Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis

BACKGROUND: Treatment with glucocorticoids is associated with bone loss starting soon after therapy is initiated and an increased risk of fracture. METHODS: We performed a randomized, double-placebo, double-blind clinical trial of 18 months' duration among patients with a rheumatic disease who were starting glucocorticoids at a daily dose that was equivalent to at least 7.5 mg of prednisone. A total of 201 patients were assigned to receive either alendronate (10 mg) and a placebo capsule of alfacalcidol daily or alfacalcidol (1 mu g) and a placebo tablet of alendronate daily. The primary outcome was the change in bone mineral density of the lumbar spine in 18 months; the secondary outcome was the incidence of morphometric vertebral deformities. RESULTS: A total of 100 patients received alendronate, and 101 received alfacalcidol; 163 patients completed the study. The bone mineral density of the lumbar spine increased by 2.1 percent in the alendronate group (95 percent confidence interval, 1.1 to 3.1 percent) and decreased by 1.9 percent in the alfacalcidol group (95 percent confidence interval, -3.1 to -0.7 percent). At 18 months, the mean difference of change in bone mineral density between the two groups was 4.0 percent (95 percent confidence interval, 2.4 to 5.5 percent). Three patients in the alendronate group had a new vertebral deformity, as compared with eight patients in the alfacalcidol group (of whom three had symptomatic vertebral fractures) (hazard ratio, 0.4; 95 percent confidence interval, 0.1 to 1.4). CONCLUSIONS: During this 18-month trial in patients with rheumatic diseases, alendronate was more effective in the prevention of glucocorticoid-induced bone loss than was alfacalcidol

Plasma neurofilament light chain and amyloid-β are associated with the kynurenine pathway metabolites in preclinical Alzheimer's disease

BACKGROUND: Blood markers indicative of neurodegeneration (neurofilament light chain; NFL), Alzheimer's disease amyloid pathology (amyloid-β; Aβ), and neuroinflammation (kynurenine pathway; KP metabolites) have been investigated independently in neurodegenerative diseases. However, the association of these markers of neurodegeneration and AD pathology with neuroinflammation has not been investigated previously. Therefore, the current study examined whether NFL and Aβ correlate with KP metabolites in elderly individuals to provide insight on the association between blood indicators of neurodegeneration and neuroinflammation. METHODS: Correlations between KP metabolites, measured using liquid chromatography and gas chromatography coupled with mass spectrometry, and plasma NFL and Aβ concentrations, measured using single molecule array (Simoa) assays, were investigated in elderly individuals aged 65-90 years, with normal global cognition (Mini-Mental State Examination Score ≥ 26) from the Kerr Anglican Retirement Village Initiative in Ageing Health cohort. RESULTS: A positive correlation between NFL and the kynurenine to tryptophan ratio (K/T) reflecting indoleamine 2,3-dioxygenase activity was observed (r = .451, p < .0001). Positive correlations were also observed between NFL and kynurenine (r = .364, p < .0005), kynurenic acid (r = .384, p < .0001), 3-hydroxykynurenine (r = .246, p = .014), anthranilic acid (r = .311, p = .002), and quinolinic acid (r = .296, p = .003). Further, significant associations were observed between plasma Aβ40 and the K/T (r = .375, p < .0005), kynurenine (r = .374, p < .0005), kynurenic acid (r = .352, p < .0005), anthranilic acid (r = .381, p < .0005), and quinolinic acid (r = .352, p < .0005). Significant associations were also observed between plasma Aβ42 and the K/T ratio (r = .215, p = .034), kynurenic acid (r = .214, p = .035), anthranilic acid (r = .278, p = .006), and quinolinic acid (r = .224, p = .027) in the cohort. On stratifying participants based on their neocortical Aβ load (NAL) status, NFL correlated with KP metabolites irrespective of NAL status; however, associations between plasma Aβ and KP metabolites were only pronounced in individuals with high NAL while associations in individuals with low NAL were nearly absent. CONCLUSIONS: The current study shows that KP metabolite changes are associated with biomarker evidence of neurodegeneration. Additionally, the association between KP metabolites and plasma Aβ seems to be NAL status dependent. Finally, the current study suggests that an association between neurodegeneration and neuroinflammation manifests in the periphery, suggesting that preventing cytoskeleton cytotoxicity by KP metabolites may have therapeutic potential

DADOS-Survey: an open-source application for CHERRIES-compliant Web surveys

BACKGROUND: The Internet has been increasingly utilized in biomedical research. From online searching for literature to data sharing, the Internet has emerged as a primary means of research for many physicians and scientists. As a result, Web-based surveys have been employed as an alternative to traditional, paper-based surveys. We describe DADOS-Survey, an open-source Web-survey application developed at our institution that, to the best of our knowledge, is the first to be compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). DADOS-Survey was designed with usability as a priority, allowing investigators to design and execute their own studies with minimal technical difficulties in doing so. RESULTS: To date, DADOS-Survey has been successfully implemented in five Institutional Review Board-approved studies conducted by various departments within our academic center. Each of these studies employed a Web-survey design as their primary methodology. Our initial experience indicates that DADOS-Survey has been used with relative ease by each of the investigators and survey recipients. This has been further demonstrated through formal and field usability testing, during which time suggestions for improvement were incorporated into the software design. CONCLUSION: DADOS-Survey has the potential to have an important role in the future direction of Web-survey administration in biomedical research. This CHERRIES-compliant application is tailored to the emerging requirements of quality data collection in medicine

First report of generalized face processing difficulties in möbius sequence.

Reverse simulation models of facial expression recognition suggest that we recognize the emotions of others by running implicit motor programmes responsible for the production of that expression. Previous work has tested this theory by examining facial expression recognition in participants with Möbius sequence, a condition characterized by congenital bilateral facial paralysis. However, a mixed pattern of findings has emerged, and it has not yet been tested whether these individuals can imagine facial expressions, a process also hypothesized to be underpinned by proprioceptive feedback from the face. We investigated this issue by examining expression recognition and imagery in six participants with Möbius sequence, and also carried out tests assessing facial identity and object recognition, as well as basic visual processing. While five of the six participants presented with expression recognition impairments, only one was impaired at the imagery of facial expressions. Further, five participants presented with other difficulties in the recognition of facial identity or objects, or in lower-level visual processing. We discuss the implications of our findings for the reverse simulation model, and suggest that facial identity recognition impairments may be more severe in the condition than has previously been noted

Liveable Open Public Space - From Flaneur to Cyborg

Open public spaces have always been key elements of the city. Now they are also crucial for mixed reality. It is the main carrier of urban life, place for socialization, where users rest, have fun and talk. Moreover, “Seeing others and being seen” is a condition of socialization. Intensity of life in public spaces provides qualities like safety, comfort and attractiveness. Furthermore, open public spaces represent a spatial framework for meetings and multileveled interactions, and should include virtual flows, stimulating merging of physical and digital reality. Aim of the chapter is to present a critical analysis of public open spaces, aspects of their social role and liveability. It will also suggest how new technologies, in a mixed reality world, may enhance design approaches and upgrade the relationship between a user and his surroundings. New technologies are necessary for obtaining physical/digital spaces, becoming playable and liveable which will encourage walking, cycling, standing and interacting. Hence, they will attract more citizens and visitors, assure a healthy environment, quality of life and sociability. Public space, acting as an open book of the history of the city and of its future, should play a new role, being a place of reference for the flaneur/cyborg citizen personal and social life. The key result is a framework for understanding the particular importance of cyberparks in contemporary urban life in order to better adapt technologies in the modern urban life needs

Evidence-Based Health Services Management for Nurse Leaders: An Intracampus Partnership and Curriculum

ABSTRACT OBJECTIVE: In 2008, the New York University Graduate School of Public Service and NYU Libraries faculty partnered to offer a credit course to prepare nurse managers in a graduate program to use the evidence-based paradigm as a framework for locating and filtering best quality evidence to support decision making in the workplace. METHODS: Using lecture, demonstration, hands-on exercises, online tutorials, and readings, the students gained a theoretical basis for framing answerable research questions and exploiting the structure of bibliographic databases to retrieve evidence for management challenges such as medication administration, patient safety, reducing nursing turnover, among many research topics focused on healthcare quality, cost, and access. Critically appraising the literature in the context of the evidence pyramid is introduced along with sources for both free and fee-based data, statistics, and government information. RESULTS: Nurse managers gained competence in navigating, citing, and communicating; they demonstrated an understanding of the evidence hierarchy, assessing methodological quality, and the social and ethical issues related to the provision, dissemination, and sharing of information. CONCLUSIONS: Nurse leaders, in their critical role in contemporary healthcare organizations, have a pressing need to locate evidence-based research. Information literacy embedded in a framework of evidence empowers nurse managers with strategies to retrieve research to support decision making and practice changes in the workplace. A credit course dedicated to an evidence-based approach to the profusion of available information provides a foundation for lifelong professional competence in the use of health services management research

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination

Food color is in the eye of the beholder: the role of human trichromatic vision in food evaluation

Non-human primates evaluate food quality based on brightness of red and green shades of color, with red signaling higher energy or greater protein content in fruits and leafs. Despite the strong association between food and other sensory modalities, humans, too, estimate critical food features, such as calorie content, from vision. Previous research primarily focused on the effects of color on taste/flavor identification and intensity judgments. However, whether evaluation of perceived calorie content and arousal in humans are biased by color has received comparatively less attention. In this study we showed that color content of food images predicts arousal and perceived calorie content reported when viewing food even when confounding variables were controlled for. Specifically, arousal positively co-varied with red-brightness, while green-brightness was negatively associated with arousal and perceived calorie content. This result holds for a large array of food comprising of natural food - where color likely predicts calorie content - and of transformed food where, instead, color is poorly diagnostic of energy content. Importantly, this pattern does not emerged with nonfood items. We conclude that in humans visual inspection of food is central to its evaluation and seems to partially engage the same basic system as non-human primates

Cue Integration in Categorical Tasks: Insights from Audio-Visual Speech Perception

Previous cue integration studies have examined continuous perceptual dimensions (e.g., size) and have shown that human cue integration is well described by a normative model in which cues are weighted in proportion to their sensory reliability, as estimated from single-cue performance. However, this normative model may not be applicable to categorical perceptual dimensions (e.g., phonemes). In tasks defined over categorical perceptual dimensions, optimal cue weights should depend not only on the sensory variance affecting the perception of each cue but also on the environmental variance inherent in each task-relevant category. Here, we present a computational and experimental investigation of cue integration in a categorical audio-visual (articulatory) speech perception task. Our results show that human performance during audio-visual phonemic labeling is qualitatively consistent with the behavior of a Bayes-optimal observer. Specifically, we show that the participants in our task are sensitive, on a trial-by-trial basis, to the sensory uncertainty associated with the auditory and visual cues, during phonemic categorization. In addition, we show that while sensory uncertainty is a significant factor in determining cue weights, it is not the only one and participants' performance is consistent with an optimal model in which environmental, within category variability also plays a role in determining cue weights. Furthermore, we show that in our task, the sensory variability affecting the visual modality during cue-combination is not well estimated from single-cue performance, but can be estimated from multi-cue performance. The findings and computational principles described here represent a principled first step towards characterizing the mechanisms underlying human cue integration in categorical tasks

A Normative Pragmatic Theory of Exhorting

The final publication is available at Springer via http://dx.doi.org/10.1007/s10503-018-9465-y.We submit a normative pragmatic theory of exhorting—an account of conceptually necessary and potentially efficacious components of a coherent strategy for securing a sympathetic hearing for efforts to urge and inspire addressees to act on high-minded principles. Based on a Gricean analysis of utterance-meaning, we argue that the concept of exhorting comprises making statements openly urging addressees to perform some high-minded, principled course of action; openly intending to inspire addressees to act on the principles; and intending that addressees’ recognition of the intentions to urge and inspire creates reasons for addressees to grant a sympathetic hearing to what the speaker has to say. We show that the theory accounts for the design of Abraham Lincoln’s Cooper Union address. By doing so we add to the inventory of reasons why social actors make arguments, continue a line of research showing the relationship of arguing to master speech acts, and show that making arguments can be an effective strategy for inspiring principled action