Treatments for spasticity and pain in multiple sclerosis: a systematic review

Objectives: To identify the drug treatments currently available for the management of spasticity and pain in multiple sclerosis (MS), and to evaluate their clinical and cost-effectiveness. Data sources: Electronic bibliographic databases, National Research Register, MRC Clinical Trials Register and the US National Institutes of Health Clinical Trials Register. Review methods: Systematic searches identified 15 interventions for the treatment of spasticity and 15 interventions for treatment of pain. The quality and outcomes of the studies were evaluated. Reviews of the treatment of spasticity and pain when due to other aetiologies were also sought. Results: There is limited evidence of the effectiveness of four oral drugs for spasticity: baclofen, dantrolene, diazepam and tizanidine. Tizanidine appears to be no more effective than comparator drugs such as baclofen and has a slightly different side-effects profile. Despite claims that it causes less muscle weakness, there was very little evidence that tizanidine performed any better in this respect than other drugs, although it is more expensive. The findings of this review are consistent with reviews of the same treatments for spasticity derived from other aetiologies. There is good evidence that both botulinum toxin (BT) and intrathecal baclofen are effective in reducing spasticity, and both are associated with functional benefit. However, they are invasive, and substantially more expensive. None of the studies included in the review of pain were designed specifically to evaluate the alleviation of pain in patients with MS and there was no consistency regarding the use of validated outcome measures. It was suggested that, although expensive, the use of intrathecal baclofen may be associated with significant savings in hospitalisation costs in relation to bed-bound patients who are at risk of developing pressure sores, thus enhancing its cost-effectiveness. No studies of cost-effectiveness were identified in the review of pain. There is evidence, albeit limited, of the clinical effectiveness of baclofen, dantrolene, diazepam, tizanidine, intrathecal baclofen and BT and of the potential cost-effectiveness of intrathecal baclofen in the treatment of spasticity in MS. Conclusions: Many of the interventions identified are not licensed for the alleviation of pain or spasticity in MS and the lack of evidence relating to their effectiveness may also limit their widespread use. Indeed, forthcoming information relating to the use of cannabinoids in MS may result in there being better evidence of the effectiveness of new treatments than of any of the currently used drugs. It may therefore be of value to carry out double-blind randomised controlled trials of interventions used in current practice, where outcomes could include functional benefit and impact on quality of life. Further research into the development and validation of outcomes measures for pain and spasticity may also be useful, as perhaps would cost–utility studies

Creating Honeypots to Prevent Online Child Exploitation

Honeypots have been a key tool in controlling and understanding digital crime for several decades. The tool has traditionally been deployed against actors who are attempting to hack into systems or as a discovery mechanism for new forms of malware. This paper presents a novel approach to using a honeypot architecture in conjunction with social networks to respond to non-technical digital crimes. The tool is presented within the context of Child Exploitation Material (CEM), and to support the goal of taking an educative approach to Internet users who are developing an interest in this material. The architecture that is presented in the paper includes multiple layers, including recruitment, obfuscation, and education. The approach does not aim to collect data to support punitive action, but to educate users, increasing their knowledge and awareness of the negative impacts of such material

Energy Analysis of the Texas Capitol Restoration

This paper presents the methodology and results of a detailed energy analysis of the Texas Capitol Restoration. The purpose of this analysis was two-fold: 1) to determine the projected energy cost savings of a series of design alternatives for the Capitol Restoration, and 2) to calibrate the simulation model of the Capitol in its prerestored condition (in September 1991) using monitored energy use data from the Texas LoanSTAR program. The Capitol in its proposed restored condition was simulated using the DOE-2 building energy analysis computer program with long-term Austin weather data to project the annual energy use, peak electric demand, and annual energy cost. Then a series of 13 energy efficient design altematives was simulated. The results were compared to those of the base case to determine the projected annual energy and energy cost savings for each measure, and for combinations of several of the measures. Finally, the paper documents the calibration of the DOE-2 model for the Capitol in its prerestored condition, using monitored hourly whole-building electric data (excluding heating and cooling energy)

Formation of a buried soft layer in SiC for compliant substrate by ion implantation

Radiation damage and its removal have been studied in ion implanted 6H-SiC by Rutherford backscattering/Channeling (RBS). They have implanted Ga and Ti at 800 C using doses of 1 {times} 10{sup 16} to 2 {times} 10{sup 17} cm{sup {minus}2}. The implanted samples have been subsequently annealed at 1,050 C, and then at 1,400 C for 30 sec to study the removal of damage produced during implantation. The energies of implanted species have been chosen to obtain 20--40 nm projected ranges to form a buried metallic or graphitic layer. No significant damage removal has been observed after 1,050 C anneal, however 1,400 C annealing of 40 and 120 keV Ga implanted samples (fluence 2 {times} 10{sup 16} cm{sup {minus}2}) resulted in significantly less damage as can be observed from RBS/Channeling data. In the case of Ti implanted samples annealing led to an appreciable increase in the channeled backscattering yield, which might be due to the formation of some new phase (e.g., TiSi or TiSi{sub 2}) and may be related to distortions of the existing lattice

Development of HVAC System Performance Criteria Using Factorial Design and DOE-2 Simulation

A new approach is described for the development of Heating, Ventilating, and Air-conditioning (HVAC) System Performance Criteria for the Texas Building Energy Design Standard. This approach integrates a design of experimental methodology and DOE-2 simulation to identify the effects of control parameters on HVAC system energy performance. Three new criteria - transport, plant, and system performance factors-are used as measures of system performance. The procedure has been applied to the development of criteria for a variable-air-volume (VAV) and a constant-air-volume (CAV) system in three Texas climates. The results show that the air distribution system pressure loss, cooling coil exit temperature set-pint, operation of an economizer, and use of dead band controls have significant effects on air transport energy use and total system performance. The selection of control strategies and set-points have a clear impact on energy use. There is also a great energy-saving potential of converting from a CAV to a VAV system