Osteoarthritis and the rule of halves

<b>Background</b> Symptomatic osteoarthritis poses a major challenge to primary health care but no studies have related accessing primary care ("detection"), receiving recommended treatments ("treatment"), and achieving adequate control ("control").<p></p> <b>Objective</b> To provide estimates of detection, treatment, and control within a single population adapting the approach used to determine a Rule of Halves for other long-term conditions.<p></p> <b>Setting</b> General population.<p></p> <b>Participants</b> 400 adults aged 50+ years with prevalent symptomatic knee osteoarthritis.<p></p> <b>Design</b> Prospective cohort with baseline questionnaire, clinical assessment, and plain radiographs, and questionnaire follow-up at 18 and 36 months and linkage to primary care medical records.<p></p> <b>Outcome measures</b> "Detection" was defined as at least one musculoskeletal knee-related GP consultation between baseline and 36 months. "Treatment" was self-reported use of at least one recommended treatment or physiotherapy/hospital specialist referral for their knee problem at all three measurement points. Pain was "controlled" if characteristic pain intensity <5 out of 10 on at least two occasions.<p></p> <b>Results</b> In 221 cases (55.3%; 95%CI: 50.4, 60.1) there was evidence that the current problem had been detected in general practice. Of those detected, 164 (74.2% (68.4, 80.0)) were receiving one or more of the recommended treatments at all three measurement points. Of those detected and treated, 45 (27.4% (20.5, 34.3)) had symptoms under control on at least two occasions. Using narrower definitions resulted in substantially lower estimates.<p></p> <b>Conclusion</b> Osteoarthritis care does not conform to a Rule of Halves. Symptom control is low among those accessing health care and receiving treatment

Free-fall drop test with interchangeable surfaces to recreate concussive ice hockey head impacts

Ice hockey has one of the highest concussion rates in sport. During collisions with other players, helmets offer limited protection. Various test protocols exist often requiring various types of laboratory equipment. A simplified test protocol was developed to facilitate testing by more researchers, and modifications to certification standards. Measured kinematics (acceleration vs. time trace shape, peak accelerations, and impact duration) of a Hybrid III headform dropped onto different surfaces were compared to published laboratory representations of concussive impacts. An exemplary comparison of five different helmets, ranging from low (US$50) to high cost (US$300), covering a range of helmet and liner designs, was also undertaken. Different impact conditions were created by changing the impact surface (Modular Elastomer Programmer pad, or 24 to 96 mm of EVAZOTE-50 foam with a Young's modulus of ~ 1 MPa), surface orientation (0 or 45°), impact site, and helmet make/model. With increasing impact surface compliance, peak accelerations decreased and impact duration increased. Impacts onto a 45° anvil covered with 48 mm of foam produced a similar response to reference concussive collisions in ice hockey. Specifically, these impacts gave similar acceleration vs. time trace shapes, while normalized pairwise differences between reference and measured peak acceleration and impact duration, were less than 10% (difference/maximum value), and mean (± SD) of accelerations and duration fell within the interquartile range of the reference data. These results suggest that by modifying the impact surface, a free-fall drop test can produce a kinematic response in a helmeted headform similar to the method currently used to replicate ice hockey collisions. A wider range of impact scenarios, i.e., fall onto different surfaces, can also be replicated. This test protocol for ice hockey helmets could facilitate simplified testing in certification standards and research

Lessons from using iPads to understand young children's creativity

This paper explores how iPads can be used as part of a child-centred data collection approach to understanding young children’s creativity. Evidence is presented from a pilot study about 3- to 5-year-old children’s creative play. Researchers’ reflective accounts of children’s engagement with iPad video diaries and free to use apps were logged across two early educational settings over a three-month period. Findings suggest that iPads offer a mechanism to allow children to express their creative play and to encourage involvement in the research process. However, bespoke research software to use with early years children is required to improve this process

Protocolised non-invasive compared with invasive weaning from mechanical ventilation for adults in intensive care : the Breathe RCT

Background: Invasive mechanical ventilation (IMV) is a life-saving intervention. Following resolution of the condition that necessitated IMV, a spontaneous breathing trial (SBT) is used to determine patient readiness for IMV discontinuation. In patients who fail one or more SBTs, there is uncertainty as to the optimum management strategy. Objective: To evaluate the clinical effectiveness and cost-effectiveness of using non-invasive ventilation (NIV) as an intermediate step in the protocolised weaning of patients from IMV. Design: Pragmatic, open-label, parallel-group randomised controlled trial, with cost-effectiveness analysis. Setting: A total of 51 critical care units across the UK. Participants: Adult intensive care patients who had received IMV for at least 48 hours, who were categorised as ready to wean from ventilation, and who failed a SBT. Interventions: Control group (invasive weaning): patients continued to receive IMV with daily SBTs. A weaning protocol was used to wean pressure support based on the patient’s condition. Intervention group (non-invasive weaning): patients were extubated to NIV. A weaning protocol was used to wean inspiratory positive airway pressure, based on the patient’s condition. Main outcome measures: The primary outcome measure was time to liberation from ventilation. Secondary outcome measures included mortality, duration of IMV, proportion of patients receiving antibiotics for a presumed respiratory infection and health-related quality of life. Results: A total of 364 patients (invasive weaning, n = 182; non-invasive weaning, n = 182) were randomised. Groups were well matched at baseline. There was no difference between the invasive weaning and non-invasive weaning groups in median time to liberation from ventilation {invasive weaning 108 hours [interquartile range (IQR) 57–351 hours] vs. non-invasive weaning 104.3 hours [IQR 34.5–297 hours]; hazard ratio 1.1, 95% confidence interval [CI] 0.89 to 1.39; p = 0.352}. There was also no difference in mortality between groups at any time point. Patients in the non-invasive weaning group had fewer IMV days [invasive weaning 4 days (IQR 2–11 days) vs. non-invasive weaning 1 day (IQR 0–7 days); adjusted mean difference –3.1 days, 95% CI –5.75 to –0.51 days]. In addition, fewer non-invasive weaning patients required antibiotics for a respiratory infection [odds ratio (OR) 0.60, 95% CI 0.41 to 1.00; p = 0.048]. A higher proportion of non-invasive weaning patients required reintubation than those in the invasive weaning group (OR 2.00, 95% CI 1.27 to 3.24). The within-trial economic evaluation showed that NIV was associated with a lower net cost and a higher net effect, and was dominant in health economic terms. The probability that NIV was cost-effective was estimated at 0.58 at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. Conclusions: A protocolised non-invasive weaning strategy did not reduce time to liberation from ventilation. However, patients who underwent non-invasive weaning had fewer days requiring IMV and required fewer antibiotics for respiratory infections. Future work: In patients who fail a SBT, which factors predict an adverse outcome (reintubation, tracheostomy, death) if extubated and weaned using NIV? Trial registration: Current Controlled Trials ISRCTN15635197. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 48. See the NIHR Journals Library website for further project information

The Effect of Weak Interactions on the Ultra-Relativistic Bose-Einstein Condensation Temperature

We calculate the ultra-relativistic Bose-Einstein condensation temperature of a complex scalar field with weak lambda Phi^4 interaction. We show that at high temperature and finite density we can use dimensional reduction to produce an effective three-dimensional theory which then requires non-perturbative analysis. For simplicity and ease of implementation we illustrate this process with the linear delta expansion.Comment: Latex2e, 12 pages, three eps figures, replacement with additional discussion and extra figur

Radio polarization from the inner Galaxy at arcminute resolution

The Southern Galactic Plane Survey (SGPS) is an HI and 1.4-GHz continuum survey of the 4th quadrant of the Galaxy at arcmin resolution. We present here results on linearly polarized continuum emission from an initial 28-square-degree Test Region for the SGPS, consisting of 190 mosaiced pointings of the Australia Telescope Compact Array, and covering the range 325.5 < l < 332.5, -0.5 < b < +3.5. Complicated extended structure is seen in linear polarization throughout the Test Region, almost all of which has no correlation with total intensity. We interpret the brightest regions of polarized emission as representing intrinsic structure in extended polarization, most likely originating in the Crux spiral arm at a distance of 3.5 kpc; fainter polarized structure is imposed by Faraday rotation in foreground material. Two large areas in the field are devoid of polarization. We argue that these voids are produced by foreground HII regions in which the magnetic field is disordered on scales of ~0.1-0.2 pc. We also identify a depolarized halo around the HII region RCW 94, which we suggest results from the interaction of the HII region with a surrounding molecular cloud.Comment: 21 pages, 5 embedded EPS figures, 9 jpeg figures, uses emulateapj apjfonts. Accepted to the Astrophysical Journal. Version with all 14 figures in embedded EPS format available at http://space.mit.edu/~bmg/sgps

Effects of non-perturbatively improved dynamical fermions in QCD at fixed lattice spacing

We present results for the static inter-quark potential, lightest glueballs, light hadron spectrum and topological susceptibility using a non-perturbatively improved action on a $16^3\times 32$ lattice at a set of values of the bare gauge coupling and bare dynamical quark mass chosen to keep the lattice size fixed in physical units ($\sim 1.7$ fm). By comparing these measurements with a matched quenched ensemble, we study the effects due to two degenerate flavours of dynamical quarks. With the greater control over residual lattice spacing effects which these methods afford, we find some evidence of charge screening and some minor effects on the light hadron spectrum over the range of quark masses studied ($M_{PS}/M_{V}\ge0.58$). More substantial differences between quenched and unquenched simulations are observed in measurements of topological quantities.Comment: 53 pages, LaTeX/RevTeX, 16 eps figures; corrected clover action expression and various typos, no results change

Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD?

Item does not contain fulltextThis study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3)~whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99~children ages 6–12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).17 p