Presenting evidence-based health information for people with multiple sclerosis : the IN-DEEP project protocol

Background - Increasingly, evidence-based health information, in particular evidence from systematic reviews, is being made available to lay audiences, in addition to health professionals. Research efforts have focused on different formats for the lay presentation of health information. However, there is a paucity of data on how patients integrate evidence-based health information with other factors such as their preferences for information and experiences with information-seeking. The aim of this project is to explore how people with multiple sclerosis (MS) integrate health information with their needs, experiences, preferences and values and how these factors can be incorporated into an online resource of evidence-based health information provision for people with MS and their families.Methods - This project is an Australian-Italian collaboration between researchers, MS societies and people with MS. Using a four-stage mixed methods design, a model will be developed for presenting evidence-based health information on the Internet for people with MS and their families. This evidence-based health information will draw upon systematic reviews of MS interventions from The Cochrane Library. Each stage of the project will build on the last. After conducting focus groups with people with MS and their family members (Stage 1), we will develop a model for summarising and presenting Cochrane MS reviews that is integrated with supporting information to aid understanding and decision making. This will be reviewed and finalised with people with MS, family members, health professionals and MS Society staff (Stage 2), before being uploaded to the Internet and evaluated (Stages 3 and 4).Discussion - This project aims to produce accessible and meaningful evidence-based health information about MS for use in the varied decision making and management situations people encounter in everyday life. It is expected that the findings will be relevant to broader efforts to provide evidence-based health information for patients and the general public. The international collaboration also permits exploration of cultural differences that could inform international practice.<br /

Comparison of routes for achieving parenteral access with a focus on the management of patients with Ebola virus disease.

Dehydration is an important cause of death in patients with Ebola virus disease (EVD). Parenteral fluids are often required in patients with fluid requirements in excess of their oral intake. The peripheral intravenous route is the most commonly used method of parenteral access, but inserting and maintaining an intravenous line can be challenging in the context of EVD. Therefore it is important to consider the advantages and disadvantages of different routes for achieving parenteral access (e.g. intravenous, intraosseous, subcutaneous and intraperitoneal). To compare the reliability, ease of use and speed of insertion of different parenteral access methods. We ran the search on 17 November 2014. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R) In-Process &amp; Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE(R) and Ovid OLDMEDLINE(R), Embase Classic + Embase (OvidSP), CINAHL (EBSCOhost), clinicaltrials.gov and screened reference lists. Randomised controlled trials comparing different parenteral routes for the infusion of fluids or medication. Two review authors examined the titles and abstracts of records obtained by searching the electronic databases to determine eligibility. Two review authors extracted data from the included trials and assessed the risk of bias. Outcome measures of interest were success of insertion; time required for insertion; number of insertion attempts; number of dislodgements; time period with functional access; local site reactions; clinicians' perception of ease of administration; needlestick injury to healthcare workers; patients' discomfort; and mortality. For trials involving the administration of fluids we also collected data on the volume of fluid infused, changes in serum electrolytes and markers of renal function. We rated the quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach for the following outcomes: success of insertion, time required for insertion, number of dislodgements, volume of fluid infused and needlestick injuries. We included 17 trials involving 885 participants. Parenteral access was used to infuse fluids in 11 trials and medications in six trials. None of the trials involved patients with EVD. Intravenous and intraosseous access was compared in four trials; intravenous and subcutaneous access in 11; peripheral intravenous and intraperitoneal access in one; saphenous vein cutdown and intraosseous access in one; and intraperitoneal with subcutaneous access in one. All of the trials assessing the intravenous method involved peripheral intravenous access.We judged few trials to be at low risk of bias for any of the assessed domains.Compared to the intraosseous group, patients in the intravenous group were more likely to experience an insertion failure (risk ratio (RR) 3.89, 95% confidence interval (CI) 2.39 to 6.33; n = 242; GRADE rating: low). We did not pool data for time to insertion but estimates from the trials suggest that inserting intravenous access takes longer (GRADE rating: moderate). Clinicians judged the intravenous route to be easier to insert (RR 0.15, 95% CI 0.04 to 0.61; n = 182). A larger volume of fluids was infused via the intravenous route (GRADE rating: moderate). There was no evidence of a difference between the two routes for any other outcomes, including adverse events.Compared to the subcutaneous group, patients in the intravenous group were more likely to experience an insertion failure (RR 14.79, 95% CI 2.87 to 76.08; n = 238; GRADE rating: moderate) and dislodgement of the device (RR 3.78, 95% CI 1.16 to 12.34; n = 67; GRADE rating: low). Clinicians also judged the intravenous route as being more difficult to insert and patients were more likely to be agitated in the intravenous group. Patients in the intravenous group were more likely to develop a local infection and phlebitis, but were less likely to develop erythema, oedema or swelling than those in the subcutaneous group. A larger volume of fluids was infused into patients via the intravenous route. There was no evidence of a difference between the two routes for any other outcome.There were insufficient data to reliably determine if the risk of insertion failure differed between the saphenous vein cutdown (SVC) and intraosseous method (RR 4.00, 95% CI 0.51 to 31.13; GRADE rating: low). Insertion using SVC took longer than the intraosseous method (MD 219.60 seconds, 95% CI 135.44 to 303.76; GRADE rating: moderate). There were no data and therefore there was no evidence of a difference between the two routes for any other outcome.There were insufficient data to reliably determine the relative effects of intraperitoneal or central intravenous access relative to any other parenteral access method. There are several different ways of achieving parenteral access in patients who are unable meet their fluid requirements with oral intake alone. The quality of the evidence, as assessed using the GRADE criteria, is somewhat limited because of the lack of adequately powered trials at low risk of bias. However, we believe that there is sufficient evidence to draw the following conclusions: if peripheral intravenous access can be achieved easily, this allows infusion of larger volumes of fluid than other routes; but if this is not possible, the intraosseous and subcutaneous routes are viable alternatives. The subcutaneous route may be suitable for patients who are not severely dehydrated but in whom ongoing fluid losses cannot be met by oral intake.A film to accompany this review can be viewed here (http://youtu.be/ArVPzkf93ng)

Registration of ‘Hallam’ Wheat

‘Hallam’ (Reg. no. CV-983, PI 638790) is a hard red winter wheat (Triticum aestivum L.) cultivar developed cooperatively by the Nebraska Agricultural Experiment Station and the USDA-ARS and released in 2005 by the developing institutions. Hallam was released primarily for its superior adaptation to rainfed wheat production systems in eastern Nebraska. The name Hallam was chosen to honor Hallam, NE, a town and its people rebuilding after a tornado. Hallam was selected from the cross ‘Brule’ (Schmidt et al., 1983)/‘Bennett’ (Schmidt et al., 1981)//‘Niobrara’ (Baenziger et al., 1996) that was made in 1992. The F1 generation was grown in the greenhouse and the F2 to F3 generations were advanced using the bulk breeding method in the field at Mead, NE. In 1995, single F3:4 rows were planted for selection. Hallam was selected in the F4 and there was no further selection thereafter. Hallam was evaluated as NE98471 in Nebraska yield nurseries starting in 1999, in the Northern Regional Performance Nursery in 2001 and 2002, and in Nebraska cultivar performance trials from 2002 to 2004. In the Nebraska cultivar performance trials, it was narrowly adapted and performs best in eastern Nebraska. The average Nebraska rainfed yield of Hallam of 4110 kg ha-1 (41 environments from 2002 to 2004) was greater than the yields of ‘Wahoo’ (4030 kg ha-1; Baenziger et al., 2002), ‘Alliance’ (3880 kg ha-1; Baenziger et al., 1995), and ‘Harry’ (4000 kg ha-1; Baenziger et al., 2004b), but was lower than ‘Millennium’ (4180 kg ha-1; Baenziger et al., 2001) and ‘Wesley’ (4210 kg ha-1; Peterson et al., 2001). In its primary area of adaptation (eastern Nebraska), Hallam has yielded 4540 kg ha-1 (five environments), which was greater than Wesley (4150 kg ha-1), Millennium (4250 kg ha-1), Wahoo (3940 kg ha-1), and Alliance (3900 kg ha21). In the Northern Regional Performance Nursery, Hallam ranked 14th of 30 in 2001 (12 environments) and fourth of 25 entries in 2002 (13 environments) and averaged 100 kg ha-1 more grain yield than ‘Nekota’ (Haley et al., 1996). Hallam is not recommended for use in irrigated production systems where other wheat cultivars with superior performance, especially with better straw strength (described below), would be recommended. Other measurements of performance from comparison trials show that Hallam is moderately early in maturity (142 d after January 1, five environments), about 2.5 d and 1.2 d earlier flowering than Millennium and Wesley, respectively. Hallam is a semidwarf wheat cultivar. Hallam has a medium short coleoptile (46 mm), as expected for a semidwarf wheat cultivar, and is shorter than ‘Goodstreak’ (61 mm; Baenziger et al., 2004a) and slightly longer than semidwarf wheat cultivars such as Harry (36 mm). The mature plant height of Hallam (86 cm) is 3 cm shorter than Millennium and 6 cm taller than Wesley (41 environments). Hallam has moderate straw strength (45% lodged), similar to Wahoo (46% lodged), but worse than Wesley (34% lodged) in those environments (3) where severe lodging was found. The winter hardiness of Hallamis good to very good, similar to ‘Abilene’ (PI 511307) and comparable to other winter wheat cultivars adapted and commonly grown in Nebraska

Presenting evidence-based health information for people with multiple sclerosis: the IN-DEEP project protocol.

BACKGROUND: Increasingly, evidence-based health information, in particular evidence from systematic reviews, is being made available to lay audiences, in addition to health professionals. Research efforts have focused on different formats for the lay presentation of health information. However, there is a paucity of data on how patients integrate evidence-based health information with other factors such as their preferences for information and experiences with information-seeking. The aim of this project is to explore how people with multiple sclerosis (MS) integrate health information with their needs, experiences, preferences and values and how these factors can be incorporated into an online resource of evidence-based health information provision for people with MS and their families. METHODS: This project is an Australian-Italian collaboration between researchers, MS societies and people with MS. Using a four-stage mixed methods design, a model will be developed for presenting evidence-based health information on the Internet for people with MS and their families. This evidence-based health information will draw upon systematic reviews of MS interventions from The Cochrane Library. Each stage of the project will build on the last. After conducting focus groups with people with MS and their family members (Stage 1), we will develop a model for summarising and presenting Cochrane MS reviews that is integrated with supporting information to aid understanding and decision making. This will be reviewed and finalised with people with MS, family members, health professionals and MS Society staff (Stage 2), before being uploaded to the Internet and evaluated (Stages 3 and 4). DISCUSSION: This project aims to produce accessible and meaningful evidence-based health information about MS for use in the varied decision making and management situations people encounter in everyday life. It is expected that the findings will be relevant to broader efforts to provide evidence-based health information for patients and the general public. The international collaboration also permits exploration of cultural differences that could inform international practice

Registration of ‘Hallam’ Wheat

‘Hallam’ (Reg. no. CV-983, PI 638790) is a hard red winter wheat (Triticum aestivum L.) cultivar developed cooperatively by the Nebraska Agricultural Experiment Station and the USDA-ARS and released in 2005 by the developing institutions. Hallam was released primarily for its superior adaptation to rainfed wheat production systems in eastern Nebraska. The name Hallam was chosen to honor Hallam, NE, a town and its people rebuilding after a tornado. Hallam was selected from the cross ‘Brule’ (Schmidt et al., 1983)/‘Bennett’ (Schmidt et al., 1981)//‘Niobrara’ (Baenziger et al., 1996) that was made in 1992. The F1 generation was grown in the greenhouse and the F2 to F3 generations were advanced using the bulk breeding method in the field at Mead, NE. In 1995, single F3:4 rows were planted for selection. Hallam was selected in the F4 and there was no further selection thereafter. Hallam was evaluated as NE98471 in Nebraska yield nurseries starting in 1999, in the Northern Regional Performance Nursery in 2001 and 2002, and in Nebraska cultivar performance trials from 2002 to 2004. In the Nebraska cultivar performance trials, it was narrowly adapted and performs best in eastern Nebraska. The average Nebraska rainfed yield of Hallam of 4110 kg ha-1 (41 environments from 2002 to 2004) was greater than the yields of ‘Wahoo’ (4030 kg ha-1; Baenziger et al., 2002), ‘Alliance’ (3880 kg ha-1; Baenziger et al., 1995), and ‘Harry’ (4000 kg ha-1; Baenziger et al., 2004b), but was lower than ‘Millennium’ (4180 kg ha-1; Baenziger et al., 2001) and ‘Wesley’ (4210 kg ha-1; Peterson et al., 2001). In its primary area of adaptation (eastern Nebraska), Hallam has yielded 4540 kg ha-1 (five environments), which was greater than Wesley (4150 kg ha-1), Millennium (4250 kg ha-1), Wahoo (3940 kg ha-1), and Alliance (3900 kg ha21). In the Northern Regional Performance Nursery, Hallam ranked 14th of 30 in 2001 (12 environments) and fourth of 25 entries in 2002 (13 environments) and averaged 100 kg ha-1 more grain yield than ‘Nekota’ (Haley et al., 1996). Hallam is not recommended for use in irrigated production systems where other wheat cultivars with superior performance, especially with better straw strength (described below), would be recommended. Other measurements of performance from comparison trials show that Hallam is moderately early in maturity (142 d after January 1, five environments), about 2.5 d and 1.2 d earlier flowering than Millennium and Wesley, respectively. Hallam is a semidwarf wheat cultivar. Hallam has a medium short coleoptile (46 mm), as expected for a semidwarf wheat cultivar, and is shorter than ‘Goodstreak’ (61 mm; Baenziger et al., 2004a) and slightly longer than semidwarf wheat cultivars such as Harry (36 mm). The mature plant height of Hallam (86 cm) is 3 cm shorter than Millennium and 6 cm taller than Wesley (41 environments). Hallam has moderate straw strength (45% lodged), similar to Wahoo (46% lodged), but worse than Wesley (34% lodged) in those environments (3) where severe lodging was found. The winter hardiness of Hallamis good to very good, similar to ‘Abilene’ (PI 511307) and comparable to other winter wheat cultivars adapted and commonly grown in Nebraska

‘O sibling, where art thou?’ – a review of avian sibling recognition with respect to the mammalian literature

Avian literature on sibling recognition is rare compared to that developed by mammalian researchers. We compare avian and mammalian research on sibling recognition to identify why avian work is rare, how approaches differ and what avian and mammalian researchers can learn from each other. Three factors: (1) biological differences between birds and mammals, (2) conceptual biases and (3) practical constraints, appear to influence our current understanding. Avian research focuses on colonial species because sibling recognition is considered adaptive where ‘mixing potential’ of dependent young is high; research on a wider range of species, breeding systems and ecological conditions is now needed. Studies of acoustic recognition cues dominate avian literature; other types of cues (e.g. visual, olfactory) deserve further attention. The effect of gender on avian sibling recognition has yet to be investigated; mammalian work shows that gender can have important influences. Most importantly, many researchers assume that birds recognise siblings through ‘direct familiarisation’ (commonly known as associative learning or familiarity); future experiments should also incorporate tests for ‘indirect familiarisation’ (commonly known as phenotype matching). If direct familiarisation proves crucial, avian research should investigate how periods of separation influence sibling discrimination. Mammalian researchers typically interpret sibling recognition in broad functional terms (nepotism, optimal outbreeding); some avian researchers more successfully identify specific and testable adaptive explanations, with greater relevance to natural contexts. We end by reporting exciting discoveries from recent studies of avian sibling recognition that inspire further interest in this topic

Do Zebra Finch Parents Fail to Recognise Their Own Offspring?

Individual recognition systems require the sender to be individually distinctive and the receiver to be able to perceive differences between individuals and react accordingly. Many studies have demonstrated that acoustic signals of almost any species contain individualized information. However, fewer studies have tested experimentally if those signals are used for individual recognition by potential receivers. While laboratory studies using zebra finches have shown that fledglings recognize their parents by their “distance call”, mutual recognition using the same call type has not been demonstrated yet. In a laboratory study with zebra finches, we first quantified between-individual acoustic variation in distance calls of fledglings. In a second step, we tested recognition of fledgling calls by parents using playback experiments. With a discriminant function analysis, we show that individuals are highly distinctive and most measured parameters show very high potential to encode for individuality. The response pattern of zebra finch parents shows that they do react to calls of fledglings, however they do not distinguish between own and unfamiliar offspring, despite individual distinctiveness. This finding is interesting in light of the observation of a high percentage of misdirected feedings in our communal breeding aviaries. Our results demonstrate the importance of adopting a receiver's perspective and suggest that variation in fledgling contact calls might not be used in individual recognition of offspring

A search for resonant production of ttˉt\bar{t} pairs in $4.8\ \rm{fb}^{-1}ofintegratedluminosityof of integrated luminosity of p\bar{p}collisionsat collisions at \sqrt{s}=1.96\ \rm{TeV}$

We search for resonant production of tt pairs in 4.8 fb^{-1} integrated luminosity of ppbar collision data at sqrt{s}=1.96 TeV in the lepton+jets decay channel, where one top quark decays leptonically and the other hadronically. A matrix element reconstruction technique is used; for each event a probability density function (pdf) of the ttbar candidate invariant mass is sampled. These pdfs are used to construct a likelihood function, whereby the cross section for resonant ttbar production is estimated, given a hypothetical resonance mass and width. The data indicate no evidence of resonant production of ttbar pairs. A benchmark model of leptophobic Z \rightarrow ttbar is excluded with m_{Z'} < 900 GeV at 95% confidence level.Comment: accepted for publication in Physical Review D Sep 21, 201

Evidence for t\bar{t}\gamma Production and Measurement of \sigma_t\bar{t}\gamma / \sigma_t\bar{t}

Using data corresponding to 6.0/fb of ppbar collisions at sqrt(s) = 1.96 TeV collected by the CDF II detector, we present a cross section measurement of top-quark pair production with an additional radiated photon. The events are selected by looking for a lepton, a photon, significant transverse momentum imbalance, large total transverse energy, and three or more jets, with at least one identified as containing a b quark. The ttbar+photon sample requires the photon to have 10 GeV or more of transverse energy, and to be in the central region. Using an event selection optimized for the ttbar+photon candidate sample we measure the production cross section of, and the ratio of cross sections of the two samples. Control samples in the dilepton+photon and lepton+photon+\met, channels are constructed to aid in decay product identification and background measurements. We observe 30 ttbar+photon candidate events compared to the standard model expectation of 26.9 +/- 3.4 events. We measure the ttbar+photon cross section to be 0.18+0.08 pb, and the ratio of the cross section of ttbar+photon to ttbar to be 0.024 +/- 0.009. Assuming no ttbar+photon production, we observe a probability of 0.0015 of the background events alone producing 30 events or more, corresponding to 3.0 standard deviations.Comment: 9 pages, 3 figure

Measurements of branching fraction ratios and CP-asymmetries in suppressed B^- -> D(-> K^+ pi^-)K^- and B^- -> D(-> K^+ pi^-)pi^- decays

We report the first reconstruction in hadron collisions of the suppressed decays B^- -> D(-> K^+ pi^-)K^- and B^- -> D(-> K^+ pi^-)pi^-, sensitive to the CKM phase gamma, using data from 7 fb^-1 of integrated luminosity collected by the CDF II detector at the Tevatron collider. We reconstruct a signal for the B^- -> D(-> K^+ pi^-)K^- suppressed mode with a significance of 3.2 standard deviations, and measure the ratios of the suppressed to favored branching fractions R(K) = [22.0 \pm 8.6(stat)\pm 2.6(syst)]\times 10^-3, R^+(K) = [42.6\pm 13.7(stat)\pm 2.8(syst)]\times 10^-3, R^-(K)= [3.8\pm 10.3(stat)\pm 2.7(syst]\times 10^-3, as well as the direct CP-violating asymmetry A(K) = -0.82\pm 0.44(stat)\pm 0.09(syst) of this mode. Corresponding quantities for B^- -> D(-> K^+ pi^-)pi^- decay are also reported.Comment: 8 pages, 1 figure, accepted by Phys.Rev.D Rapid Communications for Publicatio