A cost-effectiveness analysis of teledietetics in short-, intermediate-, and long-term weight reduction

Objective To evaluate the effectiveness of teledietetics in weight loss for 24 weeks and the cost-effectiveness of weight loss between face-to-face and teledietetics services. Study setting The study was conducted at a community health center and a community dietetics clinic. Study design The study was a quasiexperimental design. Methods Fifty adults aged 20–50 with a BMI ≥23 participated in the study. The face-to-face (FD) group received 12 dietary counselling sessions and recorded their diet in a log book. The teledietetics (TD) group attended three group nutrition seminars and recorded their diet on a Web-based platform. Changes in variables were compared using an independent t-test. Direct and indirect costs were applied to compute cost-effectiveness ratios. Results At week 6, the FD group showed greater reductions in all variables than did the TD group. At week 12, the effects reversed. At week 24, the accumulated reductions in weight and fat in the TD group were significantly higher than those in the FD group (all at p < 0.0001). The observed direct costs for 1% weight loss and 1% fat loss were USD 28.24 and USD17.09, respectively. Conclusion A dietetic service delivered as a teledietetics model is more cost-effective than the face-to-face dietetics model in weight reduction.postprin

Semi-automatic tumor boundary detection in MR image sequences

The authors present a semi-automatic approach for the detection of tumor boundary in MR image sequences. An initial slice with an obvious tumor is selected from the image sequence. The tumor is roughly segmented using fuzzy c-means algorithm and its boundary can be further refined by region and contour deformation. For the rest of the slices, the initial plan applied for each slice is extracted from the resulting boundary of the previous slice. The tumor boundary is located using region and contour deformation. Performance of our approach is evaluated on the MR image sequence. Comparisons with manual tracing show the accuracy and effectiveness of our approach.published_or_final_versio

Tumor boundary extraction in multislice MR brain images using region and contour deformation

In this paper, we present a new approach for the extraction of brain tumor boundary in a series of 2D MR image slices. The shape and position of tumor in one slice could be assumed to be similar to that in its neighboring slices. Using this correlation between consecutive images, the initial plan applied for each slice is extracted from the resulting boundary of the previous slice. The tumor boundary is located using region and contour deformation, which tolerates a rough initial plan. Therefore, only one coarse manual initial plan is required for the whole series of MR image slices. Performance of our approach is evaluated on MR image set. Comparisons with manual tracing show the accuracy and effectiveness of our approach.published_or_final_versio

Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong

published_or_final_versio

Deliberate concealment

Purpose – Welwyn Hatfield Council v Secretary of State for Communities and Local Government [2009] EWHC 966 (Admin), Welwyn Hatfield Council v. Secretary of State for Communities and Local Government [2010] EWCA Civ 26 and Welwyn Hatfield Council v. Secretary of State for Communities and Local Government [2011] UKSC 15 (Beesley hereafter) and Fidler v. Secretary of State for Communities and Local Government [2010] EWHC 143 (Admin), Fidler v. Secretary of State for Communities and Local Government [2011] EWCA civ 1159 (Fidler hereafter) are two recent cases concerning deliberately concealed breaches of planning control. The defendants engaged in dishonest and misleading conduct, in an attempt to rely on a loophole within Section 171B of the Town and Country Planning Act 1990 (T&CPA). This study aims to critically analyse two solutions which were created to close the loophole; in addition, this study analyses various alternative remedies that have been suggested, and finally, whether the present law has been sufficient to remedy the situation. Design/methodology/approach – The T&CPA is a key piece of legislation regulating planning controls; Section 171A-C provides the time limits for taking enforcement action against a breach of planning control. To achieve the above purpose, an evaluation of those provisions will be undertaken in detail. Subsequently, this study will analyse two solutions which were created to close the loophole; firstly, the Supreme Court (SC) decision (Welwyn Hatfield Borough Council v. Secretary of State for Communities and Local Government [2011] UKSC 15) and, secondly, the governments’ decision to amend the T&CPA without awaiting the SC’s decision[1]. Findings – This research concludes that the government should have awaited the SC’s decision before amending statute to prohibit reliance upon the expiration of time where there is an element of deliberate concealment. Additionally, this study suggests that the statutory amendments were not required in light of the SC’s solution in Beesley. As a result of the governments’ ill-considered decision, uncertainty has permeated through the conveyancing process, causing ambiguity, delays and additional expense in transactions at a time when a precarious property market needs anything but uncertainty. Research limitations implications – The scope of this research is limited to deliberate concealment of breaches of planning control and the four-year enforcement period; whilst considering the consequences of the solutions proposed, this study does not provide a detailed overview of the planning system, but rather assumes prior knowledge. Originality/value – This study offers a unique assessment of the law relating to the deliberate concealment of planning breaches and offers a thorough criticism of the law with recommendations for reform. Additionally, a variety of alternative solutions are considered. Both legal academics, planning professionals and those interested in planning law will find the paper a thought-provoking digest

Genetic variation at mouse and human ribosomal DNA influences associated epigenetic states

Background Ribosomal DNA (rDNA) displays substantial inter-individual genetic variation in human and mouse. A systematic analysis of how this variation impacts epigenetic states and expression of the rDNA has thus far not been performed. Results Using a combination of long- and short-read sequencing, we establish that 45S rDNA units in the C57BL/6J mouse strain exist as distinct genetic haplotypes that influence the epigenetic state and transcriptional output of any given unit. DNA methylation dynamics at these haplotypes are dichotomous and life-stage specific: at one haplotype, the DNA methylation state is sensitive to the in utero environment, but refractory to post-weaning influences, whereas other haplotypes entropically gain DNA methylation during aging only. On the other hand, individual rDNA units in human show limited evidence of genetic haplotypes, and hence little discernible correlation between genetic and epigenetic states. However, in both species, adjacent units show similar epigenetic profiles, and the overall epigenetic state at rDNA is strongly positively correlated with the total rDNA copy number. Analysis of different mouse inbred strains reveals that in some strains, such as 129S1/SvImJ, the rDNA copy number is only approximately 150 copies per diploid genome and DNA methylation levels are < 5%. Conclusions Our work demonstrates that rDNA-associated genetic variation has a considerable influence on rDNA epigenetic state and consequently rRNA expression outcomes. In the future, it will be important to consider the impact of inter-individual rDNA (epi)genetic variation on mammalian phenotypes and diseases

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK

Predictive Value of POSSUM and ACPGBI Scoring in Mortality and Morbidity of Colorectal Resection: A Case–Control Study

Contains fulltext : 97239.pdf (publisher's version ) (Open Access)BACKGROUND: Preoperative risk prediction to assess mortality and morbidity may be helpful to surgical decision making. The aim of this study was to compare mortality and morbidity of colorectal resections performed in a tertiary referral center with mortality and morbidity as predicted with physiological and operative score for enumeration of mortality and morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), and colorectal POSSUM (CR-POSSUM). The second aim of this study was to analyze the accuracy of different POSSUM scores in surgery performed for malignancy, inflammatory bowel diseases, and diverticulitis. POSSUM scoring was also evaluated in colorectal resection in acute vs. elective setting. In procedures performed for malignancy, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) score was assessed in the same way for comparison. METHODS: POSSUM, P-POSSUM, and CR-POSSUM predictor equations for mortality were applied in a retrospective case-control study to 734 patients who had undergone colorectal resection. The total group was assessed first. Second, the predictive value of outcome after surgery was assessed for malignancy (n = 386), inflammatory bowel diseases (n = 113), diverticulitis (n = 91), and other indications, e.g., trauma, endometriosis, volvulus, or ischemia (n = 144). Third, all subgroups were assessed in relation to the setting in which surgery was performed: acute or elective. In patients with malignancy, the ACPGBI score was calculated as well. In all groups, receiver operating characteristic (ROC) curves were constructed. RESULTS: POSSUM, P-POSSUM, and CR-POSSUM have a significant predictive value for outcome after colorectal surgery. Within the total population as well as in all four subgroups, there is no difference in the area under the curve between the POSSUM, P-POSSUM, and CR-POSSUM scores. In the subgroup analysis, smallest areas under the ROC curve are seen in operations performed for malignancy, which is significantly worse than for diverticulitis and in operations performed for other indications. For elective procedures, P-POSSUM and CR-POSSUM predict outcome significantly worse in patients operated for carcinoma than in patients with diverticulitis. In acute surgical interventions, CR-POSSUM predicts mortality better in diverticulitis than in patients operated for other indications. The ACPGBI score has a larger area under the curve than any of the POSSUM scores. Morbidity as predicted by POSSUM is most accurate in procedures for diverticulitis and worst when the indication is malignancy. CONCLUSION: The POSSUM scores predict outcome significantly better than can be expected by chance alone. Regarding the indication for surgery, each POSSUM score predicts outcome in patients operated for diverticulitis or other indications more accurately than for malignancy. The ACPGBI score is found to be superior to the various POSSUM scores in patients who have (elective) resection of colorectal malignancy

A Novel Method to Adjust Efficacy Estimates for Uptake of Other Active Treatments in Long-Term Clinical Trials

BACKGROUND: When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials. METHODOLOGY/PRINCIPAL FINDINGS: We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction) (P = 0.16) and an 11% reduction in cardiovascular disease events (P = 0.04). After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06) and 15% (P = 0.008), respectively. CONCLUSIONS/SIGNIFICANCE: This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence-based estimates for other therapies, preserves comparisons between the randomized groups, and is applicable to other long-term trials. In the FIELD study example, the effects of fenofibrate on the risks of coronary heart disease and cardiovascular disease events were underestimated by up to one-third in the original analysis. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN64783481