Transcutaneous electrical nerve stimulation for cancer pain in adults.

Background Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown. Objectives The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED and PEDRO databases (11/04/08). Selection criteria Only randomised controlled trials (RCTS) investigating the use of TENS for the management of cancer-related pain in adults were included. Data collection and analysis The search strategy identified 37 possible published studies which were divided between two pairs of review authors that decided on study selection. A study eligibility form was used to screen each abstract and where study eligibility could not be determined from the abstract, the full paper was obtained and assessed by one pair of review authors. A standardised data extraction sheet was used to collect information on the studies and the quality of the studies was assessed independently by two review authors using the validated five-point Oxford Quality Scale. Final scores were discussed and agreed between all four review authors. The small sample sizes and differences in patient study populations of the two included studies prevented meta-analysis. Main results Only two RCTs met the eligibility criteria (64 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Authors' conclusions The results of this systematic review are inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults

Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey

Objective: To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function. Design: Cross sectional survey. Setting: Four centre general practice in Poole, Dorset. Subjects: 817 elderly patients aged 70-84 years. Main outcomes: Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction. Results: The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. Conclusions: Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown

Spectral Analysis for Matrix Hamiltonian Operators

In this work, we study the spectral properties of matrix Hamiltonians generated by linearizing the nonlinear Schr\"odinger equation about soliton solutions. By a numerically assisted proof, we show that there are no embedded eigenvalues for the three dimensional cubic equation. Though we focus on a proof of the 3d cubic problem, this work presents a new algorithm for verifying certain spectral properties needed to study soliton stability. Source code for verification of our comptuations, and for further experimentation, are available at http://www.math.toronto.edu/simpson/files/spec_prop_code.tgz.Comment: 57 pages, 22 figures, typos fixe

Contributions of climate feedbacks to changes in atmospheric circulation

The projected response of the atmospheric circulation to the radiative changes induced by CO2 forcing and climate feedbacks is currently uncertain. In this modelling study, the impact of CO2-induced climate feedbacks on changes in jet latitude and speed is assessed by imposing surface albedo, cloud, and water vapor feedbacks as if they were forcings in two climate models, CAM4 and ECHAM6. The jet response to radiative feedbacks can be broadly interpreted through changes in midlatitude baroclinicity. Clouds enhance baroclinicity, favoring a strengthened, poleward shifted jet; this is mitigated by surface albedo changes which have the opposite effect on baroclinicity and the jet, while water vapor has opposing effects on upper- and lower-level baroclinicity with little net impact on the jet. Large differences between the CAM4 and ECHAM6 responses illustrate how model uncertainty in radiative feedbacks causes a large spread in the baroclinicity response to CO2 forcing. Across the CMIP5 models, differences in shortwave feedbacks by clouds and albedo are a dominant contribution to this spread. Forcing CAM4 with shortwave cloud and albedo feedbacks from a representative set of CMIP5 models yields a wide range of jet responses that strongly correlate with the meridional gradient of the anomalous shortwave heating and the associated baroclinicity response. Differences in shortwave feedbacks statistically explain about 50% of the inter-model spread in CMIP5 jet shifts for our set of models, demonstrating the importance of constraining radiative feedbacks for accurate projections of circulation changes

Comparing Ecological Sensitivity with Stream Flow Rates in the Apalachicola-Chattahoochee-Flint River Basin

Environmental Economics and Policy, Resource /Energy Economics and Policy,

Assessment of Biosignals for Managing a Virtual Keyboard

In this paper we propose an assessment of biosignals for handling an application based on virtual keyboard and automatic scanning. The aim of this work is to measure the effect of using such application, through different interfaces based on electromyography and electrooculography, on cardiac and electrodermal activities. Five people without disabilities have been tested. Each subject wrote twice the same text using an electromyography interface in first test and electrooculography in the second one. Each test was divided into four parts: instruction, initial relax, writing and final relax. The results of the tests show important differences in the electrocardiogram and electrodermal activity among the parts of tests.Junta de Andalucía p08-TIC-363

Degenerate dispersive equations arising in the study of magma dynamics

An outstanding problem in Earth science is understanding the method of transport of magma in the Earth's mantle. Models for this process, transport in a viscously deformable porous media, give rise to scalar degenerate, dispersive, nonlinear wave equations. We establish a general local well-posedness for a physical class of data (roughly $H^1$) via fixed point methods. The strategy requires positive lower bounds on the solution. This is extended to global existence for a subset of possible nonlinearities by making use of certain conservation laws associated with the equations. Furthermore, we construct a Lyapunov energy functional, which is locally convex about the uniform state, and prove (global in time) nonlinear dynamic stability of the uniform state for any choice of nonlinearity. We compare the dynamics to that of other problems and discuss open questions concerning a larger range of nonlinearities, for which we conjecture global existence.Comment: 27 Pages, 7 figures are not present in this version. See http://www.columbia.edu/~grs2103/ for a PDF with figures. Submitted to Nonlinearit

Mass Accretion onto T Tauri Stars

It is now accepted that accretion onto classical T Tauri stars is controlled by the stellar magnetosphere, yet to date most accretion models have assumed that their magnetic fields are dipolar. By considering a simple steady state accretion model with both dipolar and complex magnetic fields we find a correlation between mass accretion rate and stellar mass of the form $\dot{M} \propto M_{\ast}^{\alpha}$, with our results consistent within observed scatter. For any particular stellar mass there can be several orders of magnitude difference in the mass accretion rate, with accretion filling factors of a few percent. We demonstrate that the field geometry has a significant effect in controlling the location and distribution of hot spots, formed on the stellar surface from the high velocity impact of accreting material. We find that hot spots are often at mid to low latitudes, in contrast to what is expected for accretion to dipolar fields, and that particularly for higher mass stars, the accretion flow is predominantly carried by open field lines.Comment: 17 pages, 10 figures, accepted for publication by MNRA