Efficacy of rehabilitation interventions in rheumatic conditions

All industrialized nations are facing a crisis in health care financing. Rising expectations coupled with increasing specialization and technologic capacities have forced health care payers to examine their assumptions and to seek data on the outcomes of medical interventions. Clinical investigators who have been taught to use randomized controlled trials that evaluate efficacy under experimental conditions have been redirected toward studies that can help answer health policy questions. Such studies examine the effectiveness of interventions in more realistic settings on a richer array of patient-centered outcomes such as function and consider cost effectiveness and relative cost effectiveness. Rehabilitation interventions, which are by and large pragmatic, have never had a strong scientific basis grounded in controlled trials, and this lack of evidence has put tremendous pressure on clinicians to justify their practices. In this article, we review the recent literature on effectiveness of rehabilitation interventions in rheumatic disorders

Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug—Induced Gastropathy in Patients With Chronic Arthritis?

Whether misoprostol, a synthetic prostaglandin E1 analogue, should be routinely prescribed along with nonsteriodal anti-inflammatory drugs (NSAIDS) to prevent gastric damage is of great clinical importance and has profound cost implications. No consensus exists on whether misoprostol cotherapy results in a cost-saving, is cost-effective, or is costly. The different conclusions reached by five economic evaluations of misoprostol can be explained solely by the assumed absolute risk reduction of symptomatic ulcer, which was more than seven times greater in the studies that concluded that misoprostol was cost-effective than in a study that concluded misoprostol to be costly. Since no study has directly shown the effectiveness of misoprostol cotherapy in preventing clinically significant ulcer disease (ie, hemorrhage and preforation), it is impossible to judge which assumptions are most appropriate. The absence of firm data on the rate of NSAID-induced gastric ulcers reduced by misoprostol makes it impossible to conclude whether it is cost-effective in patients with chronic arthritis who use NSAIDS

SLE - Practical and theoretical barriers to the prevention of accelerated atherosclerosis in systemic lupus erythematosus

Accelerated atherosclerotic vascular disease (ASVD) is a major cause of death in systemic lupus erythematosus (SLE). Although many authorities are calling for aggressive assessment and management of cardiac risk factors in patients with SLE, both theoretical and practical barriers to this approach exist. It seems that SLE and/or its treatment are themselves strong risk factors for the development of ASVD and it is unclear how much this risk can be decreased by the control of traditional risk factors. Studies from several centers have shown that suboptimal risk factor management and barriers to acceptance of these measures must also be studied further

New developments in osteoarthritis. Prevention of injury-related knee osteoarthritis: opportunities for the primary and secondary prevention of knee osteoarthritis

Where risk factors have been identified in knee and hip osteoarthritis (OA), with few exceptions, no prevention strategies have proven beneficial. The major risk factors for knee OA are advanced age, injury and obesity. However, there is limited or no evidence that they are modifiable or to what degree modifying them is effective in preventing development of knee OA or in preventing symptoms and progressive disease in persons with early OA. The notable exception is the growing epidemic of (sports) injury related knee OA. This review details the biological and clinical data indicating the efficacy of interventions targeting neuromuscular and biomechanical factors that make this subset of OA an attractive public health target, and highlights research opportunities for the future

Optical Design and Wavelength Calibration of a DMD-based Multi-Object Spectrograph

The multi-object spectrograph (MOS) has been the benchmark for the current generation of astronomical spectrographs, valued for its ability to acquire the spectra of hundreds of objects simultaneously. In the last two decades, the digital micromirror device (DMD) has shown potential in becoming the central component of the MOS, being used as a programmable slit array. We have designed a seeing-limited DMD-based MOS covering a spectral range of 0.4 to 0.7 $\mu$m, with a field of view (FOV) of $10.5^\prime \times 13.98^\prime$ and a spectral resolution of $R\sim1000$. This DMD-MOS employs all-spherical refractive optics, and a volume phase holographic (VPH) grism as the dispersive element for high throughput. In this paper, we present the optical design and optimization process of this DMD-MOS, as well as a preliminary wavelength calibration procedure for hyperspectral data reduction. Using simulated data of the DMD-MOS, a procedure was developed to measure hyperspectral imaging distortion and to construct pixel-to-wavelength mappings on the detector. An investigation into the relationships between DMD micromirrors and detector pixels was conducted. This DMD-MOS will be placed on a 0.5 m diameter telescope as an exploratory study for future DMD-based MOS systems.Comment: 15 pages, 32 figures, 1 table, SPIE Astronomical Telescopes + Instrumentation 202

Design and Fabrication of Ultralight Weight, Adjustable Multi-electrode Probes for Electrophysiological Recordings in Mice

The number of physiological investigations in the mouse, mus musculus, has experienced a recent surge, paralleling the growth in methods of genetic targeting for microcircuit dissection and disease modeling. The introduction of optogenetics, for example, has allowed for bidirectional manipulation of genetically-identified neurons, at an unprecedented temporal resolution. To capitalize on these tools and gain insight into dynamic interactions among brain microcircuits, it is essential that one has the ability to record from ensembles of neurons deep within the brain of this small rodent, in both head-fixed and freely behaving preparations. To record from deep structures and distinct cell layers requires a preparation that allows precise advancement of electrodes towards desired brain regions. To record neural ensembles, it is necessary that each electrode be independently movable, allowing the experimenter to resolve individual cells while leaving neighboring electrodes undisturbed. To do both in a freely behaving mouse requires an electrode drive that is lightweight, resilient, and highly customizable for targeting specific brain structures. A technique for designing and fabricating miniature, ultralight weight, microdrive electrode arrays that are individually customizable and easily assembled from commercially available parts is presented. These devices are easily scalable and can be customized to the structure being targeted; it has been used successfully to record from thalamic and cortical regions in a freely behaving animal during natural behavior.Simons FoundationNational Institute of Neurological Disorders and Stroke (U.S.) (NIH Pathway to Independence Career Award)National Institutes of Health (U.S.

Contribution of transcriptional regulation to natural variations in Arabidopsis

BACKGROUND: Genetic control of gene transcription is a key component in genome evolution. To understand the transcriptional basis of natural variation, we have studied genome-wide variations in transcription and characterized the genetic variations in regulatory elements among Arabidopsis accessions. RESULTS: Among five accessions (Col-0, C24, Ler, WS-2, and NO-0) 7,508 probe sets with no detectable genomic sequence variations were identified on the basis of the comparative genomic hybridization to the Arabidopsis GeneChip microarray, and used for accession-specific transcriptome analysis. Two-way ANOVA analysis has identified 60 genes whose mRNA levels differed in different accession backgrounds in an organ-dependent manner. Most of these genes were involved in stress responses and late stages of plant development, such as seed development. Correlation analysis of expression patterns of these 7,508 genes between pairs of accessions identified a group of 65 highly plastic genes with distinct expression patterns in each accession. CONCLUSION: Genes that show substantial genetic variation in mRNA level are those with functions in signal transduction, transcription and stress response, suggesting the existence of variations in the regulatory mechanisms for these genes among different accessions. This is in contrast to those genes with significant polymorphisms in the coding regions identified by genomic hybridization, which include genes encoding transposon-related proteins, kinases and disease-resistance proteins. While relatively fewer sequence variations were detected on average in the coding regions of these genes, a number of differences were identified from the upstream regions, several of which alter potential cis-regulatory elements. Our results suggest that nucleotide polymorphisms in regulatory elements of genes encoding controlling factors could be primary targets of natural selection and a driving force behind the evolution of Arabidopsis accessions