Measuring treatment response in rheumatoid arthritis : the use of patient‐reported outcome measures

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that may have major consequences for a patient’s life. Treatment generally consists of pharmacological and non-pharmacological interventions, and focuses on relieving symptoms, reducing inflammation, controlling joint damage, and maintaining or improving functional ability and psychosocial functioning. To justify these interventions from health care and health economic perspectives, it is important to assess their effects using reliable, valid, and responsive outcome measures. This thesis consists of three main parts. The first part (Chapters 2 and 3) focuses on the psychometric properties of commonly used patient‐reported outcome measures. The second (Chapters 4 and 5) and third (Chapters 6 and 7) parts focus on the effects of non‐pharmacological treatment interventions, with an emphasis on the use of orthoses and assistive devices, respectively. In this final chapter, the main findings of the studies conducted within these themes are summarized

Kinetic and mechanistic aspects of the oxidative coupling of methane over a Li/MgO catalyst

The rate of reaction of methane with oxygen in the presence of a Li-doped MgO catalyst has been studied as a function of the partial pressures of CH4, O2 and CO2 in a well-mixed reaction system which is practically gradientless with respect to gas-phase concentrations. It is concluded that the rate determining step involves reaction of methane adsorbed on the catalyst surface with a di-atomic oxygen species. The adsorption of oxygen is relatively weak. Carbon dioxide acts as a poison for the reaction of methane with oxygen, this probably being caused by competitive adsorption on the sites where oxygen (and possibly also methane) adsorbs

An investigation of the comparative reactivities of ethane and ethylene in the presence of oxygen over Li/MgO and Ca/Sm2O3 catalysts in relation to the oxidative coupling of methane

In order to examine the importance of the further oxidation of the desired C2 products in the oxidative coupling of methane, ethylene and ethane have been added to the feed (containing methane and oxygen) to a Li/MgO or Ca/Sm2O3 catalyst. The results of these measurements show that neither of these C2 molecules is stable under these conditions with either of the catalysts. Additionally, the rates of the oxidation of ethane and of ethylene alone have been measured using a gradientless reactor for both catalysts as well as for a quartz bed. It was found that the Ca/Sm2O3 material had higher activities for the oxidation of C2H6 and C2H4 (and also of CH4) than had the Li/MgO material. These higher activities result in a lower optimal reaction temperature for the oxidative coupling of methane and are (at least partially) responsible for the lower selectivity to C2 products observed with the Ca/Sm2O3 catalyst compared to that with the Li/MgO catalyst

The selective oxidation of methane to ethane and ethylene over doped and un-doped rare earth oxides

A comparison has been made of the behaviour in the oxidative coupling of methane of the oxides of Sm, Dy, Gd, La and Tb with that of a Li/MgO material. All but the Tb4O7 (which gave total oxidation) were found to give higher yields than the Li/MgO material at temperatures up to approaching 750°C but the Li/MgO system gave better results at higher temperatures. The cubic structure of Sm2O3 was found to be responsible for its good performance while the monoclinic structure was relatively inactive and unselective. The addition of Na or Ca to cubic Sm2O3 gives a higher optimum C2 yield than that of unpromoted Sm2O3. Sm2O3 and Ca/Sm2O3 catalysts are more stable than Li/MgO, Li/Sm2O3 or Na/Sm2O3. The addition of Li or Na to Sm2O3 causes the structure to change from cubic to monoclinic; the deactivation of the Na/Sm2O3 catalysts is caused by a loss of Na coupled with the formation of the monoclinic form of Sm2O3

Reaction path of the oxidative coupling of methane over a lithium-doped magnesium oxide catalyst:Factors affecting the Rate of Total Oxidation of Ethane and Ethylene

Experiments using gas mixtures of O2, C2H6 or C2H4 and CH4 or He have been carried out with a Li/MgO catalyst using a well-mixed reaction system which show that the total oxidation products, CO and CO2, are formed predominantly from ethylene, formed in the oxidative coupling of methane. It is therefore concluded that the network of reactions taking place during oxidative coupling of methane over a Li-doped MgO catalyst can be simplified to a serial reaction scheme: CH4→C2H6→C2H4→COx. Additional experiments have shown that the rates of gas-phase oxidation reaction of C2H6 and C2H4 are lowered by the presence of excess CH4 or by alkali metal carbonates

The Efficacy of Mindfulness-Based Cognitive Therapy as a Public Mental Health Intervention for Adults with Mild to Moderate Depressive Symptomatology: A Randomized Controlled Trial

Objective Although there has been growing evidence for the efficacy of mindfulness-based cognitive therapy (MBCT) for different clinical populations, its effectiveness as a public mental health intervention has not been studied. The present study evaluates a community-based MBCT intervention for adults with mild to moderate depressive symptomatology in a large multi-site, pragmatic randomized controlled trial. Method The participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the MBCT intervention (n = 76) or to a waiting list control group (n = 75). Participants completed measures before and after the intervention. Participants in the experimental condition also completed these measures at a 3-month follow-up. Results In the experimental condition significant reductions in depression, anxiety, and experiential avoidance, and improvements in mindfulness and emotional- and psychological mental health were found, compared to the waiting list (effect sizes Cohen's d = 0.31–0.56). These effects were sustained at the 3-month follow-up. The likelihood of a clinically significant change in depressive symptoms was significantly higher for the MBCT group [odds ratio (OR) 3.026, p<0.01 at post-treatment; NNT = 5.10]. Discussion MBCT as a public mental health intervention for adults with mild to moderate depressive symptoms seems effective and applicable in a natural setting

Does the Elderly’s Number of Prescribed Medications across Months Matter? National Cohort versus Single-Center Cohort

AbstractObjectivesTo investigate the monthly number of prescribed medication (NPM) patterns among different elderly populations and the factors associated with monthly NPM changes.MethodsThis retrospective cohort study was conducted using the databases obtained from National Health Insurance Research Databases and a 2000-bed academic medical center in Taiwan (i.e., single-center cohort). We compared the monthly NPMs, demographic characteristics, disease states, and health care contacts among the National Health Insurance elderly cohorts in 2006 and 2007, and for those elderly in the national and single-center cohorts who had outpatient visits from November to October in 2006 to 2007 and 2007 to 2008, respectively. Generalized estimating equation analyses of repeated measures were performed for monthly NPMs.ResultsThe average monthly NPMs among the National Health Insurance elderly cohort was 2.33 in 2006 and 4.39 in 2007, respectively. After controlling for other factors, the increment in the proportion of monthly NPMs among the older elderly patients, in certain months and for those patients with hypertension and dyslipidemia, was statistically significant among the single-center cohort but was not observed in the national elderly cohort. The proportional changes decreased significantly among patients who made visits to emergency rooms and who were hospitalized during a 1-year period.ConclusionsThere was an incremental trend of monthly NPMs among the national cohort from 2006 to 2007. Although acute exacerbations and hospitalization might be the protecting factors of increasing monthly NPMs, more attention should be paid toward high-utilization patients with specific diseases during certain months for different elderly cohorts

A Novel Visualization Tool for Evaluating Medication Side-Effects in Multi-drug Regimens

The evaluation and management of medication side-effects is a common and complex task for physicians. Information visualization has the potential to increase the efficiency and reduce the cognitive load involved in this process. We describe the design and development of Rxplore, a novel tool for assessing medication side-effects. Rxplore supports simultaneous lookup of multiple medications and an intuitive visual representation of query results. In a pilot study of Rxplore’s usability and utility, physicians rated the system highly for efficiency, intuitiveness, and clinical value