A Scoping Literature Review of Studies Assessing Effectiveness and Cost-Effectiveness of Prosthetic and Orthotic Interventions

Purpose: Approximately 1.5% of the world’s population (~100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development. Methods: Fourteen databases were searched from 1995-2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies. Results: The searches resulted in a total of 28,958 articles, a focus on studies with the words “randomised” OR “randomized” OR “cost” OR “economic” in their citation reduced this total to 2,644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. 346 randomised controlled trials were identified, with only four randomised controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures. Conclusions: While various international organisations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments

Phase diagram and upper critical field of homogenously disordered epitaxial 3-dimensional NbN films

We report the evolution of superconducting properties with disorder, in 3-dimensional homogeneously disordered epitaxial NbN thin films. The effective disorder in NbN is controlled from moderately clean limit down to Anderson metal-insulator transition by changing the deposition conditions. We propose a phase diagram for NbN in temperature-disorder plane. With increasing disorder we observe that as kFl-->1 the superconducting transition temperature (Tc) and minimum conductivity (sigma_0) go to zero. The phase diagram shows that in homogeneously disordered 3-D NbN films, the metal-insulator transition and the superconductor-insulator transition occur at a single quantum critical point at kFl~1.Comment: To appear in Journal of Superconductivity and Novel Magnetism (ICSM2010 proceedings

Tunneling studies in a homogeneously disordered s-wave superconductor: NbN

We report the evolution of superconducting properties as a function of disorder in homogeneously disordered epitaxial NbN thin films grown on (100) MgO substrates, studied through a combination of electrical transport, Hall Effect and tunneling measurements. The thickness of all our films are >50nm much larger than the coherence length ~5nm. The effective disorder in different films encompasses a large range, with the Ioffe-Regel parameter varying in the range kFl~1.38-8.77. Tunneling measurements on films with different disorder reveals that for films with large disorder the bulk superconducting transition temperature (Tc) is not associated with a vanishing of the superconducting energy gap, but rather a large broadening of the superconducting density of states. Our results provide strong evidence of the loss of superconductivity via phase-fluctuations in a disordered s-wave superconductor.Comment: pdf file including figure

Temperature dependence of resistivity and Hall-coefficient in a strongly disordered metal: NbN

We report the temperature dependence of resistivity (rho) and Hall coefficient (R_H) in the normal state of homogeneously disordered epitaxial NbN thin films with kFl~3.27-10.12. The superconducting transition temperature (Tc) of these films varies from 8.13K to 16.8K. While our least disordered film displays usual metallic behavior, for all the films with kFl<8.13, both and are negative up to 300K. We observe that R_H(T) varies linearly with rho(T) for all the films. Measurements performed on a 2nm thick Be film shows similar behavior >. This behavior is inconsistent with existing theories of localization and e-e interactions in a disordered metal.Comment: pdf file with figure

Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

&lt;p&gt;Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.&lt;/p&gt; &lt;p&gt;Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate &#60;60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.&lt;/p&gt; &lt;p&gt;Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.&lt;/p&gt

A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions.

BACKGROUND: Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE: The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS: Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS: A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS: At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness

Mind your heart: Healthy heart for hearty health

The incidence and prevalence of cardiovascular disease (CVD) are burgeoning in many countries, including India. Lifestyle management and the use of appropriate preventive therapies are keys to halting this rapidly growing public health problem. Importantly, the role of psychosocial stress in causation of CVD is now being increasingly recognized. It is important to recognize the positive aspects of life and suppress the negative personality traits to achieve long-term happiness and physical health, free from CVD

Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms

Stress cardiomyopathy (SC) typically presents as potential acute coronary syndrome (ACS) in previously healthy people. While there may be physical or mental stressors, the initial symptom is usually chest pain. This form conforms to the published Mayo diagnostic criteria, is well reported and as the presentation is initially cardiac, is considered primary SC. Increasingly we see SC develop several days into the hospitalization secondary to medical or surgical critical illness. This condition is more complex, presents atypically, is not easy to recognize and carries a much worse prognosis. Label of Secondary SC is appropriate as it manifests in sicker hospitalized patients with numerous comorbidities. We review the limited but provocative literature pertinent to SC in the critically ill and describe important clues to identify global, subclinical and probable forms of SC. We illustrate the several unique clinical features, demographic differences and propose a diagnostic algorithm to optimize cardiac care in the critically ill

Performance of cellular CDMA with voice/data traffic with an SIR based admission control

We analyze the performance of an SIR based admission control strategy in cellular CDMA systems with both voice and data traffic. Most studies In the current literature to estimate CDMA system capacity with both voice and data traf-Bc do not take signal-tlFlnterference ratio (SIR) based admission control into account In this paper, we present an analytical approach to evaluate the outage probability for voice trafllc, the average system throughput and the mean delay for data traffic for a volce/data CDMA system which employs an SIR based admission controL We show that for a dataaniy system, an improvement of about 25% In both the Erlang capacity as well as the mean delay performance is achieved with an SIR based admission control as compared to code availability based admission control. For a mixed voice/data srtem with 10 Erlangs of voice traffic, the Lmprovement in the mean delay performance for data Is about 40%.Ah, for a mean delay of 50 ms with 10 Erlangs voice traffic, the data Erlang capacity improves by about 9%