Idiopathic pulmonary fibrosis: evaluation of progression and prognosis after the ATS/ERS/JRS/ALAT statement 2011

Objectives The prediction of usual interstitial pneumonia (UIP) progression and prognosis by the a application of HRCT criteria pattern recommended by ATS/ERS/JALAT guidelines 2011 Materials and methods Two radiologists after assessing the baseline HRCT have distributed 70 patients affected by fibrotic idiopathic interstitial pneumonia (IIP) in three groups (UIP type= group 1, possible-UIP=group 2, inconsistence UIP=group 3) on the basis of 2011 guidelines. The different abnormalities (honeycombing, reticulation, ground-glass, bronchiectasis) were visually scored at baseline and during the follow-up (total HRCT 179). Overall CT score and fibrotic score (honeycombing plus reticulation) were calculated. The progression of the abnormalities and the correlation with mortality rate were assessed (Kaplan-Mayer survival estimates). Results The inter-observed agreement was substantial or almost perfect (k=0.73-0.85). Forty-four patients were classified into group 1, 13 into group 2 and 13 into group 3. After a mean follow-up of 1386 days (DS 915), the mortality rate was significantly greater in the group 1 (18 died) versus group 2 and 3 (1 died each). In the group 1 patients whom showed at baseline a honeycombing rate greater than 25%, fibrotic score greater than 30, overall CT score greater than 45 and bronchiectasis in more than 4 lobes obtained the better prognostic value and significantly predicted mortality risk. A significant increment of fibrotic score and honeycombing rate was demonstrated in the group 1 and 3 but not in the group 2. Honeycombing progression was quantified in 3 points/year for UIP type. Conclusion In our study HRCT criteria for UIP pattern on the basis of 2011 guidelines showed high accuracy in the risk stratification of patients with idiopathic pulmonary fibrosis (IPF)

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Background/aim. In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play. Methods. A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play. Results. Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group. Conclusion. Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children’s play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed

Development of a reoffending measure using the Police National Computer database.

This work aims to develop a reoffending score for assessing the likelihood of an offender reoffending within a certain fixed period of time. Currently, OGRS - the Offenders Group Reconviction Score - is a heavily used measure for assessing reconviction scores of a group or set of offenders. However, dates of conviction can be far removed from the reality of offending. The aim in this report is to develop a new approach which focuses on 'offending' rather than 'conviction' and, hence, to provide a 'reoffending measure' rather than a 'reconviction measure'. While OGRS has been remarkably successful, there is a need to develop a new measure. There are various reasons - to make offending behaviour rather than convictions as the primary focus of interest; the existing score is somewhat outdated; to confront the problems with the existing OGRS score; to improve the documentation relating to the construction of a measure; and to make the measure more 'user-friendly' for the practitioners

DO CELL GROUP INDEPENDENT ACTIVITIES IMPACT STUDENTS’ SCORE ACHIEVEMENT?

There are many methods offered to teach in a university level. In teaching English Entrant, one course of general English courses at Binus University, a lecturer needs to choose an appropriate method. One appropriate method used is cooperative learning one. In this method, students in a class are divided into groups called cell group. In the cell group, they needed to do some activities independently. Based on the above reason, this paper aimed to find out whether the cell group independent activities impact the students’ score achievement in reading and listening. The data for the paper was the students’ scores of listening and reading they gained in mid semester test, final test English Entrant and the weekly reports of students’ cell activities. The method used to analyze the data was percentage number to compare the scores and cell group activities for both listening and reading. The result shows that there was a significant higher achievement of the students in both listening and reading either the number of cell group activities 1-3 or 4-6 times of activities. It could be concluded that the cell group activities gave good impact in supporting students to achieve high score in reading or listening

Atenolol versus losartan in children and young adults with Marfan's syndrome

BACKGROUND : Aortic-root dissection is the leading cause of death in Marfan's syndrome. Studies suggest that with regard to slowing aortic-root enlargement, losartan may be more effective than beta-blockers, the current standard therapy in most centers. METHODS : We conducted a randomized trial comparing losartan with atenolol in children and young adults with Marfan's syndrome. The primary outcome was the rate of aortic-root enlargement, expressed as the change in the maximum aortic-root-diameter z score indexed to body-surface area (hereafter, aortic-root z score) over a 3-year period. Secondary outcomes included the rate of change in the absolute diameter of the aortic root; the rate of change in aortic regurgitation; the time to aortic dissection, aortic-root surgery, or death; somatic growth; and the incidence of adverse events. RESULTS : From January 2007 through February 2011, a total of 21 clinical centers enrolled 608 participants, 6 months to 25 years of age (mean [+/- SD] age, 11.5 +/- 6.5 years in the atenolol group and 11.0 +/- 6.2 years in the losartan group), who had an aorticroot z score greater than 3.0. The baseline-adjusted rate of change (+/- SE) in the aortic-root z score did not differ significantly between the atenolol group and the losartan group (-0.139 +/- 0.013 and -0.107 +/- 0.013 standard-deviation units per year, respectively; P = 0.08). Both slopes were significantly less than zero, indicating a decrease in the degree of aortic-root dilatation relative to body-surface area with either treatment. The 3-year rates of aortic-root surgery, aortic dissection, death, and a composite of these events did not differ significantly between the two treatment groups. CONCLUSIONS : Among children and young adults with Marfan's syndrome who were randomly assigned to losartan or atenolol, we found no significant difference in the rate of aorticroot dilatation between the two treatment groups over a 3-year period

Effects of the anti-RANKL antibody denosumab on joint structural damage in patients with rheumatoid arthritis treated with conventional synthetic disease-modifying antirheumatic drugs (DESIRABLE study): a randomised, double-blind, placebo-controlled phase 3 trial.

ObjectiveTo evaluate the efficacy of denosumab in suppressing joint destruction when added to conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy in patients with rheumatoid arthritis (RA).MethodsThis was a multi-centre, randomised, double-blind, parallel-group, placebo-controlled phase 3 study in Japan. Patients with RA aged ≥20 years receiving csDMARDs were randomly assigned (1:1:1) to denosumab 60 mg every 3 months (Q3M), denosumab 60 mg every 6 months (Q6M) or placebo. The change in the modified total Sharp score (mTSS) and effect on bone mineral density (BMD) at 12 months was evaluated.ResultsIn total, 654 patients received the trial drugs. Denosumab groups showed significantly less progression of joint destruction. The mean changes in the mTSS at 12 months were 1.49 (95% CI 0.99 to 1.99) in the placebo group, 0.99 (95% CI 0.49 to 1.49) in the Q6M group (p=0.0235) and 0.72 (95% CI 0.41 to 1.03) in the Q3M group (p=0.0055). The mean changes in bone erosion score were 0.98 (95% CI 0.65 to 1.31) in the placebo group, 0.51 (95% CI 0.22 to 0.80) in the Q6M group (p=0.0104) and 0.22 (95% CI 0.09 to 0.34) in the Q3M group (p=0.0001). No significant between-group difference was observed in the joint space narrowing score. The per cent change in lumbar spine (L1-L4) BMD in the placebo, Q6M and Q3M groups were -1.03%, 3.99% (p<0.0001) and 4.88% (p<0.0001). No major differences were observed among safety profiles.ConclusionsDenosumab inhibits the progression of joint destruction, increases BMD and is well tolerated in patients with RA taking csDMARD

A Comparison of Bond Strength Between Direct- and Indirect-bonding Methods

The purpose of this study was to evaluate and compare the shear bond strength and the sites of bond failure for brackets bonded to teeth, using two indirect-bonding material protocols and a direct-bonding technique. Sixty extracted human premolars were collected and randomly divided into three groups. The direct-bonded group (group 1) used a light-cured adhesive and primer (Transbond XT). One indirect-bonded group (group 2) consisted of a chemical-cured primer (Sondhi Rapid Set) and light-cured adhesive (Transbond XT), whereas the other group (group 3) used a light-cured primer (Orthosolo) and adhesive (Enlight LV). Forty hours after bonding, the samples were debonded. Mean shear bond strengths were 16.27, 13.83, and 14.76 MPa for groups 1, 2, and 3, respectively. A one-way analysis of variance showed no significant difference in mean bond strength between groups (P = .21). Furthermore, a Weibull analysis showed all three groups tested provided over a 90% survival rate at normal masticatory and orthodontic force levels. For each tooth, an Adhesive Remnant Index (ARI) score was determined. Group 2 was found to have a significantly lower ARI score (P \u3c .05) compared with groups 1 and 3. In addition, Pearson correlation coefficients indicated no strong correlation between bond strength and ARI score within or across all groups

Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus : randomised controlled trial

Objective: To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. Design: Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). Setting: 22 tertiary referral hospitals, United Kingdom. Participants: 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. Main outcome measures: The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. Results: 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference −7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). Conclusions: Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures

The Effectiveness of Spotify in Enhancing Students’ Listening Skills at MA Muhammadiyah 1 Plus Malang

The researcher applied Spotify as a teaching media for English listening in XI IPA at MA Muhammadiyah 1 Plus Malang. This study aimed to determine the effectiveness of using Spotify as a teaching media in enhancing students’ listening skills. The researcher used Classroom Action Research (CAR). The subjects of this study were 23 students in XI IPA class. The instruments used in this study were tests and observation checklists. In cycle I, individual learning was used in teaching and learning activities. Meanwhile, the researcher used the pair group or group strategy in cycle II. The researcher conducted a pre-test before implementing the treatment using Spotify in teaching and learning activities. Furthermore, a post-test was conducted after the treatment using Spotify. From the results of the data analysis, it was concluded that the average score of students in post-test I increased by 5.43 points compared to the pre-test but still did not reach the minimum score (75). Also, the average score in post-test II increased by 12.39 points. Since the average score in post-test II reached the minimum passing score (KKM), this study ended in cycle II. Moreover, through observation results, students felt enthusiastic when using Spotify in learning activities, and Spotify helped students reduce boredom while learning listening. In addition, using Spotify as a teaching media enhanced students’ listening skills

Intrarenal Resistance Index as a Prognostic Parameter in Patients with Liver Cirrhosis Compared with Other Hepatic Scoring Systems

Background and Aims: Patients with advanced liver cirrhosis who develop renal dysfunction have a poor prognosis. Elevated intrarenal resistance indices (RIs) due to renal vascular constriction have been described before in cirrhotic patients. In the current study, we prospectively investigated the course of intrarenal RIs and compared their prognostic impact with those of the Model for End-Stage Liver Disease (MELD) and the Child-Pugh scores. Methods: Sixty-three patients with liver cirrhosis underwent a baseline visit which included a sonographic examination and laboratory tests. Forty-four patients were prospectively monitored. The end points were death or survival at the day of the follow-up visit. Results: In 28 patients, a follow-up visit was performed after 22 8 months (group 1). Sixteen patients died during follow-up after 12 8 months (group 2). Group 2 patients showed a significantly higher baseline RI (0.76 +/- 0.05) than group 1 patients (RI = 0.72 +/- 0.06; p < 0.05). As shown by receiver operating characteristic analysis, the RI and the MELD score achieved similar sensitivity and specificity {[}area under the curve (AUC): 0.722; 95% confidence interval (95% CI): 0.575-0.873 vs. AUC: 0.724; 95% CI: 0.575-0.873, z = 0.029, n.s.] in predicting survival and were superior to the Child-Pugh score (AUC: 0.677; 96% Cl: 0.518-0.837). Conclusion: The RI is not inferior in sensitivity and specificity to the MELD score. Cirrhotic patients with elevated RIs have impaired short- and long-term survival. The RI may help identify high-risk patients that require special therapeutic care. Copyright (C) 2012 S. Karger AG, Base