457 research outputs found
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
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
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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
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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
Evaluating Texas State University Energy Consumption According to Productivity
The Energy Utilization Index, energy
consumption per square foot of floor area, is the
most commonly used index of building energy
consumption. However, a building or facility exists
solely to support the activities of its occupants. Floor
area alone is not a complete measure of the amount
of service a facility provides. The energy
consumption of a service institution, such as a
university, could be evaluated according to its annual
level of service. However, the variety of services
delivered by an institution of higher education
cannot be measured by a single, readily available
number. Data Envelopment Analysis, a tool used
primarily in management science, can find
"benchmark" input consumption levels for
productive entities with multiple inputs and outputs.
It finds a consumption target for each form of energy
consumed by an institution, based on the actual
performance of comparable institutions. This
method is applicable to the energy consumption of
Texas state institutions of higher education
Development of Revised Energy Standards for Texas Buildings: Preliminary Results
In 1977, the State of Texas published a two-part
Energy Conservation Manual to aid designers,
builders, and contractors in the design of energy-efficient
state buildings. Under the sponsorship
of the Governor's Energy Management Center, the
Center for Energy Studies (CES) at The University
of Texas at Austin is revising and updating the
nonresidential building portion of the Energy
Conservation Manual.
The proposed revision is a Texas-specific
adaptation of ASHRAE Standard 90.1P ("Energy
Efficient Design of New Buildings Except Low-Rise
Residential Buildings"). These modifications
include editorial changes, such as deletion of
criteria that do not apply to Texas climates, as
well as improved envelope criteria and the
addition of HVAC system performance criteria.
This paper documents the approach taken in
the development of the revised Texas standards.
Preliminary results are presented for the new
envelope calculation procedures that will be
included in the compliance software. This
software will parallel that provided for the
envelope and lighting sections in the ASHRAE
Standard and will ultimately extend the standard
to include a performance-based approach for HVAC
systems and whole-building Energy Targets
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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
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