386 research outputs found

    Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials

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    Objective: To examine the overall treatment effect and the proportion attributable to contextual effect (PCE) in randomised controlled trials (RCTs) of diverse treatments for osteoarthritis (OA). Methods: We searched MEDLINE, EMBASE, CENTRAL, Science Citation Index, AMED, CINAHL through October 2014, supplemented with manual search of reference lists, published meta-analyses and systematic reviews. Included were RCTs in OA comparing placebo with representative complementary, pharmacological, non-pharmacological and surgical treatments. The primary outcome was pain. Secondary outcomes were function and stiffness. The overall treatment effect was defined as the improvement from baseline in the treatment group. The contextual effect was defined as that of the placebo group. The PCE was calculated by dividing the contextual effect over the overall treatment effect. The effect size (ES) of overall treatment effect and the PCE were pooled using random-effects model. Subgroup analysis and meta-regression were conducted to examine determinants of the PCE. Results: In total, 215 trials (41,392 participants) were included. The overall treatment effect for pain-reduction ranged from the smallest with lavage (ES=0.46, 95%CI: 0.24, 0.68) to the largest with topical NSAIDs (ES=1.37, 95%CI 1.19, 1.55). On average, 75% (PCE=0.75, 95%CI 0.72, 0.79) of pain reduction was attributable to contextual effect. It varied by treatment from 47% (PCE=0.47, 95%CI: 0.32, 0.70) for intra-articular corticosteroid to 91% (PCE=0.91, 95%CI: 0.60, 1.37) for joint lavage. Similar results were observed for function and stiffness. Treatment delivered by needle/injection and other means but oral medication, longer duration of treatment, larger sample size (≥100 per arm) and public funding source were associated with increased PCE for pain-reduction. Conclusions: The majority (75%) of the overall treatment effect in OA RCTs is attributable to contextual effects, rather than the specific effect of treatments. Reporting overall treatment effect and PCE, in addition to traditional ES over placebo, permits a more balanced, clinically meaningful interpretation of RCT results. This would help dispel the frequent discordance between conclusions from RCT evidence and clinical experience - the “efficacy paradox”

    Pricing in inflationary times: The penny drops

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    How does the frequency and magnitude of micro-price rises and falls relate to macroeconomic crisis, as well as moderation? Weekly micropricing behaviour in British groceries was investigated across three leading retailers over the moderation period 2004–7 and the crisis period 2008–10. We find significant price flexibility sharply distinguished from behaviour observed in most previous works. Downward price flexibility increased markedly in 2008. Overall basket prices rise, but significantly more individual prices fall than rise in the latter period. Tests of obfuscation in price setting suggested that large numbers of small price falls were used to disguise the basket price rises

    A basic introduction to fixed-effect and random-effects models for meta-analysis

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    There are two popular statistical models for meta-analysis, the fixed-effect model and the random-effects model. The fact that these two models employ similar sets of formulas to compute statistics, and sometimes yield similar estimates for the various parameters, may lead people to believe that the models are interchangeable. In fact, though, the models represent fundamentally different assumptions about the data. The selection of the appropriate model is important to ensure that the various statistics are estimated correctly. Additionally, and more fundamentally, the model serves to place the analysis in context. It provides a framework for the goals of the analysis as well as for the interpretation of the statistics. In this paper we explain the key assumptions of each model, and then outline the differences between the models. We conclude with a discussion of factors to consider when choosing between the two models

    Mapping multiple gas/odor sources in an uncontrolled indoor environment using a Bayesian occupancy grid mapping based method

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    Author Posting. © The Author(s), 2011. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Robotics and Autonomous Systems 59 (2011): 988–1000, doi:10.1016/j.robot.2011.06.007.In this paper we address the problem of autonomously localizing multiple gas/odor sources in an indoor environment without a strong airflow. To do this, a robot iteratively creates an occupancy grid map. The produced map shows the probability each discrete cell contains a source. Our approach is based on a recent adaptation [15] to traditional Bayesian occupancy grid mapping for chemical source localization problems. The approach is less sensitive, in the considered scenario, to the choice of the algorithm parameters. We present experimental results with a robot in an indoor uncontrolled corridor in the presence of different ejecting sources proving the method is able to build reliable maps quickly (5.5 minutes in a 6 m x 2.1 m area) and in real time

    Human Exposure following Mycobacterium tuberculosis Infection of Multiple Animal Species in a Metropolitan Zoo

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    From 1997 to 2000, Mycobacterium tuberculosis was diagnosed in two Asian elephants (Elephas maximus), three Rocky Mountain goats (Oreamnos americanus), and one black rhinoceros (Diceros bicornis) in the Los Angeles Zoo. DNA fingerprint patterns suggested recent transmission. An investigation found no active cases of tuberculosis in humans; however, tuberculin skin-test conversions in humans were associated with training elephants and attending an elephant necropsy

    The prevalence of intrusive memories in adult depression: A meta-analysis

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    Background Intrusive memories have typically been associated with post-traumatic stress disorder (PTSD) but some studies have suggested they can also occur in depression-alone. Objective This meta-analysis aimed to estimate the prevalence of intrusive memories in adult depression and to explore methodological and other factors that may moderate this prevalence. Method The databases PsycINFO, PsycARTICLES, MedLine, PubMed, CINAHL and Embase were searched for relevant articles, published up to and including July 2016. Studies measuring point prevalence of intrusive memories in adults aged 18 years or above with depression were included and assessed for quality. Meta-analysis was completed under a random effects model. Results Seven studies measuring point prevalence of intrusive memories in adult depression were included. The overall pooled prevalence estimate calculated was 76.0% (95% CI 59.4 – 89.4%), reducing to 66.0% (95% CI 51.0 – 79.5%) when restricted to intrusive memories experienced within the week prior to assessment. Heterogeneity was high. Between-groups analyses indicated that adults with depression are as likely to experience intrusive memories as adults with PTSD, and more likely to experience intrusive memories than healthy controls (risk ratio of 2.94, 95% CI 1.53 – 5.67). Limitations The strength of conclusions is limited by the small number of studies included. Consideration of the relationship between depression, intrusive memories and trauma exposure is required. Conclusions Intrusive memories are experienced by a large majority of adults with depression and may therefore be an important target for cognitive intervention. Larger scale measurement of clinical outcome is needed with identification of individual factors predicting treatment response
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