2,856 research outputs found

    Efficacy of interspinous device versus surgical decompression in the treatment of lumbar spinal stenosis: a modified network analysis.

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    Study designSystematic review using a modified network analysis.ObjectivesTo compare the effectiveness and morbidity of interspinous-device placement versus surgical decompression for the treatment of lumbar spinal stenosis.SummaryTraditionally, the most effective treatment for degenerative lumbar spinal stenosis is through surgical decompression. Recently, interspinous devices have been used in lieu of standard laminectomy.MethodsA review of the English-language literature was undertaken for articles published between 1970 and March 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing surgical decompression with interspinous-device placement for the treatment of lumbar spinal stenosis. First, studies making the direct comparison (cohort or randomized trials) were searched. Second, randomized controlled trials (RCTs) comparing each treatment to conservative management were searched to allow for an indirect comparison through a modified network analysis approach. Comparison studies involving simultaneous decompression with placement of an interspinous device were not included. Studies that did not have a comparison group were not included since a treatment effect could not be calculated. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. The strengths of evidence for indirect comparisons were downgraded. Disagreements were resolved by consensus.ResultsWe identified five studies meeting our inclusion criteria. No RCTs or cohort studies were identified that made the direct comparison of interspinous-device placement with surgical decompression. For the indirect comparison, three RCTs compared surgical decompression to conservative management and two RCTs compared interspinous-device placement to conservative management. There was low evidence supporting greater treatment effects for interspinous-device placement compared to decompression for disability and pain outcomes at 12 months. There was low evidence demonstrating little to no difference in treatment effects between the groups for walking distance and complication rates.ConclusionThe indirect treatment effect for disability and pain favors the interspinous device compared to decompression. The low evidence suggests that any further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. No significant treatment effect differences were observed for postoperative walking distance improvement or complication rates; however, findings should be considered with caution because of indirect comparisons and short follow-up periods

    Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.

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    ObjectiveThere is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke.DesignRetrospective.SettingWe conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database.ParticipantsAmong 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio <80%. Also, 355 were excluded due to history of atrial fibrillation, valvular heart disease or coagulopathy. Therefore, 1884 patients were included in our final analysis.InterventionsPatients were categorised into two groups based on whether clopidogrel or aspirin was prescribed during the follow-up period. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction, death or the end of 2010.Primary and secondary outcome measuresThe primary end point was hospitalisation due to a new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke.ResultsCompared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates.ConclusionsAmong patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation

    Seasonal variation of Sargassum ilicifolium (Phaeophyceae) growth on equatorial coral reefs

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    Temporal and spatial variations in Sargassum ilicifolium thallus density and length were investigated on equatorial coral reefs in Singapore from November 2011 to October 2012. Thalli density varied little throughout the year, however, we found strong seasonal patterns in thallus length and identified temperature as the significant driver. Sargassum ilicifolium reached maximum length in December (110.39 ± 2.37 cm) during periods of cooler water temperatures, and minimum length in May (9.88 ± 0.48 cm) during periods of warmer water temperatures. Significant spatial variation was also observed for both thallus density and length of S. ilicifolium among reefs. Within reefs, densities of S. ilicifolium were higher on reef flats (20.40 ± 0.40 individuals · 0.25 m−2) compared to upper reef slopes (5.66 ± 0.23 individuals · 0.25 m−2). Our findings highlight that marked seasonality in the growth of canopy-forming macroalgae can occur within equatorial reef systems where temperature ranges are restricted (\u3c3°C)

    Serverification of Molecular Modeling Applications: the Rosetta Online Server that Includes Everyone (ROSIE)

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    The Rosetta molecular modeling software package provides experimentally tested and rapidly evolving tools for the 3D structure prediction and high-resolution design of proteins, nucleic acids, and a growing number of non-natural polymers. Despite its free availability to academic users and improving documentation, use of Rosetta has largely remained confined to developers and their immediate collaborators due to the code's difficulty of use, the requirement for large computational resources, and the unavailability of servers for most of the Rosetta applications. Here, we present a unified web framework for Rosetta applications called ROSIE (Rosetta Online Server that Includes Everyone). ROSIE provides (a) a common user interface for Rosetta protocols, (b) a stable application programming interface for developers to add additional protocols, (c) a flexible back-end to allow leveraging of computer cluster resources shared by RosettaCommons member institutions, and (d) centralized administration by the RosettaCommons to ensure continuous maintenance. This paper describes the ROSIE server infrastructure, a step-by-step 'serverification' protocol for use by Rosetta developers, and the deployment of the first nine ROSIE applications by six separate developer teams: Docking, RNA de novo, ERRASER, Antibody, Sequence Tolerance, Supercharge, Beta peptide design, NCBB design, and VIP redesign. As illustrated by the number and diversity of these applications, ROSIE offers a general and speedy paradigm for serverification of Rosetta applications that incurs negligible cost to developers and lowers barriers to Rosetta use for the broader biological community. ROSIE is available at http://rosie.rosettacommons.org

    Omnidirectional wavelength selective emitters/absorbers based on dielectric-filled anti-reflection coated two-dimensional metallic photonic crystals

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    We demonstrate designs of dielectric-filled anti-reflection coated (ARC) two-dimensional (2D) metallic photonic crystals (MPhCs) capable of omnidirectional, polarization insensitive, wavelength selective emission/absorption. Up to 26% improvement in hemispherically averaged emittance/absorptance below the cutoff wavelength is observed for optimized hafnium oxide filled 2D tantalum (Ta) PhCs over the unfilled 2D Ta PhCs. The optimized designs possess high hemispherically averaged emittance/absorptance of 0.86 at wavelengths below the cutoff wavelength and low hemispherically averaged emittance/absorptance of 0.12 at wavelengths above the cutoff wavelength, which is extremely promising for applications such as thermophotovoltaic energy conversion, solar absorption, and infrared spectroscopy.Massachusetts Institute of Technology. Institute for Soldier Nanotechnologies (Contract W911NF-13-D-0001)United States. Dept. of Energy. Office of Science (Solid-State Solar-Thermal Energy Conversion Center Grant DE-SC0001299

    Robust free space board-to-board optical interconnect with closed loop MEMS tracking

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    We present a free-space optical interconnect system capable of dynamic closed-loop optical alignment using a microlens scanner with a proportional integral and derivative controller. Electrostatic microlens scanners based on combdrive actuators are designed and characterized with vertical cavity surface emitting lasers (VCSELs) for adaptive optical beam tracking in the midst of mechanical vibration noise. The microlens scanners are fabricated on silicon-on-insulator wafers with a bulk micromachining process using deep reactive ion etching. We demonstrate dynamic optical beam positioning with a 700 Hz bandwidth and a maximum noise reduction of approximately 40 dB. Eye diagrams with a 1 Gb/s modulation rate are presented to demonstrate the improved optical link in the presence of mechanical noise
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