Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening.

AimTo analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG).MethodsProspective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up.ResultsOf 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05).ConclusionsSG≤2 is not associated with worse outcomes in AIT or phaco-AIT

Collaborative study to evaluate a candidate World Health Organization international standard for chikungunya virus for nucleic acid amplification technique (NAT)-based assays

Collaborative Study Group - Portugal:Maria João Alves, Líbia Zé-Zé (National Institute of Health Dr. Ricardo Jorge, Center for Vectors and Infectious Diseases Research)This report describes the World Health Organization (WHO) project to develop an international standard (IS) for Chikungunya virus (CHIKV) RNA for use with nucleic acid amplification technique (NAT)-based assays. An international collaborative study was conducted to determine the potency of the candidate standard using a range of NAT-based assays for CHIKV, and to evaluate the suitability of the candidate for the calibration of secondary reference materials and the standardization of CHIKV viral load measurements. The candidate standard consisted of a heat inactivated CHIKV strain of the East/South/Central African genotype (ESCA), also known as the Indian Ocean Lineage, isolated from a patient returning from India to the United States in 20061 , diluted in human negative plasma. The lyophilized candidate preparation (Sample 1), the corresponding liquid-frozen bulk material (Sample 2) and three different clinical samples (Sample 3, Sample 4 and Sample 5) were included in the collaborative study. Twenty-five laboratories representing 14 countries participated in the study to evaluate the material using their routine CHIKV NAT assays. Twenty-four laboratories returned 31 data sets from 17 commercial assays and 14 in-house methods. Of these 31 methods, 11 were quantitative and 20 were qualitative. The results of the study indicate the suitability of the candidate material of the CHIKV strain of ESCA genotype (Sample 1) as the proposed 1st WHO IS for CHIKV. It is therefore proposed that the candidate material (PEI code 11785/16) is established as the 1st WHO IS for CHIKV RNA for NAT-based assays with an assigned potency of 2,500,000 International Units (IU)/mL when reconstituted in 0.5 mL of nuclease-free water. On-going studies for real-time and accelerated stability of the proposed IS indicate that the preparation is stable and suitable for long-term use under the proposed storage conditions.info:eu-repo/semantics/publishedVersio

Virological outcomes of second-line protease inhibitor-based treatment for human immunodeficiency virus type 1 in a high-prevalence rural South African setting: a competing-risks prospective cohort analysis

Background. Second-line antiretroviral therapy (ART) based on ritonavir-boosted protease inhibitors (bPIs) represents the only available option after first-line failure for the majority of individuals living with human immunodeficiency virus (HIV) worldwide. Maximizing their effectiveness is imperative. Methods. This cohort study was nested within the French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. We prospectively investigated risk factors for virological failure (VF) of bPI-based ART in the combined study arms. VF was defined by a plasma viral load >1000 copies/mL ≥6 months after initiating bPI-based ART. Cumulative incidence of VF was estimated and competing risk regression was used to derive the subdistribution hazard ratio (SHR) of the associations between VF and patient clinical and demographic factors, taking into account death and loss to follow-up. Results. One hundred one participants contributed 178.7 person-years of follow-up. Sixty-five percent were female; the median age was 37.4 years. Second-line ART regimens were based on ritonavir-boosted lopinavir, combined with zidovudine or tenofovir plus lamivudine or emtricitabine. The incidence of VF on second-line ART was 12.9 per 100 person-years (n = 23), and prevalence of VF at censoring was 17.8%. Thirteen of these 23 (56.5%) virologic failures resuppressed after a median of 8.0 months (interquartile range, 2.8-16.8 months) in this setting where viral load monitoring was available. Tuberculosis treatment was associated with VF (SHR, 11.50 [95% confidence interval, 3.92-33.74]; P < .001). Conclusions. Second-line VF was frequent in this setting. Resuppression occurred in more than half of failures, highlighting the value of viral load monitoring of second-line ART. Tuberculosis was associated with VF; therefore, novel approaches to optimize the effectiveness of PI-based ART in high-tuberculosis-burden settings are needed

Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men.

BackgroundKnowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.MethodsIn community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model.ResultsWe identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9).ConclusionsSeveral non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men

Cardiovascular Disease Mortality in Europeans in Relation to Fasting and 2-h Plasma Glucose Levels Within a Normoglycemic Range

OBJECTIVE - To study mortality in relation to fasting plasma glucose (FPG) and 2-h plasma glucose levels within the normoglycemic range

Managing the environmental impact of research

The environmental impact of research increasingly needs to be taken into account in design and execution. This makes good financial sense. However, it is especially in the research world as one of the key reasons for doing health research is to improve our knowledge to improve health. Specifically, doing research in a more sustainable way allows us to generate more knowledge with the same resource. Research not only needs to be done increasingly sustainably, but the content of the research needs to direct how we promote health and deliver healthcare in more sustainable ways

Non-universal gauge boson Z′Z' and the spin correlation of top quark pair production at e−e+e^{-}e^{+} colliders

In the off-diagonal basis, we discuss the contributions of the non-universal gauge boson $Z'$ predicted by the topcolor-assisted technicolor ($TC2$) model to the spin configurations and the spin correlation observable of the top quark pair production via the process $e^{-}e^{+}\to t\bar{t}$. Our numerical results show that the production cross sections for the like-spin states, which vanish in the standard model, can be significantly large as $M_{Z'}\approx \sqrt{S}$. With reasonable values of the $Z'$ mass $M_{Z'}$ and the coupling parameter $k_{1}$, $Z'$ exchange can generate large corrections to the spin correlation observable.Comment: 16 pages, 5 figure

Physics Beyond the Standard Model and Cosmological Connections: A Summary from LCWS 06

The International Linear Collider (ILC) is likely to provide us important insights into the sector of physics that may supersede our current paradigm viz., the Standard Model. In anticipation of the possibility that the ILC may come up in the middle of the next decade, several groups are vigourously investigating its potential to explore this new sector of physics. The Linear Collider Workshop in Bangalore (LCWS06) had several presentations of such studies which looked at supersymmetry, extra dimensions and other exotic possibilities which the ILC may help us discover or understand. Some papers also looked at the understanding of cosmology that may emerge from studies at the ILC. This paper summarises these presentations.Comment: 8 pages (including cover page) LaTeX, Summary talk presented at the International Linear Collider Workshop in Bangalore, India in March 200

Impact of question order on prioritisation of outcomes in the development of a core outcome set: a randomised controlled trial

BACKGROUND: Core outcome set (COS) developers increasingly employ Delphi surveys to elicit stakeholders' opinions of which outcomes to measure and report in trials of a particular condition or intervention. Research outside of Delphi surveys and COS development demonstrates that question order can affect response rates and lead to 'context effects', where prior questions determine an item's meaning and influence responses. This study examined the impact of question order within a Delphi survey for a COS for oesophageal cancer surgery. METHODS: A randomised controlled trial was nested within the Delphi survey. Patients and health professionals were randomised to receive a survey including clinical and patient-reported outcomes (PROs), where the PRO section appeared first or last. Participants rated (1-9) the importance of 68 items for inclusion in a COS (ratings 7-9 considered 'essential'). Analyses considered the impact of question order on: (1) survey response rates; (2) participants' responses; and (3) items retained at end of the survey. RESULTS: In total, 116 patients and 71 professionals returned completed surveys. Question order did not affect response rates among patients, but fewer professionals responded when clinical items appeared first (difference = 31.3%, 95% confidence interval [CI] = 13.6-48.9%, P = 0.001). Question order led to different context effects within patients and professionals. While patients rated clinical items highly, irrespective of question order, more PROs were rated essential when appearing last rather than first (difference = 23.7%, 95% CI = 10.5-40.8%). Among professionals, the greatest impact was on clinical items; a higher percentage rated essential when appearing last (difference = 11.6%, 95% CI = 0.0-23.3%). An interaction between question order and the percentage of PRO/clinical items rated essential was observed for patients (P = 0.025) but not professionals (P = 0.357). Items retained for further consideration at the end of the survey were dependent on question order, with discordant items (retained by one question order group only) observed in patients (18/68 [26%]) and professionals (20/68 [29%]). CONCLUSIONS: In the development of a COS, participants' ratings of potential outcomes within a Delphi survey depend on the context (order) in which the outcomes are asked, consequently impacting on the final COS. Initial piloting is recommended with consideration of the randomisation of items in the survey to reduce potential bias. TRIAL REGISTRATION: The randomised controlled trial reported within this paper was nested within the development of a core outcome set to investigate processes in core outcome set development. Outcomes were not health-related and trial registration was not therefore applicable