived from other aetiologies. There is good evidence that both botulinum toxin (BT) and intrathecal baclofen are effective in reducing spasticity, and both are associated with functional benefit. However, they are invasive, and substantially more expensive. None of the studies included in the review of pain were designed specifically to evaluate the alleviation of pain in patients with MS and there was no consistency regarding the use of validated outcome measures. It was suggested that, although expensive, the use of intrathecal baclofen may be associated with significant savings in hospitalisation costs in relation to bed-bound patients who are at risk of developing pressure sores, thus enhancing its cost-effectiveness. No studies of cost-effectiveness were identified in the review of pain. There is evidence, albeit limited, of the clinical effectiveness of baclofen, dantrolene, diazepam, tizanidine, intrathecal baclofen and BT and of the potential cost-effectiveness of intrathecal baclofen in the treatment of spasticity in MS. Conclusions: Many of the interventions identified are not licensed for the alleviation of pain or spasticity in MS and the lack of evidence relating to their effectiveness may also limit their widespread use. Indeed, forthcoming information relating to the use of cannabinoids in MS may result in there being better evidence of the effectiveness of new treatments than of any of the currently used drugs. It may therefore be of value to carry out double-blind randomised controlled trials of interventions used in current practice, where outcomes could include functional benefit and impact on quality of life. Further research into the development and validation of outcomes measures for pain and spasticity may also be useful, as perhaps would cost–utility studies

Towards a More Equal City: Framing the Challenges and Opportunities

Cities are growing differently today than before. As much as 70 percent of people in emerging cities in Asia, Africa and Latin America is under-served. Furthermore, cities face challenges in four areas:Highest rates of urbanization are in sub-Saharan Africa, South and Southeast AsiaUrbanization is now happening in more low-income countries than in the pastThe share of poor people living in urban areas is on the rise worldwideCities in the Global South have the fewest public resources per capitaWe need a new approach that will benefit all urban residents and create sustainable, productive cities for the 21st century. The World Resources Report (WRR) examines if prioritizing access to core urban services, we can create cities that are prosperous and sustainable for all people.This first installment of the WRR developed a new categorization of cities into emerging, struggling, thriving, and stabilizing cities. It focuses on solutions for struggling and emerging cities—over half the cities included in the analysis—because they have the greatest opportunity to alter their development trajectory

Putting Soybeans into Permanent Farming

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Electromagnetic properties of ice coated surfaces

The electromagnetic scattering from ice coated structures is examined. The influence of ice is shown from a measurement standpoint and related to a simple analytical model. A hardware system for the realistic measurement of ice coated structures is also being developed to use in an existing NASA Lewis icing tunnel. Presently, initial measurements have been performed with a simulated tunnel to aid in the development

Large collection of astrophysical S-factors and its compact representation

Numerous nuclear reactions in the crust of accreting neutron stars are strongly affected by dense plasma environment. Simulations of superbursts, deep crustal heating and other nuclear burning phenomena in neutron stars require astrophysical S-factors for these reactions (as a function of center-of-mass energy E of colliding nuclei). A large database of S-factors is created for about 5000 non-resonant fusion reactions involving stable and unstable isotopes of Be, B, C, N, O, F, Ne, Na, Mg, and Si. It extends the previous database of about 1000 reactions involving isotopes of C, O, Ne, and Mg. The calculations are performed using the Sao Paulo potential and the barrier penetration formalism. All calculated S-data are parameterized by an analytic model for S(E) proposed before [Phys. Rev. C 82, 044609 (2010)] and further elaborated here. For a given reaction, the present S(E)-model contains three parameters. These parameters are easily interpolated along reactions involving isotopes of the same elements with only seven input parameters, giving an ultracompact, accurate, simple, and uniform database. The S(E) approximation can also be used to estimate theoretical uncertainties of S(E) and nuclear reaction rates in dense matter, as illustrated for the case of the 34Ne+34Ne reaction in the inner crust of an accreting neutron star.Comment: 13 pages, 2 figures, Phys. Rev. C, accepte