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

Inelastic chaotic scattering on a Bose-Einstein condensate

We devise a microscopic scattering approach to probe the excitation spectrum of a Bose-Einstein condensate. We show that the experimentally accessible scattering cross section exhibits universal Ericson fluctuations, with characteristic properties rooted in the underlying classical field equations.Comment: 11 pages, 5 figure

Individual and combined impacts of carbon dioxide enrichment, heatwaves, flow velocity variability, and fine sediment deposition on stream invertebrate communities

Climate change and land‐use change are widely altering freshwater ecosystem functioning and there is an urgent need to understand how these broad stressor categories may interact in future. While much research has focused on mean temperature increases, climate change also involves increasing variability of both water temperature and flow regimes and increasing concentrations of atmospheric CO2, all with potential to alter stream invertebrate communities. Deposited fine sediment is a pervasive land‐use stressor with widespread impacts on stream invertebrates. Sedimentation may be managed at the catchment scale; thus, uncovering interactions with these three key climate stressors may assist mitigation of future threats. This is the first experiment to investigate the individual and combined effects of enriched CO2, heatwaves, flow velocity variability, and fine sediment on realistic stream invertebrate communities. Using 128 mesocosms simulating small stony‐bottomed streams in a 7‐week experiment, we manipulated dissolved CO2 (ambient; enriched), fine sediment (no sediment; 300 g dry sediment), temperature (ambient; two 7‐day heatwaves), and flow velocity (constant; variable). All treatments changed community composition. CO2 enrichment reduced abundances of Orthocladiinae and Chironominae and increased Copepoda abundance. Variable flow velocity had only positive effects on invertebrate abundances (7 of 13 common taxa and total abundance), in contrast to previous experiments showing negative impacts of reduced velocity. CO2 was implicated in most stressor interactions found, with CO2 × sediment interactions being most common. Communities forming under enriched CO2 conditions in sediment‐impacted mesocosms had ~20% fewer total invertebrates than those with either treatment alone. Copepoda abundances doubled in CO2‐enriched mesocosms without sediment, whereas no CO2 effect occurred in mesocosms with sediment. Our findings provide new insights into potential future impacts of climate change and land use in running freshwaters, in particular highlighting the potential for elevated CO2 to interact with fine sediment deposition in unpredictable ways

Cyanoacrylate Dermal Closure in Spine Surgery: Systematic Review and Pooled Analysis

Study Design: Systematic review. Objectives: Cyanoacrylate glue closure has been utilized for dermal closure in surgical incisions. Its safety and efficacy in spine surgery are not established. The authors perform a systematic review to determine the rate of surgical site infection (SSI), wound dehiscence, and wound erythema with cyanoacrylate dermal closure in spine surgery. Methods: A systematic review adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the PubMed/MEDLINE, EMBASE, and Cochrane databases on patients undergoing spine surgery with cyanoacrylate dermal closure. Pooled analysis was performed with stratification of patients according to spinal level and the presence/absence of instrumentation. Risk-of-bias and methodological quality was appraised using 17 prespecified criteria. Results: Five articles (1 retrospective cohort study, 4 cases series) with a total of 1282 patients were included. A total of 967 patients, all diagnosed with degenerative spine disease, were suitable for pooled analysis. In 290 patients who underwent anterior cervical discectomy and fusion, and in 23 patients with posterior cervical decompression (without instrumentation), there was 0% rate of SSI, wound dehiscence, and erythema. In 489 patients who underwent lumbar microdiscectomy, there was 0.41% rate of SSI, 0.20% rate of wound dehiscence, and 0.20% rate of wound erythema. In 165 lumbar laminectomy patients, there was a 1.82% rate of SSI, 0.61% rate of wound dehiscence, and 0% rate of wound erythema. Conclusion: Cyanoacrylate dermal closure for the aforementioned procedures is associated with low rates of wound complications (SSI, dehiscence, and erythema). Further studies should be performed, especially in nondegenerative surgery, instrumented thoracic and lumbar spine surgery

Evaporative-cooling potential for office buildings

This paper presents the results of both a performance and an economic assessment of the evaporative-cooling potential for office buildings in 11 US climate zones. Evaporative-cooling systems of the direct and combined direct/indirect type that are part of the heating, ventilating and air-conditioning (HVAC) system were evaluated. Thermal-storage strategies were not considered in this study. The DOE-2 building-energy-analysis computer program was used to simulate the evaporative-cooling performance of typical single-story and multistory office buildings. Performance results are presented as energy and peak demand reductions for each type of office building in each climate zone. Economic results are summarized as investment targets and aggregate/energy cost savings

Water-Resources Investigations Report 83-4075

From purpose and scope: The purpose of this report is to present an analysis of the stream-aquifer system of the Santa Fe River basin, including the quantity and quality of water available from each source and their interrelation. Much information is available in previously published reports, but the basin has not been previously evaluated as a hydrologic unit

Child sexual abuse material in child-centred institutions: situational crime prevention approaches

This paper focuses on the potential for child-centred institutions to use situational crime prevention (SCP) strategies to prevent or reduce child sexual abuse material (CSAM)1 offending as a distinct form of child sexual abuse (CSA). We discuss the failure of the Royal Commission into Institutional Responses to Child Sexual Abuse in Australia to address the potential for CSAM offending to occur in child-centred institutions. Our premise is that CSAM offending is markedly shaped by the situation in which it occurs, rather than by any pre-existing preparedness to offend sexually against children. In this context, SCP for CSAM offending must be considered as part of overall strategies to combat CSA in institutional settings. However, we acknowledge that effective implementation of SCP in this area is not straightforward. We consider some of the challenges in implementing SCP at an institutional level

ASHRAE's New Performance Measurement Protocols for Commercial Buildings

ASHRAE, CIBSE and USGBC are developing a standardized, consistent set of protocols to facilitate the comparison of the measured performance of buildings, especially those claimed to be green, sustainable, and/or high performance. Such protocols are needed because claims of high performance cannot be credible without such standardized protocols being applied consistently in the U.S. as well as internationally. The protocols will identify what is to be measured, how it is to be measured (instrumentation and spatial resolution), and how often it is to be measured. They will address both the use and reporting of the measured data, as well as appropriate benchmarks for each of the following characteristics: Energy Use (site, and source), Indoor Environmental Quality (IEQ)-Thermal Comfort, IEQ-Indoor Air Quality, IEQ-Lighting/ Daylighting Quality, IEQ-Acoustics and Water Use. The primary users of the protocols document will be building owners and facility managers, rating and labeling system developers, government officials, as well as architects and design engineers. To date, a scoping document has been developed, an extensive literature review has been performed (available on ASHRAE’s web site), and a committee formed to write the protocols, which are intended for publication in January 2009

Solar Energy Research Institute Validation Test House Site Handbook

The Validation Test House at the Solar Energy Research Institute in Golden, Colorado, is being used to collect performance data for analysis/design tool validation as part of the DOE Passive Solar Class A Performance Evaluation Program