931 research outputs found
PIN21 Age Related Consultation Rates of Clinically-Diagnosed Influenza And Acute Respiratory Illnesses Observed Through A Network of Gp Practices Across England
Dynamics of F=2 Spinor Bose-Einstein Condensates
We experimentally investigate and analyze the rich dynamics in F=2 spinor
Bose-Einstein condensates of Rb87. An interplay between mean-field driven spin
dynamics and hyperfine-changing losses in addition to interactions with the
thermal component is observed. In particular we measure conversion rates in the
range of 10^-12 cm^3/s for spin changing collisions within the F=2 manifold and
spin-dependent loss rates in the range of 10^-13 cm^3/s for hyperfine-changing
collisions. From our data we observe a polar behavior in the F=2 ground state
of Rb87, while we measure the F=1 ground state to be ferromagnetic. Furthermore
we see a magnetization for condensates prepared with non-zero total spin.Comment: 4 pages, 2 figures, RevTe
Нерешенные вопросы диагностики и лечения синдрома острого повреждения желудка
Освещены основные вопросы развития, диагностики и лечебных мероприятий синдрома острого повреждения желудка. Определены основные направления в изучении данного состояния.Main questions of development, diagnosis and treatment of syndrome of acute lesion of the stomach are featured. Main directions in the investigation of this state were determined
Evaluation of biases present in the cohort multiple randomised controlled trial design: a simulation study
Background
The cohort multiple randomised controlled trial (cmRCT) design provides an opportunity to incorporate the benefits of randomisation within clinical practice; thus reducing costs, integrating electronic healthcare records, and improving external validity. This study aims to address a key concern of the cmRCT design: refusal to treatment is only present in the intervention arm, and this may lead to bias and reduce statistical power.
Methods
We used simulation studies to assess the effect of this refusal, both random and related to event risk, on bias of the effect estimator and statistical power. A series of simulations were undertaken that represent a cmRCT trial with time-to-event endpoint. Intention-to-treat (ITT), per protocol (PP), and instrumental variable (IV) analysis methods, two stage predictor substitution and two stage residual inclusion, were compared for various refusal scenarios.
Results
We found the IV methods provide a less biased estimator for the causal effect when refusal is present in the intervention arm, with the two stage residual inclusion method performing best with regards to minimum bias and sufficient power. We demonstrate that sample sizes should be adapted based on expected and actual refusal rates in order to be sufficiently powered for IV analysis.
Conclusion
We recommend running both an IV and ITT analyses in an individually randomised cmRCT as it is expected that the effect size of interest, or the effect we would observe in clinical practice, would lie somewhere between that estimated with ITT and IV analyses. The optimum (in terms of bias and power) instrumental variable method was the two stage residual inclusion method. We recommend using adaptive power calculations, updating them as refusal rates are collected in the trial recruitment phase in order to be sufficiently powered for IV analysis
Proton pump inhibitors, fracture risk and selection bias: three studies, same database, two answers
Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001-2012 : Interrupted time series regression analysis
OBJECTIVES: To measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK. DESIGN: Interrupted time series regression analysis and incidence measures. SETTING: General practices in the UK contributing to the Clinical Practice Research Datalink (CPRD). PARTICIPANTS: Patients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012. INTERVENTIONS: (1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery. MAIN OUTCOME MEASURES: Incidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases. RESULTS: During the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (-6.3% (-11.0 to -1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (-0.8% per quarter (-1.4 to -0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (-1.7% per quarter (-2.2 to -1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated. CONCLUSIONS: SBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in clinical trial recommendations may change clinical practice. However, better ways are needed to understand and circumvent barriers in implementing clinical trial findings.Publisher PDFPeer reviewe
Advances in Glucocorticoid-Induced Osteoporosis
Glucocorticoid-induced osteoporosis (GIOP) is one of the most important side effects of glucocorticoid use, as it leads to an increased risk of fractures. Recently, many published studies have focused on the cellular and molecular mechanisms of bone metabolism, the pathophysiology of GIOP, and the intervention options to prevent GIOP. In this review, recent advances in GIOP are summarized, particularly recent progress in our understanding of the mechanisms of GIOP resulting in improved insight that might result in the development of new treatment options in the near future
Long-term exposure to outdoor air pollution and the incidence of chronic obstructive pulmonary disease in a national English cohort.
OBJECTIVES: The role of outdoor air pollution in the incidence of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated this question using a large, nationally representative cohort based on primary care records linked to hospital admissions.
METHODS: A cohort of 812 063 patients aged 40-89 years registered with 205 English general practices in 2002 without a COPD diagnosis was followed from 2003 to 2007. First COPD diagnoses recorded either by a general practitioner (GP) or on admission to hospital were identified. Annual average concentrations in 2002 for particulate matter with an aerodynamic diameter <10 µm (PM10) and <2.5 µm (PM2.5), nitrogen dioxide (NO2), ozone and sulfur dioxide (SO2) at 1 km(2) resolution were estimated from emission-based dispersion models. Hazard ratios (HRs) per interquartile range change were estimated from Cox models adjusting for age, sex, smoking, body mass index and area-level deprivation. RESULTS: 16 034 participants (1.92%) received a COPD diagnosis from their GP and 2910 participants (0.35%) were admitted to hospital for COPD. After adjustment, HRs for GP recorded COPD and PM10, PM2.5 and NO2 were close to unity, positive for SO2 (HR=1.07 (95% CI 1.03 to 1.11) per 2.2 µg/m(3)) and negative for ozone (HR=0.94 (0.89 to 1.00) per 3 µg/m(3)). For admissions HRs for PM2.5 and NO2 remained positive (HRs=1.05 (0.98 to 1.13) and 1.06 (0.98 to 1.15) per 1.9 µg/m(3) and 10.7 µg/m(3), respectively).
CONCLUSIONS: This large population-based cohort study found limited, inconclusive evidence for associations between air pollution and COPD incidence. Further work, utilising improved estimates of air pollution over time and enhanced socioeconomic indicators, is required to clarify the association between air pollution and COPD incidence
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