Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): An international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset with usual stroke unit care

Rationale: A key objective of A Very Early Rehabilitation Trial is to determine if the intervention, very early mobilisation following stroke, is cost-effective. Resource use data were collected to enable an economic evaluation to be undertaken and a plan for the main economic analyses was written prior to the completion of follow up data collection. Aim and hypothesis To report methods used to collect resource use data, pre-specify the main economic evaluation analyses and report other intended exploratory analyses of resource use data. Sample size estimates: Recruitment to the trial has been completed. A total of 2,104 participants from 56 stroke units across three geographic regions participated in the trial. Methods and design: Resource use data were collected prospectively alongside the trial using standardised tools. The primary economic evaluation method is a cost-effectiveness analysis to compare resource use over 12 months with health outcomes of the intervention measured against a usual care comparator. A cost-utility analysis is also intended. Study outcome: The primary outcome in the cost-effectiveness analysis will be favourable outcome (modified Rankin Scale score 0-2) at 12 months. Cost-utility analysis will use health-related quality of life, reported as quality-adjusted life years gained over a 12 month period, as measured by the modified Rankin Scale and the Assessment of Quality of Life. Discussion: Outcomes of the economic evaluation analysis will inform the cost-effectiveness of very early mobilisation following stroke when compared to usual care. The exploratory analysis will report patterns of resource use in the first year following stroke

Elektrokemijski imunosenzor za dokazivanje progesterona u mlijeku krava muzara

In this study, an electrochemical immunosensor for milk progesterone produced by dairy cows was developed. Using the immunosensor, milk progesterone levels in healthy estrus dairy cows was found to range from 1 to 6 ng/mL 20 days after estrus. There were high levels of progesterone in the milk from cows with prolonged luteal phase and luteal cysts, which ranged from 15 to 28 and 19 to 29 ng/mL, respectively. Cows with inactive ovaries also showed low milk progesterone levels of 1-8 ng/mL, but they had lower plasma follicle-stimulating hormone (FSH) levels than the healthy estrous cycle dairy cows.Ovim je istraživanjem razvijen elektrokemijski imunosenzor za otkrivanje progesterona u mlijeku dobivenom od mliječnih krava. Upotrebom imunosenzora u zdravih krava za proizvodnju mlijeka 20 dana nakon estrusa utvrđene su razine progesterona u rasponu od 1 do 6 ng/mL. U mlijeku krava s produljenom luteinskom fazom i luteinskim cistama utvrđena je visoka razina progesterona, u rasponu od 15 do 28 te od 19 do 29 ng/mL. Krave s neaktivnim jajnicima također su pokazale nisku razinu progesterona u mlijeku, od 1 do 8 ng/mL. Te su krave, u odnosu na zdrave krave za proizvodnju mlijeka u estrusnoj fazi ciklusa, očitovale nižu razinu folikulostimulacijskog hormona u plazmi (FSH)

A Comparison of Energy Consumption in Hydrothermal Liquefaction and Pyrolysis of Microalgae

The energy requirements for converting one tonne (1,000 kg) of Chlorella slurry of 20 wt% solids via fast pyrolysis, microwave-assisted pyrolysis (MAP), and hydrothermal liquefaction (HTL) were compared. Drying microalgae prior to pyrolysis by using a spray drying process with a 50% energy efficiency required an energy input of 4,107 MJ, which is higher than the energy content (4,000 MJ) of raw microalgae. The energy inputs to conduct fast pyrolysis, MAP, and HTL reactions were 504 MJ (50% efficient), 1,057 MJ (~25% efficient), and 2,776 MJ (50% efficient), respectively. The overall energy requirement of fast pyrolysis is theoretically about 1.6 times more than that of HTL. The energy recovery ratios for fast pyrolysis, MAP, and HTL of microalgae were 78.7%, 57.2%, and 89.8%, respectively. From the energy balance point of view, hydrothermal liquefaction is superior, and it achieved a higher energy recovery with a less energy cost. To improve the pyrolysis process, developing drying devices powered by renewable energies, optimizing the pyrolysis process (specifically microwave-assisted), and improving the energy efficiency of equipment are options.Citation: Zhang, B., Wu, J., Deng, Z.,  Yang, C., Cui, C., and Ding, Y. (2017). A Comparison of Energy Consumption in Hydrothermal Liquefaction and Pyrolysis of Microalgae. Trends in Renewable Energy, 3(1), 76-85. DOI: 10.17737/tre.2017.3.1.001

Incontinence pessaries: size, POPQ measures, and successful fitting

The aim of the study was to determine whether successful incontinence pessary fitting or pessary size can be predicted by specific POPQ measurements in women without advanced pelvic organ prolapse. In a multicenter study, women with stress urinary incontinence (SUI) and POPQ stage ≤2 were randomized to three treatment arms: (1) incontinence pessary, (2) behavioral therapy, or (3) both. This study evaluates incontinence pessary size, POPQ measures, and successful fitting in the 266 women assigned to treatment arms 1 and 3. Two hundred thirty-five women (92%) were successfully fitted with an incontinence ring (n = 122) or dish (n = 113). Hysterectomy, genital hiatus (GH), and GH/total vaginal length (TVL) ratios did not predict unsuccessful fitting (p > 0.05). However, mean TVL was greater in women successfully fitted (9.6 vs. 8.8 cm, p < 0.01). Final pessary diameter was not predicted by TVL, point D, or point C (p > 0.05). The vast majority of women with SUI can be successfully fitted with an incontinence pessary, but specific POPQ measures were not helpful in determining incontinence pessary size

Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos

Background To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usually involves one trophectoderm biopsy at blastocyst stage, assumed to represent embryo ploidy. Whether one such biopsy can correctly assess embryo ploidy has recently, however, been questioned. Methods This descriptive study investigated accuracy of PGS in two ways. Part I: Two infertile couples donated 11 embryos, previously diagnosed as aneuploid and, therefore, destined to be discarded. They were dissected into 37 anonymized specimens, and sent to another national laboratory for repeat analyses to assess (i) inter-laboratory congruity and (ii) intra-embryo congruity of multiple embryo biopsies in a single laboratory. Part II: Reports on human IVF cycle outcomes after transfer of allegedly aneuploid embryos into 8 infertile patients. Results Only 2/11 (18.2 %) embryos were identically assessed at two PGS laboratories; 4/11 (36.4 %), on repeat analysis were chromosomally normal, 2 mosaic normal/abnormal, and 5/11 (45.5 %) completely differed in reported aneuploidies. In intra-embryo analyses, 5/10 (50 %) differed between biopsy sites. Eight transfers of previously reported aneuploid embryos resulted in 5 chromosomally normal pregnancies, 4 delivered and 1 ongoing. Three patients did not conceive, though 1 among them experienced a chemical pregnancy. Conclusions Though populations of both study parts are too small to draw statistically adequately powered conclusions on specific degrees of inaccuracy of PGS, here presented results do raise concerns especially about false-positive diagnoses. While inter-laboratory variations may at least partially be explained by different diagnostic platforms utilized, they cannot explain observed intra-embryo variations, suggesting more frequent trophectoderm mosiaicsm than previously reported. Together with recentl published mouse studies of lineages-specific degrees of survival of aneuploid cells in early stage embryos, these results call into question the biological basis of PGS, based on the assumption that a single trophectoderm biopsy can reliably determine embryo ploidy

Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Locomotor training using body weight support and a treadmill as a therapeutic modality for rehabilitation of walking post-stroke is being rapidly adopted into clinical practice. There is an urgent need for a well-designed trial to determine the effectiveness of this intervention.</p> <p>The objective of the Locomotor Experience Applied Post-Stroke (LEAPS) trial is to determine if there is a difference in the proportion of participants who recover walking ability at one year post-stroke when randomized to a specialized locomotor training program (LTP), conducted at 2- or 6-months post-stroke, or those randomized to a home based non-specific, low intensity exercise intervention (HEP) provided 2 months post-stroke. We will determine if the timing of LTP delivery affects gait speed at 1 year and whether initial impairment severity interacts with the timing of LTP. The effect of number of treatment sessions will be determined by changes in gait speed taken pre-treatment and post-12, -24, and -36 sessions.</p> <p>Methods/Design</p> <p>We will recruit 400 adults with moderate or severe walking limitations within 30 days of stroke onset. At two months post stroke, participants are stratified by locomotor impairment severity as determined by overground walking speed and randomly assigned to one of three groups: (a) LTP-Early; (b) LTP-Late or (c) Home Exercise Program -Early. The LTP program includes body weight support on a treadmill and overground training. The LTP and HEP interventions are delivered for 36 sessions over 12 weeks.</p> <p>Primary outcome measure include successful walking recovery defined as the achievement of a 0.4 m/s gait speed or greater by persons with initial severe gait impairment or the achievement of a 0.8 m/s gait speed or greater by persons with initial moderate gait impairment.</p> <p>LEAPS is powered to detect a 20% difference in the proportion of participants achieving successful locomotor recovery between the LTP groups and the HEP group, and a 0.1 m/s mean difference in gait speed change between the two LTP groups.</p> <p>Discussion</p> <p>The goal of this single-blinded, phase III randomized clinical trial is to provide evidence to guide post-stroke walking recovery programs.</p> <p>Trial registration</p> <p>NCT00243919.</p

Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia

BACKGROUND: Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case. METHODS: All malaria cases (2007–2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control. RESULTS: After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011–2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence. CONCLUSION: Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase

Knowledge and attitudes of healthcare workers in Chinese intensive care units regarding 2009 H1N1 influenza pandemic

<p>Abstract</p> <p>Background</p> <p>To describe the knowledge and attitudes of critical care clinicians during the 2009 H1N1 influenza pandemic.</p> <p>Methods</p> <p>A survey conducted in 21 intensive care units in 17 provinces in China.</p> <p>Results</p> <p>Out of 733 questionnaires distributed, 695 were completed. Three hundred and fifty-six respondents (51.2%) reported their experience of caring for H1N1 patients. Despite the fact that 88.5% of all respondents ultimately finished an H1N1 training program, only 41.9% admitted that they had the knowledge of 2009 H1N1 influenza. A total of 572 respondents (82.3%) expressed willingness to care for H1N1 patients. Independent variables associated with increasing likelihood to care for patients in the logistic regression analysis were physicians or nurses rather than other professionals (odds ratio 4.056 and 3.235, p = 0.002 and 0.007, respectively), knowledge training prior to patient care (odds ratio 1.531, p = 0.044), and the confidence to know how to protect themselves and their patients (odds ratio 2.109, p = 0.001).</p> <p>Conclusion</p> <p>Critical care clinicians reported poor knowledge of H1N1 influenza, even though most finished a relevant knowledge training program. Implementation of appropriate education program might improve compliance to infection control measures, and willingness to work in a pandemic.</p