How to assess the external validity of therapeutic trials: a conceptual approach

Background External validity of study results is an important issue from a clinical point of view. From a methodological point of view, however, the concept of external validity is more complex than it seems to be at first glance. Methods Methodological review to address the concept of external validity. Results External validity refers to the question whether results are generalizable to persons other than the population in the original study. The only formal way to establish the external validity would be to repeat the study for that specific target population. We propose a three-way approach for assessing the external validity for specified target populations. (i) The study population might not be representative for the eligibility criteria that were intended. It should be addressed whether the study population differs from the intended source population with respect to characteristics that influence outcome. (ii) The target population will, by definition, differ from the study population with respect to geographical, temporal and ethnical conditions. Pondering external validity means asking the question whether these differences may influence study results. (iii) It should be assessed whether the study's conclusions can be generalized to target populations that do not meet all the eligibility criteria. Conclusion Judging the external validity of study results cannot be done by applying given eligibility criteria to a single target population. Rather, it is a complex reflection in which prior knowledge, statistical considerations, biological plausibility and eligibility criteria all have plac

A two-level approach to automated conformance testing of VHDL designs

For manufacturers of consumer electronics, conformance testing of embedded software is a vital issue. To improve performance, parts of this software are implemented in hardware, often designed in the Hardware Description Language VHDL. Conformance testing is a time consuming and error-prone process. Thus automating (parts of) this process is essential. There are many tools for test generation and for VHDL simulation. However, most test generation tools operate on a high level of abstraction and applying the generated tests to a VHDL design is a complicated task. For each specific case one can build a layer of dedicated circuitry and/or software that performs this task. It appears that the ad-hoc nature of this layer forms the bottleneck of the testing process. We propose a {em generic solution for bridging this gap: a generic layer of software dedicated to interface with VHDL implementations. It consists of a number of Von Neumann-like components that can be instantiated for each specific VHDL design. This paper reports on the construction of and some initial experiences with a concrete tool environment based on these principles

Optimizing training adaptations by manipulating glycogen

For decades, glycogen has been recognized as a storage form of glucose within the liver and muscles. Only recently has a greater role for glycogen as a regulator of metabolic signalling been suggested. Glycogen either directly or indirectly regulates a number of signalling proteins, including the adenosine-5\u27-phosphate- (AMP-) activated protein kinase (AMPK) and p38 mitogen-activated protein kinase (MAPK). AMPK and p38 MAPK play a significant role in controlling the expression and activity of the peroxisome proliferator activated receptor &gamma; coactivators (PGCs), respectively. The PGCs can directly increase muscle mitochondrial mass and endurance exercise performance. As low muscle glycogen is generally associated with greater activation of these pathways, the concept of training with low glycogen to maximize the physiological adaptations to endurance exercise is gaining acceptance in the scientific community. In this review, we evaluate the scientific basis for this philosophy and propose some practical applications of this philosophy for the general population as well as elite endurance athletes.<br /

Pioglitazone improves cardiac function and alters myocardial substrate metabolism without affecting cardiac triglyceride accumulation and high-energy phosphate metabolism in patients with well-controlled type 2 diabetes mellitus

0.001). CONCLUSIONS: In T2DM patients, pioglitazone was associated with improvement in some measures of left ventricular diastolic function, myocardial glucose uptake, and whole-body insulin sensitivity. The functional changes, however, were not associated with myocardial substrate and high-energy phosphate metabolis

The risk for breast cancer is not evidently increased in women with hyperprolactinemia

The question has been raised whether hyperprolactinemia in humans is associated with an excess risk for breast cancer. We aimed to assess the risk of breast cancer in a previously defined large cohort of patients treated for idiopathic hyperprolactinemia or prolactinomas. Based on the pattern of drug prescriptions we identified 11,314 subjects in the PHARMO network with at least one dispensing of dopamine agonists between 1996 and 2006. Of these, 1,607 subjects were considered to have dopamine agonist—treated hyperprolactinemia based on the prescribing pattern. For the present analysis, we included only women (n = 1,342). Patients with breast cancer were identified by hospital discharge codes. Data on breast cancer incidence in the Netherlands were derived from the Dutch cancer registry. Standardized mortality ratio (SMR) was the measure of outcome to assess the association between hyperprolactinemia and breast cancer. The 1,342 patients accounted for a total of 6,576 person years. Eight patients with breast cancer during follow-up were identified. Indirect standardization with incidence proportions from the general Dutch population revealed a 7.47 expected cases. The calculated SMR for breast cancer risk in patients treated hyperprolactinemia was 1.07 (95% confidence interval 0.50–2.03). In conclusion, there is no clear evidence for increased breast cancer risk in female patients treated for either idiopathic hyperprolactinemia or prolactinomas. The uncertainty about the exact risk that is due to the relatively low number of breast cancer cases, should be overcome by pooling results in a future meta-analysis

Impaired neonatal macrophage phagocytosis is not explained by overproduction of prostaglandin E2

<p>Abstract</p> <p>Background</p> <p>Neonates and young infants manifest increased susceptibility to bacterial, viral and fungal lung infections. Previous work has identified a role for eicosanoids in mediating host defense functions of macrophages. This study examines the relationship between alveolar macrophage (AM) host defense and production of lipid mediators during the neonatal period compared to adult AMs.</p> <p>Methods</p> <p>AMs were harvested from young (day 7 and day 14) and adult (~10 week) rats. The functionality of these cells was assessed by examining their ability to phagocytose opsonized targets, produce cytokines, eicosanoids and intracellular cAMP measured by enzyme immunoassays, and gene expression of proteins, enzymes and receptors essential for eicosanoid generation and phagocytosis measured by real time RT-PCR.</p> <p>Results</p> <p>AMs from young animals (day 7 and 14) were defective in their ability to phagocytose opsonized targets and produce tumor necrosis factor (TNF)- α. In addition, young AMs produce more prostaglandin (PG) E₂, a suppressor of host defense, and less leukotriene (LT) B₄, a promoter of host defense. Young AMs express higher levels of enzymes responsible for the production of PGE₂and LTB₄; however, there was no change in the expression of E prostanoid (EP) receptors or LT receptors. Despite the similar EP profiles, young AMs are more responsive to PGE₂as evidenced by their increased production of the important second messenger, cyclic AMP. In addition, young AMs express higher levels of PDE3B and lower levels of PDE4C compared to adult AMs. However, even though the young AMs produced a skewed eicosanoid profile, neither the inhibition of PGE₂by aspirin nor the addition of exogenous LTB₄rescued the defective opsonized phagocytosis. Examination of a receptor responsible for mediating opsonized phagocytosis showed a significant decrease in the gene expression levels of the Fcgamma receptor in young (day 7) AMs compared to adult AMs.</p> <p>Conclusion</p> <p>These results suggest that elevated production of PGE₂and decreased production of LTB₄do not contribute to impaired opsonized macrophage phagocytosis and highlight an important difference between young and adult AMs.</p

Solar cell process development in the european integrated project crystalclear

CrystalClear is a large integrated project funded by the European Commission that aims to drastically reduce the cost of crystalline Si PV modules, down to 1 Euro/Wp. Among the different subprojects, the one dealing with the development of advanced solar cells is relatively large (with 11 partners out of the 15 Crystal Clear partners taking part) and has a crucial role. The goal of the subproject is to develop cell design concepts and manufacturing processes that would enable a reduction in the order of 40% of the cell processing costs per Wp. In this paper, we give an overview of all the development work that has taken place in the CrystalClear solar cells subproject so far. World class results have been achieved, particularly on high efficiency cells on Si ribbons, and on industrial-type solar cells on very thin (120 (j.m thick) substrates

Dynamic coordination in brain and mind

Our goal here is to clarify the concept of 'dynamic coordination', and to note major issues that it raises for the cognitive neurosciences. In general, coordinating interactions are those that produce coherent and relevant overall patterns of activity, while preserving the essential individual identities and functions of the activities coordinated. 'Dynamic coordination' is the coordination that is created on a moment-by-moment basis so as to deal effectively with unpredictable aspects of the current situation. We distinguish different computational goals for dynamic coordination, and outline issues that arise concerning local cortical circuits, brain systems, cognition, and evolution. Our focus here is on dynamic coordination by widely distributed processes of self-organisation, but we also discuss the role of central executive processes