Economic evaluation of a community based exercise programme to prevent falls

OBJECTIVE: To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women. DESIGN: An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117). SETTING: 17 general practices in Dunedin, New Zealand. PARTICIPANTS: Women aged 80 years and older living in the community and invited by their general practitioner to take part. MAIN OUTCOME MEASURES: Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented. MAIN RESULTS: 27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and$265 (1995 New Zealand dollars) per fall prevented, and $457 and$426 per fall resulting in a moderate or serious injury prevented. CONCLUSIONS: The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies

Some classes of directoid groups

Directoid groups are 2-torsion-free abelian groups with an extra binary operation assigning upper bounds. They thus constitute a generalization of abelian l-groups and an equational substitute for directed abelian groups. We discuss some classes of directoid groups, including varieties

T-cell activation without proliferation in juvenile idiopathic arthritis

A study was done to determine if the differentiation and activation phenotype of T cells in synovial fluid (SF) from patients with juvenile idiopathic arthritis (JIA) is associated with T-cell proliferation in situ. Mononuclear cells were isolated from 44 paired samples of peripheral blood and SF. Differentiation and activation markers were determined on CD4 and CD8 T cells by flow cytometry. Cell-cycle analysis was performed by propidium iodide staining, and surface-marker expression was also assessed after culture of the T cells under conditions similar to those found in the synovial compartment. The majority of the T cells in the SF were CD45RO+CD45RBdull. There was greater expression of the activation markers CD69, HLA-DR, CD25 and CD71 on T cells from SF than on those from peripheral blood. Actively dividing cells accounted for less than 1% of the total T-cell population in SF. The presence or absence of IL-16 in T-cell cultures with SF or in a hypoxic environment did not affect the expression of markers of T-cell activation. T cells from the SF of patients with JIA were highly differentiated and expressed early and late markers of activation with little evidence of in situ proliferation. This observation refines and extends previous reports of the SF T-cell phenotype in JIA and may have important implications for our understanding of chronic inflammation

Rescattering and chiral dynamics in B\to \rho\pi decay

We examine the role of B^0(\bar B^0) \to \sigma \pi^0 \to \pi^+\pi^- \pi^0 decay in the Dalitz plot analysis of B^0 (\bar B^0) \to \rho\pi \to \pi^+\pi^-\pi^0 decays, employed to extract the CKM parameter \alpha. The \sigma \pi channel is significant because it can break the relationship between the penguin contributions in B\to\rho^0\pi^0, B\to\rho^+\pi^-, and B\to\rho^-\pi^+ decays consequent to an assumption of isospin symmetry. Its presence thus mimics the effect of isospin violation. The \sigma\pi^0 state is of definite CP, however; we demonstrate that the B\to\rho\pi analysis can be generalized to include this channel without difficulty. The \sigma or f_0(400-1200) ``meson'' is a broad I=J=0 enhancement driven by strong \pi\pi rescattering; a suitable scalar form factor is constrained by the chiral dynamics of low-energy hadron-hadron interactions - it is rather different from the relativistic Breit-Wigner form adopted in earlier B\to\sigma\pi and D\to\sigma\pi analyses. We show that the use of this scalar form factor leads to an improved theoretical understanding of the measured ratio Br(\bar B^0 \to \rho^\mp \pi^\pm) / Br(B^-\to \rho^0 \pi^-).Comment: 26 pages, 8 figs, published version. typos fixed, minor change

Clinical trial of lamivudine in children with chronic hepatitis B.

N Engl J Med. 2002 May 30;346(22):1706-13. Clinical trial of lamivudine in children with chronic hepatitis B. Jonas MM, Mizerski J, Badia IB, Areias JA, Schwarz KB, Little NR, Greensmith MJ, Gardner SD, Bell MS, Sokal EM; International Pediatric Lamivudine Investigator Group. of Gastroenterology, Children's Hospital, Boston, MA 02115, USA. Erratum in: N Engl J Med 2002 Sep 19;347(12):955. Kelley, Deirdre [corrected to Kelly, Deirdre]. Comment in: J Hepatol. 2003 May;38(5):698-9. N Engl J Med. 2002 May 30;346(22):1682-3. Abstract BACKGROUND: Lamivudine therapy is effective for chronic hepatitis B infection in adults. We evaluated the efficacy and tolerability of lamivudine as a treatment for chronic infection with hepatitis B virus (HBV) in children. METHODS: Children with chronic hepatitis B were randomly assigned in a 2:1 ratio to receive either oral lamivudine (3 mg per kilogram of body weight; maximum, 100 mg) or placebo once daily for 52 weeks. The primary end point was virologic response (defined by the absence of serum hepatitis B e antigen and serum HBV DNA) at week 52 of treatment. RESULTS: Of the 403 children screened, 191 were randomly assigned to receive lamivudine and 97 to receive placebo. The rate of virologic response at week 52 was higher among children who received lamivudine than among those who received placebo (23 percent vs. 13 percent, P=0.04). Lamivudine therapy was well tolerated and was also associated with higher rates of seroconversion from hepatitis B e antigen to hepatitis B e antibody, normalization of alanine aminotransferase levels, and suppression of HBV DNA. CONCLUSIONS: In children with chronic hepatitis B, 52 weeks of treatment with lamivudine was associated with a significantly higher rate of virologic response than was placebo. PMID: 12037150 [PubMed - indexed for MEDLINE

Pervasive and intelligent decision support in Intensive Medicine – the complete picture

Series : Lecture notes in computer science (LNCS), vol. 8649In the Intensive Care Units (ICU) it is notorious the high number of data sources available. This situation brings more complexity to the way of how a professional makes a decision based on information provided by those data sources. Normally, the decisions are based on empirical knowledge and common sense. Often, they don’t make use of the information provided by the ICU data sources, due to the difficulty in understanding them. To overcome these constraints an integrated and pervasive system called INTCare has been deployed. This paper is focused in presenting the system architecture and the knowledge obtained by each one of the decision modules: Patient Vital Signs, Critical Events, ICU Medical Scores and Ensemble Data Mining. This system is able to make hourly predictions in terms of organ failure and outcome. High values of sensitivity where reached, e.g. 97.95% for the cardiovascular system, 99.77% for the outcome. In addition, the system is prepared for tracking patients’ critical events and for evaluating medical scores automatically and in real-time.(undefined

Annual Research Review: interparental conflict and youth psychopathology: an evidence review and practice focused update

The quality of the interparental relationship is recognized as an important influence on child and adolescent psychopathology. Historically, clinically-oriented research on this topic has focused on the impacts of parental divorce and domestic violence as primary interparental relationship influences on child outcomes, to the relative neglect of dimensional or qualitative features of the couple/interparental relationship for youth (child and adolescent) psychopathology. Recent research has highlighted that children are affected by attributes of interparental conflict, specifically how parents express and manage conflicts in their relationship, across a continuum of expressed severity and negativity – ranging from silence to violence. Further, new evidence highlights that children’s emotional, behavioral, social, academic outcomes and future interpersonal relationships are adversely affected by conflict between parents/carers whether adults are living together or not (i.e. married or separated), or where children are or are not genetically related to their rearing parents (e.g. adoption). We review evidence and present an integrated theoretical model, highlighting how children are affected by interparental conflict and what this evidence base means for effective intervention and prevention program development, as well as the development of possible cost-benefit models. Additionally, we review policy implications of this research and highlight some very recent examples of UK-based policy focusing on addressing the interparental relationship and its impact on youth psychopathology

Bimodal Expansion of the Lymphatic Vessels Is Regulated by the Sequential Expression of IL-7 and Lymphotoxin α1β2 in Newly Formed Tertiary Lymphoid Structures.

Lymphangiogenesis associated with tertiary lymphoid structure (TLS) has been reported in numerous studies. However, the kinetics and dynamic changes occurring to the lymphatic vascular network during TLS development have not been studied. Using a viral-induced, resolving model of TLS formation in the salivary glands of adult mice we demonstrate that the expansion of the lymphatic vascular network is tightly regulated. Lymphatic vessel expansion occurs in two distinct phases. The first wave of expansion is dependent on IL-7. The second phase, responsible for leukocyte exit from the glands, is regulated by lymphotoxin (LT)βR signaling. These findings, while highlighting the tight regulation of the lymphatic response to inflammation, suggest that targeting the LTα1β2/LTβR pathway in TLS-associated pathologies might impair a natural proresolving mechanism for lymphocyte exit from the tissues and account for the failure of therapeutic strategies that target these molecules in diseases such as rheumatoid arthritis

Spatial Periodicity of Galaxy Number Counts, CMB Anisotropy, and SNIa Hubble Diagram Based on the Universe Accompanied by a Non-Minimally Coupled Scalar Field

We have succeeded in establishing a cosmological model with a non-minimally coupled scalar field $\phi$ that can account not only for the spatial periodicity or the {\it picket-fence structure} exhibited by the galaxy $N$-$z$ relation of the 2dF survey but also for the spatial power spectrum of the cosmic microwave background radiation (CMB) temperature anisotropy observed by the WMAP satellite. The Hubble diagram of our model also compares well with the observation of Type Ia supernovae. The scalar field of our model universe starts from an extremely small value at around the nucleosynthesis epoch, remains in that state for sufficiently long periods, allowing sufficient time for the CMB temperature anisotropy to form, and then starts to grow in magnitude at the redshift $z$ of $\sim 1$, followed by a damping oscillation which is required to reproduce the observed picket-fence structure of the $N$-$z$ relation. To realize such behavior of the scalar field, we have found it necessary to introduce a new form of potential $V(\phi)\propto \phi^2\exp(-q\phi^2)$, with $q$ being a constant. Through this parameter $q$, we can control the epoch at which the scalar field starts growing.Comment: 19 pages, 18 figures, Accepted for publication in Astrophysics & Space Scienc