Problems in the reporting of acne clinical trials: a spot check from the 2009 Annual Evidence Update on Acne Vulgaris

In the course of producing the 2009 NHS Evidence - skin disorders Annual Evidence Update on Acne Vulgaris, 25 randomised controlled trials were examined. From these, at least 12 potentially serious problems of trial reporting were identified. Several trials concluded no effect of a treatment yet they were insufficiently powered to exclude potentially useful benefits. There were examples of duplicate publication and "salami publication", as well as two trials being combined and reported as one. In some cases, an incorrect "within-groups" statistical comparison was made and one trial report omitted original efficacy data and included only P values. Both of the non-inferiority studies examined failed to pre-specify a non-inferiority margin. Trials reported as "double-blind" compared treatments that were dissimilar in appearance or had differing adverse effect profiles. In one case an intention-to-treat analysis was not performed and there was a failure to account for all of the randomized participants. Trial results were made to sound more impressive by selective outcome reporting, emphasizing the statistical significance of treatment effects that were clinically insignificant, and by the use of larger-sounding odds ratios rather than rate ratios for common events. Most of the reporting problems could have been avoided by use of the CONSORT guidelines and prospective trial registration on a public clinical trials database

How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatolog

Thin-film hermeticity: A quantitative analysis of diamond-like carbon using variable angle spectroscopic ellipsometry

The purpose of this paper is twofold. First, we report on the successful application of variable angle spectroscopic ellipsometry to quantitative thin-film hermeticity evaluation. Secondly, it is shown that under a variety of film preparations and moisture introduction conditions water penetrates only a very thin diamondlike carbon (DLC) top surface-roughness region. Thus DLC is an excellent candidate for use as protective coatings in adverse chemical and aqueous environments

Graduation Rate Differences by Ethnicity/Race at Texas Community Colleges: A Statewide, Multiyear Examination

In this multiyear, statewide investigation, the degree to which differences were present in graduation rates between Black and White, Black and Hispanic, and Black and Asian students was addressed for the 2007-2008 academic year to the 2015-2016 academic years. Inferential statistical procedures revealed the presence of statistically significant differences for all 9 academic years. In all 9 years, Black students had statistically significantly lower graduation rates than White, Hispanic, and Asian students. Also identified were the Texas community colleges that had the highest and that had the lowest graduation rates of their Black students in the last two academic years. Implications of these findings and recommendations for future research were discussed

Adalimumab for Treating Moderate-to-Severe Hidradenitis Suppurativa: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the UK National Institute for Health and Care Excellence (NICE) invited the manufacturer of adalimumab (AbbVie) to submit evidence on the clinical effectiveness and cost effectiveness of adalimumab for the treatment of moderate-to-severe hidradenitis suppurativa (HS). The appraisal assessed adalimumab as monotherapy in adult patients with an inadequate response to conventional systemic HS therapy. The School of Health and Related Research Technology Appraisal Group was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology based on the company’s submission to NICE. The evidence was mainly derived from three randomised controlled trials comparing adalimumab with placebo in adults with moderate-to-severe HS. The clinical-effectiveness review found that significantly more patients achieved a clinical response in the adalimumab groups than in the control groups but that the treatment effect varied between trials and there was uncertainty regarding its impact on a range of other relevant outcomes as well as long-term efficacy. The company’s submitted Markov model assessed the incremental cost effectiveness of adalimumab versus standard care for the treatment of HS from the perspective of the UK NHS and Personal Social Services (PSS) over a lifetime horizon. The original submitted model, including a patient access scheme (PAS), suggested that the incremental cost-effectiveness ratio (ICER) for adalimumab versus standard care was expected to be £16,162 per quality-adjusted life-year (QALY) gained. Following a critique of the model, the ERG’s preferred base case, which corrected programming errors and structural problems surrounding discontinuation rules and incorporated a lower unit cost for HS surgery, resulted in a probabilistic ICER of £29,725 per QALY gained. Based on additional analyses undertaken by the company and the ERG following the publication of the appraisal consultation document (ACD), the Appraisal Committee concluded that the maximum possible ICER for adalimumab compared with supportive care was between £28,500 and £33,200 per QALY gained but was likely to be lower. The Appraisal Committee recommended adalimumab (with the PAS) for the treatment of active moderate-to-severe HS in adults whose disease has not responded to conventional systemic therapy

Testing robustness of CPUE standardization and inclusion of environmental variables with simulated longline catch datasets

Environmental variability changes the distribution, migratory patterns, and susceptibility to various fishing gears for highly migratory marine fish. These changes become especially problematic when they affect the indices of abundance (such as those based on catch-per-unit-effort: CPUE) used to assess the status of fish stocks. The use of simulated CPUE data sets with known values of underlying population trends has been recommended by ICCAT (International Commission for the Conservation of Atlantic Tunas) to test the robustness of CPUE standardization methods. A longline CPUE data simulator was developed to meet this objective and simulate fisheries data from a population with distinct habitat preferences. The simulation was used to test several statistical hypotheses regarding best practices for index standardization aimed at accurate estimation of population trends. Effort data from the US pelagic longline fleet was paired with a volume-weighted habitat suitability model for blue marlin (Makaira nigricans) to derive a simulated time series of blue marlin catch and effort from 1986 to 2015 with four different underlying population trends. The simulated CPUE data were provided to stock assessment scientists to determine if the underlying population abundance trend could accurately be detected with different methods of CPUE standardization that did or did not incorporate environmental data. While the analysts’ approach to the data and the modeling structure differed, the underlying population trends were captured, some more successfully than others. In general, the inclusion of environmental and habitat variables aided the standardization process. However, differences in approaches highlight the importance of how explanatory variables are categorized and the criteria for including those variables. A set of lessons learned from this study was developed as recommendations for best practices for CPUE standardization.FCT IF/00253/2014info:eu-repo/semantics/publishedVersio

Nature tourism and Irish film

This article provides a historical overview and reading of seminal Irish film from the perspective of nature tourism. Within Irish cultural studies, tourism is frequently equated with an overly romantic image of the island, which has been used to sell the country abroad. However, using notions like the tourist gaze and taking on board influential debates around space/place, one can posit a more progressive environmental vision of nature and landscape in our readings of film