Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes : randomised controlled trial

© 2013 Royal College of Obstetricians and Gynaecologists. Funded by Royal College of Obstetricians and Gynaecologists, London, UK; Health Research Council of New Zealand. Grant Number: RG 819/06 New Zealand Lottery Grant Board Health Services Research Unit, University of Aberdeen Chief Scientist Office of the Scottish Government Health DirectoratesPeer reviewedPostprin

Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice

WFMOS - Sounding the Dark Cosmos

Vast sound waves traveling through the relativistic plasma during the first million years of the universe imprint a preferred scale in the density of matter. We now have the ability to detect this characteristic fingerprint in the clustering of galaxies at various redshifts and use it to measure the acceleration of the expansion of the Universe. The Wide-Field Multi-Object Spectrograph (WFMOS) would use this test to shed significant light on the true nature of dark energy, the mysterious source of this cosmic acceleration. WFMOS would also revolutionise studies of the kinematics of the Milky Way and provide deep insights into the clustering of galaxies at redshifts up to z~4. In this article we discuss the recent progress in large galaxy redshift surveys and detail how WFMOS will help unravel the mystery of dark energy.Comment: 6 pages, pure pdf. An introduction to WFMOS and Baryon Acoustic Oscillations for a general audienc

Faecal incontinence persisting after childbirth : a 12 year longitudinal study

© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.Peer reviewedPostprin

Quaternionic and Poisson-Lie structures in 3d gravity: the cosmological constant as deformation parameter

Each of the local isometry groups arising in 3d gravity can be viewed as the group of unit (split) quaternions over a ring which depends on the cosmological constant. In this paper we explain and prove this statement, and use it as a unifying framework for studying Poisson structures associated with the local isometry groups. We show that, in all cases except for Euclidean signature with positive cosmological constant, the local isometry groups are equipped with the Poisson-Lie structure of a classical double. We calculate the dressing action of the factor groups on each other and find, amongst others, a simple and unified description of the symplectic leaves of SU(2) and SL(2,R). We also compute the Poisson structure on the dual Poisson-Lie groups of the local isometry groups and on their Heisenberg doubles; together, they determine the Poisson structure of the phase space of 3d gravity in the so-called combinatorial description.Comment: 34 pages, minor corrections, references adde

Patients' recollections of experiences in the intensive care unit may affect their quality of life

INTRODUCTION: We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL). METHODS: We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire. RESULTS: Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30). CONCLUSION: This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL

Extending the first-order post-Newtonian scheme in multiple systems to the second-order contributions to light propagation

In this paper, we extend the first-order post-Newtonian scheme in multiple systems presented by Damour-Soffel-Xu to the second-order contribution to light propagation without changing the virtueof the scheme on the linear partial differential equations of the potential and vector potential. The spatial components of the metric are extended to second order level both in a global coordinates ($q_{ij}/ c^4$) and a local coordinates ($Q_{ab}/ c^4$). The equations of $q_{ij}$ (or $Q_{ab}$) are obtained from the field equations.The relationship between $q_{ij}$ and $Q_{ab}$ are presented in this paper also. In special case of the solar system (isotropic condition is applied ($q_{ij} = \delta_{ij} q$)), we obtain the solution of $q$. Finally, a further extension of the second-order contributions in the parametrized post-Newtonian formalism is discussed.Comment: Latex2e; 6 pages PS fil

Super-ASTROD: Probing primordial gravitational waves and mapping the outer solar system

Super-ASTROD (Super Astrodynamical Space Test of Relativity using Optical Devices or ASTROD III) is a mission concept with 3-5 spacecraft in 5 AU orbits together with an Earth-Sun L1/L2 spacecraft ranging optically with one another to probe primordial gravitational-waves with frequencies 0.1 microHz - 1 mHz, to test fundamental laws of spacetime and to map the outer solar system. In this paper we address to its scientific goals, orbit and payload selection, and sensitivity to gravitational waves.Comment: 7 pages, 1 figure, presented to 7th International LISA Symposium, 16-20 June 2008, Barcelona; submitted to Classical and Quantum Gravity; presentation improve

Conveying Equipoise during Recruitment for Clinical Trials:Qualitative Synthesis of Clinicians’ Practices across Six Randomised Controlled Trials

<div><p>Background</p><p>Randomised controlled trials (RCTs) are essential for evidence-based medicine and increasingly rely on front-line clinicians to recruit eligible patients. Clinicians’ difficulties with negotiating equipoise is assumed to undermine recruitment, although these issues have not yet been empirically investigated in the context of observable events. We aimed to investigate how clinicians conveyed equipoise during RCT recruitment appointments across six RCTs, with a view to (i) identifying practices that supported or hindered equipoise communication and (ii) exploring how clinicians’ reported intentions compared with their actual practices.</p><p>Methods and Findings</p><p>Six pragmatic UK-based RCTs were purposefully selected to include several clinical specialties (e.g., oncology, surgery) and types of treatment comparison. The RCTs were all based in secondary-care hospitals (<i>n =</i> 16) around the UK. Clinicians recruiting to the RCTs were interviewed (<i>n =</i> 23) to understand their individual sense of equipoise about the RCT treatments and their intentions for communicating equipoise to patients. Appointments in which these clinicians presented the RCT to trial-eligible patients were audio-recorded (<i>n =</i> 105). The appointments were analysed using thematic and content analysis approaches to identify practices that supported or challenged equipoise communication. A sample of appointments was independently coded by three researchers to optimise reliability in reported findings. Clinicians and patients provided full written consent to be interviewed and have appointments audio-recorded.</p><p>Interviews revealed that clinicians’ sense of equipoise varied: although all were uncertain about which trial treatment was optimal, they expressed different levels of uncertainty, ranging from complete ambivalence to clear beliefs that one treatment was superior. Irrespective of their personal views, all clinicians intended to set their personal biases aside to convey trial treatments neutrally to patients (in accordance with existing evidence). However, equipoise was omitted or compromised in 48/105 (46%) of the recorded appointments. Three commonly recurring practices compromised equipoise communication across the RCTs, irrespective of clinical context. First, equipoise was overridden by clinicians offering treatment recommendations when patients appeared unsure how to proceed or when they asked for the clinician’s expert advice. Second, clinicians contradicted equipoise by presenting imbalanced descriptions of trial treatments that conflicted with scientific information stated in the RCT protocols. Third, equipoise was undermined by clinicians disclosing their personal opinions or predictions about trial outcomes, based on their intuition and experience. These broad practices were particularly demonstrated by clinicians who had indicated in interviews that they held less balanced views about trial treatments. A limitation of the study was that clinicians volunteering to take part in the research might have had a particular interest in improving their communication skills. However, the frequency of occurrence of equipoise issues across the RCTs suggests that the findings are likely to be reflective of clinical recruiters’ practices more widely.</p><p>Conclusions</p><p>Communicating equipoise is a challenging process that is easily disrupted. Clinicians’ personal views about trial treatments encroached on their ability to convey equipoise to patients. Clinicians should be encouraged to reflect on personal biases and be mindful of the common ways in which these can arise in their discussions with patients. Common pitfalls that recurred irrespective of RCT context indicate opportunities for specific training in communication skills that would be broadly applicable to a wide clinical audience.</p></div

ING116070: a study of the pharmacokinetics and antiviral activity of dolutegravir in cerebrospinal fluid in HIV-1-infected, antiretroviral therapy-naive subjects.

BackgroundDolutegravir (DTG), a once-daily, human immunodeficiency virus type 1 (HIV-1) integrase inhibitor, was evaluated for distribution and antiviral activity in cerebrospinal fluid (CSF).MethodsING116070 is an ongoing, single-arm, open-label, multicenter study in antiretroviral therapy-naive, HIV-1-infected adults. Subjects received DTG (50 mg) plus abacavir/lamivudine (600/300 mg) once daily. The CSF and plasma (total and unbound) DTG concentrations were measured at weeks 2 and 16. The HIV-1 RNA levels were measured in CSF at baseline and weeks 2 and 16 and in plasma at baseline and weeks 2, 4, 8, 12, and 16.ResultsThirteen white men enrolled in the study; 2 withdrew prematurely, 1 because of a non-drug-related serious adverse event (pharyngitis) and 1 because of lack of treatment efficacy. The median DTG concentrations in CSF were 18 ng/mL (range, 4-23 ng/mL) at week 2 and 13 ng/mL (4-18 ng/mL) at week 16. Ratios of DTG CSF to total plasma concentration were similar to the unbound fraction of DTG in plasma. Median changes from baseline in CSF (n = 11) and plasma (n = 12) HIV-1 RNA were -3.42 and -3.04 log10 copies/mL, respectively. Nine of 11 subjects (82%) had plasma and CSF HIV-1 RNA levels &lt;50 copies/mL and 10 of 11 (91%) had CSF HIV-1 RNA levels &lt;2 copies/mL at week 16.ConclusionsThe DTG concentrations in CSF were similar to unbound plasma concentrations and exceeded the in vitro 50% inhibitory concentration for wild-type HIV (0.2 ng/mL), suggesting that DTG achieves therapeutic concentrations in the central nervous system. The HIV-1 RNA reductions were similar in CSF and plasma. Clinical Trials Registration. NCT01499199