Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department.

BACKGROUND: Asthma is a chronic respiratory condition characterised by airways inflammation, constriction of airway smooth muscle and structural alteration of the airways that is at least partially reversible. Exacerbations of asthma can be life threatening and place a significant burden on healthcare services. Various guidelines have been published to inform management personnel in the acute setting; several include the use of a single bolus of intravenous magnesium sulfate (IV MgSO4) in cases that do not respond to first-line treatment. However, the effectiveness of this approach remains unclear, particularly in less severe cases. OBJECTIVES: To assess the safety and efficacy of IV MgSO4 in adults treated for acute asthma in the emergency department. SEARCH METHODS: We identified trials from the Cochrane Airways Review Group Specialised Register (CAGR) up to 2 May 2014. We also searched www.ClinicalTrials.gov and reference lists of other reviews, and we contacted trial authors to ask for additional information. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adults treated in the emergency department (ED) for exacerbations of asthma if they compared any dose of IV MgSO4 with placebo. DATA COLLECTION AND ANALYSIS: All review authors screened titles and abstracts for inclusion, and at least two review authors independently extracted study characteristics, risk of bias and numerical data. Disagreements were resolved by consensus, and we contacted trial investigators to obtain missing information.We analysed dichotomous data as odds ratios using study participants as the unit of analysis, and we analysed continuous data as mean differences or standardised mean differences using fixed-effect models. We rated all outcomes using GRADE and presented results in Summary of findings table 1.We carried out subgroup analyses on the primary outcome for baseline severity of exacerbations and whether or not ipratropium bromide was given as a co-medication. Unpublished data and studies at high risk of bias for blinding were removed from the main analysis in sensitivity analyses. MAIN RESULTS: Fourteen studies met the inclusion criteria, randomly assigning 2313 people with acute asthma to the comparisons of interest in this review.Most studies were double-blinded trials comparing a single infusion of 1.2 g or 2 g IV MgSO4 over 15 to 30 minutes versus a matching placebo. Eleven were conducted at a single centre, and three were multi-centre trials. Participants in almost all of the studies had already been given at least oxygen, nebulised short-acting beta2-agonists and IV corticosteroids in the ED; in some studies, investigators also administered ipratropium bromide. Ten studies included only adults, and four included both adults and children; these were included because the mean age of participants was over 18 years.Intravenous MgSO4 reduced hospital admissions compared with placebo (odds ratio (OR) 0.75, 95% confidence interval (CI) 0.60 to 0.92; I(2) = 28%, P value 0.18; n = 972; high-quality evidence). In absolute terms, this odds ratio translates into a reduction of seven hospital admissions for every 100 adults treated with IV MgSO4 (95% CI two to 13 fewer). The test for subgroup differences revealed no statistical heterogeneity between the three severity subgroups (I(2) = 0%, P value 0.73) or between the four studies that administered nebulised ipratropium bromide as a co-medication and those that did not (I(2) = 0%, P value 0.82). Sensitivity analyses in which unpublished data and studies at high risk for blinding were removed from the primary analysis did not change conclusions.Within the secondary outcomes, high- and moderate-quality evidence across three spirometric indices suggests some improvement in lung function with IV MgSO4. No difference was found between IV MgSO4and placebo for most of the non-spirometric secondary outcomes, all of which were rated as low or moderate quality (intensive care admissions, ED treatment duration, length of hospital stay, readmission, respiration rate, systolic blood pressure).Adverse events were inconsistently reported and were not meta-analysed. The most commonly cited adverse events in the IV MgSO4 groups were flushing, fatigue, nausea and headache and hypotension (low blood pressure). AUTHORS' CONCLUSIONS: This review provides evidence that a single infusion of 1.2 g or 2 g IV MgSO4 over 15 to 30 minutes reduces hospital admissions and improves lung function in adults with acute asthma who have not responded sufficiently to oxygen, nebulised short-acting beta2-agonists and IV corticosteroids. Differences in the ways the trials were conducted made it difficult for the review authors to assess whether severity of the exacerbation or additional co-medications altered the treatment effect of IV MgSO4. Limited evidence was found for other measures of benefit and safety.Studies conducted in these populations should clearly define baseline severity parameters and systematically record adverse events. Studies recruiting participants with exacerbations of varying severity should consider subgrouping results on the basis of accepted severity classifications

Differentially Private Exponential Random Graphs

We propose methods to release and analyze synthetic graphs in order to protect privacy of individual relationships captured by the social network. Proposed techniques aim at fitting and estimating a wide class of exponential random graph models (ERGMs) in a differentially private manner, and thus offer rigorous privacy guarantees. More specifically, we use the randomized response mechanism to release networks under $\epsilon$-edge differential privacy. To maintain utility for statistical inference, treating the original graph as missing, we propose a way to use likelihood based inference and Markov chain Monte Carlo (MCMC) techniques to fit ERGMs to the produced synthetic networks. We demonstrate the usefulness of the proposed techniques on a real data example.Comment: minor edit

Visualising disease progression on multiple variables with vector plots and path plots.

BACKGROUND: It is often desirable to observe how a disease progresses over time in individual patients, rather than graphing group averages; and since multiple outcomes are typically recorded on each patient, it would be advantageous to visualise disease progression on multiple variables simultaneously. METHODS: A variety of vector plots and a path plot have been developed for this purpose, and data from a longitudinal Huntington's disease study are used to illustrate the utility of these graphical methods for exploratory data analysis. RESULTS: Initial and final values for three outcome variables can be easily visualised per patient, along with the change in these variables over time. In addition to the disease trajectory, the path individual patients take from initial to final observation can be traced. Categorical variables can be coded with different types of vectors or paths (e.g. different colours, line types, line thickness) and separate panels can be used to include further categorical or continuous variables, allowing clear visualisation of further information for each individual. In addition, summary statistics such as mean vectors, bivariate interquartile ranges and convex polygons can be included to assist in interpreting trajectories, comparing groups, and detecting multivariate outliers. CONCLUSION: Vector and path plots are useful graphical methods for exploratory data analysis when individual-level information on multiple variables over time is desired, and they have several advantages over plotting each variable separately.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

The ambiguous utility of psychometrics for the interpretative foundation of socially relevant avatars

Accepted for publication in Theory & PsychologyInternational audienceThe persisting debates that measurement in psychology elicits can be explained by the conflict between two aspiration types. One, the epistemologic aspiration, resting on the search for scientific truth, and two, the social aspiration, resting on the demonstration of a capacity to contribute to psychological assessment problems in particular. Psychometrics answer essentially to psychology's demand for social utility, leading to the quasi-exclusive attribution of importance to quantitative interpretation. For psychology to be considered an empirical science, it has to establish its capacity for the measurement of psychological phenomena, even if this means that it recognizes that these phenomena are essentially qualitative

"They think we're OK and we know we're not". A qualitative study of asylum seekers' access, knowledge and views to health care in the UK

<i>Background</i>: The provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally sensitive services requires us to understand the barriers facing asylum seekers and the facilitators that help them access health care. Here, we report on two linked studies exploring these issues, along with the health care needs and beliefs of asylum seekers living in the UK. <i>Methods</i>: Two qualitative methods were employed: focus groups facilitated by members of the asylum seeking community and interviews, either one-to-one or in a group, conducted through an interpreter. Analysis was facilitated using the Framework method. <i>Results</i>: Most asylum seekers were registered with a GP, facilitated for some by an Asylum Support nurse. Many experienced difficulty getting timely appointments with their doctor, especially for self-limiting symptoms that they felt could become more serious, especially in children. Most were positive about the health care they received, although some commented on the lack of continuity. However, there was surprise and disappointment at the length of waiting times both for hospital appointments and when attending accident and emergency departments. Most had attended a dentist, but usually only when there was a clinical need. The provision of interpreters in primary care was generally good, although there was a tension between interpreters translating verbatim and acting as patient advocates. Access to interpreters in other settings, e.g. in-patient hospital stays, was problematic. Barriers included the cost of over-the-counter medication, e.g. children's paracetamol; knowledge of out-of-hours medical care; and access to specialists in secondary care. Most respondents came from countries with no system of primary medical care, which impacted on their expectations of the UK system. <i>Conclusion</i>: Most asylum seekers were positive about their experiences of health care. However, we have identified issues regarding their understanding of how the UK system works, in particular the role of general practitioners and referral to hospital specialists. The provision of an Asylum Support nurse was clearly a facilitator to accessing primary medical care. Initiatives to increase their awareness and understanding of the UK system would be beneficial. Interpreting services also need to be developed, in particular their role in secondary care and the development of the role of interpreter as patient advocate

Coefficient of restitution for elastic disks

We calculate the coefficient of restitution, $\epsilon$, starting from a microscopic model of elastic disks. The theory is shown to agree with the approach of Hertz in the quasistatic limit, but predicts inelastic collisions for finite relative velocities of two approaching disks. The velocity dependence of $\epsilon$ is calculated numerically for a wide range of velocities. The coefficient of restitution furthermore depends on the elastic constants of the material via Poisson's number. The elastic vibrations absorb kinetic energy more effectively for materials with low values of the shear modulus.Comment: 25 pages, 12 Postscript figures, LaTex2

Gene and protein expression in response to different growth temperatures and oxygen availability in Burkholderia thailandensis.

Published onlineJournal ArticleResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from Public Library of Science via the DOI in this record.Burkholderia thailandensis, although normally avirulent for mammals, can infect macrophages in vitro and has occasionally been reported to cause pneumonia in humans. It is therefore used as a model organism for the human pathogen B. pseudomallei, to which it is closely related phylogenetically. We characterized the B. thailandensis clinical isolate CDC2721121 (BtCDC272) at the genome level and studied its response to environmental cues associated with human host colonization, namely, temperature and oxygen limitation. Effects of the different growth conditions on BtCDC272 were studied through whole genome transcription studies and analysis of proteins associated with the bacterial cell surface. We found that growth at 37°C, compared to 28°C, negatively affected cell motility and flagella production through a mechanism involving regulation of the flagellin-encoding fliC gene at the mRNA stability level. Growth in oxygen-limiting conditions, in contrast, stimulated various processes linked to virulence, such as lipopolysaccharide production and expression of genes encoding protein secretion systems. Consistent with these observations, BtCDC272 grown in oxygen limitation was more resistant to phagocytosis and strongly induced the production of inflammatory cytokines from murine macrophages. Our results suggest that, while temperature sensing is important for regulation of B. thailandensis cell motility, oxygen limitation has a deeper impact on its physiology and constitutes a crucial environmental signal for the production of virulence factors.This work was supported by Fondazione CARIPLO (Progetto Vaccini, contract number 2009–3577) and by Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR) (project FIRB RBLA039LSF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Impact of land use on the hydraulic properties of the topsoil in a small French catchment

The hydraulic properties of the topsoil control the partition of rainfall into infiltration and runoff at the soil surface. They must be characterized for distributed hydrological modelling. This study presents the results of a field campaign documenting topsoil hydraulic properties in a small French suburban catchment (7 km2) located near Lyon, France. Two types of infiltration tests were performed: single ring infiltration tests under positive head and tension disk infiltration using a mini-disk. Both categories were processed using the BEST Beerkan Estimation of Soil Transfer parameters- method to derive parameters describing the retention and hydraulic conductivity curves. Dry bulk density and particle size data were also sampled. Almost all the topsoils were found to belong to the sandy loam soil class. No significant differences in hydraulic properties were found in terms of pedologic units, but the results showed a high impact of land use on these properties. The lowest dry bulk density values were obtained in forested soils with the highest organic matter content. Permanent pasture soils showed intermediate values, whereas the highest values were encountered in cultivated lands. For saturated hydraulic conductivity, the highest values were found in broad leaved forests and small woods. The complementary use of tension disk and positive head infiltration tests highlighted a sharp increase of hydraulic conductivity between near saturation and saturated conditions, attributed to macroporosity effect. The ratio of median saturated hydraulic conductivity to median hydraulic conductivity at a pressure of -20 mm of water, was about 50. The study suggests that soil texture, such as used in most pedo-transfer functions, might not be sufficient to properly map the variability of soil hydraulic properties. Land use information should be considered in the parameterizations of topsoil within hydrological models to better represent in situ conditions, as illustrated in the paper

Demography and disorders of German Shepherd Dogs under primary veterinarycare in the UK

The German Shepherd Dog (GSD) has been widely used for a variety of working roles. However, concerns for the health and welfare of the GSD have been widely aired and there is evidence that breed numbers are now in decline in the UK. Accurate demographic and disorder data could assist with breeding and clinical prioritisation. The VetCompassTM Programme collects clinical data on dogs under primary veterinary care in the UK. This study included all VetCompassTM dogs under veterinary care during 2013. Demographic, mortality and clinical diagnosis data on GSDs were extracted and reported

Speed without fear: composable self-timed GaAs circuits

technical reportWe have designed a set of self-timed gallium arsenide building blocks that are suitable for composing into larger systems. Systems designed using these modules can be easier to design and modify than their globally clocked counterparts, while maintaining high performance. The modules are suitable for use in a translation systems that automatically translates an OCCAM program into a circuit netlist