The developed leaflet contains nine shoe characteristics .


A total of @ women ranging from @ to @ years old ( average @ ) consented to participate in testing the efficacy of the leaflet .


Women using the leaflet ( n = @ ) selected better shoes than without ( P = @ ) .


Based on a literature search and expert opinion , we have developed an information leaflet for GPs to provide as a supplement to oral shoe advice .


Women using this leaflet were able to select shoes of better quality and better fit than women selecting shoes without using the leaflet .


Ideal anesthetic technique for renal allograft recipients should provide hemodynamic stability , optimum graft reperfusion and adequate analgesia .


Balanced anesthesia is preferred because renal nociception is conducted multi-segmentally and chronically ill ESRD patients have labile psychological profile .


Present study compared the efficacy ofdexmedetomidine with fentanyl administered via intravenous and epidural route before induction of general anesthesia .


Prospective , double blind randomized study , recruited sixty hemo-dynamically stable ESRD adults , @-@ years , scheduled for elective live related renal transplantation .


Patients randomly received intravenous dexmedetomidine @ g/kg followed by epidural dexmedetomidine @ g/kg alongwith @ ml ; @ % ropivacaine or intravenous fentanyl @ g/kg followed by epiduralfentanyl @ g/kg alongwith @ ml ; @ % ropivacaine .


All patients received standardized general anaesthesia and continuous epidural ropivacaine @ % ; @-@ ml/hr .


Preoperative sedation , peri-operative haemodynamics , end tidal anaesthetic agent requirement , peri-operative fluid requirement , need for vasopressors , blood loss and early graft function was assessed .


@ % patients receiving intravenous dexmedetomidine did not require rescue midazolam for achieving satisfactory sedation before induction of general anaesthesia .


Dexmedetomidine significantly reduced propofol and end tidal inhalational agents requirement and need for rescue analgesics .


Early renal graft function ( onset time of diuresis after declamping , @ hours urine output and serum creatinine levels ) was comparable .


There were no adverse sequelae .


Dexmedetomidine-based anaesthetic regimen versus fentanyl-based anaesthesia provided appropriate anxiolysis and analgesia for conducting invasive procedures and subsequent epidural administration of these agents reduced anaesthetic requirement and prolonged postoperative analgesia without compromising hemodynamics and respiratory parameters .


Further dose finding studies can be conducted in kidney transplant recipients .


The effect of the surgical site of DBS on balance and gait in Parkinson 's Disease ( PD ) is uncertain .


This is the first double-blind study of subjects randomized to either the STN ( N = @ ) or GPi ( N = @ ) who were assessed on a range of clinical balance measures .


Balance testing occurred before and @ months postsurgery .


A control PD group was tested over the same period without surgery ( N = @ ) .


All subjects were tested on and off medication and DBS subjects were also tested on and off DBS .


The Postural Instability and Gait Disability items of the UPDRS and additional functional tests , which we call the Balance and Gait scale , were assessed .


Activities of Balance Confidence and Activities of Daily Living questionnaires were also recorded .


Balance was not different between the best-treated states before and after DBS surgery for both sites .


Switching DBS on improved balance scores , and scores further improved with medication , compared to the off state .


The GPi group showed improved performance in the postsurgery off state and better ratings of balance confidence after surgery , compared to the STN group .


Clinical measures of balance function for both the STN and GPi sites showed that balance did not improve beyond the best medically treated state before surgery .


Both clinical balance testing in the off/off state and self-reported balance confidence after surgery showed better performance in the GPi than the STN group .


The scale-up of malaria rapid diagnostic tests ( RDTs ) is intended to improve case management of fever and targeting of artemisinin-based combination therapy .


Habitual presumptive treatment has hampered these intentions , suggesting a need for strategies to support behaviour change .


We aimed to assess the introduction of RDTs when packaged with basic or enhanced clinician training interventions in Cameroon .


We did a three-arm , stratified , cluster-randomised trial at @ public and mission health facilities at two study sites in Cameroon to compare three approaches to malaria diagnosis .


Facilities were randomly assigned by a computer program in a @:@:@ ratio to current practice with microscopy ( widely available , used as a control group ) ; RDTs with a basic ( @ day ) clinician training intervention ; or RDTs with an enhanced ( @ days ) clinician training intervention .


Patients ( or their carers ) and fieldworkers who administered surveys to obtain outcome data were masked to study group assignment .


The primary outcome was the proportion of patients treated in accordance with WHO malaria treatment guidelines , which is a composite indicator of whether patients were tested for malaria and given appropriate treatment consistent with the test result .


All analyses were by intention to treat .


This study is registered at ClinicalTrials.gov , number NCT@ .


The study took place between June @ and Dec @ , @ .


The analysis included @ patients from nine facilities in the control group , @ patients from @ facilities in the basic-training group , and @ from @ facilities in the enhanced-training group .


The proportion of patients treated in accordance with malaria guidelines did not improve with either intervention ; the adjusted risk ratio ( RR ) for basic training compared with control was @ ( @ % CI @-@ ; p = @ ) , and for enhanced training compared with control was @ ( @-@ ; p = @ ) .


Inappropriate use of antimalarial drugs after a negative test was reduced from @ % ( @/@ ) in the control group to @ % ( @/@ ) in the basic-training group ( unadjusted RR @ , @-@ ; p = @ ) and to @ % ( @/@ ) in the enhanced-training group ( @ , @-@ ; p = @ ) .


Enhanced clinician training , designed to translate knowledge into prescribing practice and improve quality of care , has the potential to halve overtreatment in public and mission health facilities in Cameroon .


Basic training is unlikely to be sufficient to support the behaviour change required for the introduction of RDTs .


To investigate individual patient data from a comprehensive trials programme to evaluate the safety and efficacy of the dipeptidyl peptidase-@ ( DPP-@ ) inhibitor linagliptin across a range of glucose-lowering regimens in a large elderly population with type @ diabetes mellitus ( T@DM ) .


Data were pooled from individuals aged @ years , who participated in seven phase III , placebo-controlled clinical trials of linagliptin ( @-@ weeks ) .


Safety was assessed by incidence and severity of adverse events ( AEs ) with a focus on hypoglycaemia .


The primary efficacy endpoint was change in glycated haemoglobin ( HbA@c ) .


In total , @ subjects received linagliptin @ mg once a day and @ received placebo .


At baseline , the population had a mean s.d. age of @ @ years and a mean HbA@c concentration of @ @ % ; @ % of subjects received @ antidiabetes drugs .


Overall AEs and drug-related AEs were experienced by similar proportions of patients ( linagliptin @ , placebo @ ; linagliptin @ , placebo @ % , respectively ) .


The incidence of investigator-reported hypoglycaemia was @ % with linagliptin and @ % with placebo .


Severe hypoglycaemic events were rare and there were fewer in the linagliptin group ( @ vs. @ % ) .


At week @ , the placebo-corrected adjusted mean s.e. reduction in HbA@c with linagliptin was -@ @ % ( @ % CI : -@ , -@ ) .


Data from this large cohort show that linagliptin is a well-tolerated and efficacious therapy for elderly patients with T@DM .


Treatment with linagliptin may support individualized treatment goals , while effectively managing the risk of hypoglycaemia or drug-related side effects .


We presented the pattern of health care consumption , and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings .


A cohort of @,@ adults , @ years of age and older were sampled to estimate the number of urban-resident adults per @,@ who visited a medical facility at least once in a month , by the method of three-stage stratified and cluster random sampling .


Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics .


On average per @,@ adults , @ had at least one symptom , @ considered seeking medical care , @ consulted a physician , @ visited western medical practitioners , @ visited a hospital-based outpatient clinic , @ visited traditional Chinese medical practitioners , @ visited a primary care physician , @ received care in an emergency department , @ were hospitalized .


Health care seeking behaviors varied with socio-demographic characteristics , such as gender , age , ethnicity , resident census register , marital status , education , income , and health insurance status .


In term of primary care , the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing .


This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China .


Vitamin E ( VE ) bonded polysulfone dialysis membranes have putative erythropoiesis stimulating agent ( ESA ) - sparing and anti-inflammatory properties based on data from a small number of studies .


We sought to investigate this in a large , prospective @-month randomized controlled trial .


Two-hundred and sixty prevalent haemodialysis ( HD ) patients were randomized to dialysis with VE-bonded polysulfone membranes or non-VE-bonded equivalents .


All ESA-dosing was performed by means of a computer-based anaemia management decision support system .


Monthly data were used to calculate the ESA resistance index ( ERI ) and blood tests were performed at baseline , @ and @ months for measurement of C-reactive protein ( CRP ) levels .


Of the @ patients , @ were randomized to dialysis with the VE-membrane and @-month data was available for @ patients .


At the study population level , no beneficial effect of the VE membranes on the ERI or CRP levels was observed .


Post hoc analyses indicated that there was a significant fall in ERI for patients with the highest baseline ESA resistance dialysed with the VE ( @ -LSB- @-@ @ -RSB- versus @ -LSB- @-@ @ -RSB- IU/week/kg / g/dL Hb , P = @ ) but not the control membranes ( @ -LSB- @-@ @ -RSB- versus @ -LSB- @-@ @ -RSB- IU/week/kg / g/dL Hb , P = @ ) ; this was not attributable to changes in CRP levels .


Wholesale switching of all chronic HD patients to dialysis with VE-bonded polysulfone membranes appears not to be associated with improvements in ESA-responsiveness or CRP .


These membranes may have utility in patients with heightened ESA resistance .


Radiation Therapy Oncology Group ( RTOG ) @ showed a survival advantage for patients with @ but not @ or @ brain metastasis ( BM ) treated with whole-brain radiation therapy ( WBRT ) and stereotactic radiosurgery ( SRS ) versus WBRT alone .


An improved prognostic index , the graded prognostic assessment ( GPA ) has been developed .


Our hypothesis was that if the data from RTOG @ were poststratified by the GPA , the conclusions may vary .


In this analysis , @ of the @ patients were evaluable by GPA .


Of those , @ had lung cancer .


Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database .


Multiple Cox regression was used to compare survival between treatment groups , adjusting for GPA .


Treatment comparisons within subgroups were performed with the log-rank test .


A free online tool ( brainmetgpa.com ) simplified GPA use .


The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with @ to @ metastases ; however , there was a benefit for the subset of patients with GPA @ to @ ( median survival time -LSB- MST -RSB- for WBRT + SRS vs WBRT alone was @ versus @ months , P = @ ) regardless of the number of metastases .


Among patients with GPA @ to @ treated with WBRT and SRS , the MST for patients with @ versus @ to @ metastases was @ and @ months , respectively .


This secondary analysis of predominantly lung cancer patients , consistent with the original analysis , shows no survival advantage for the group overall when treated with WBRT and SRS ; however , in patients with high GPA ( @-@ ) , there is a survival advantage regardless of whether they have @ , @ , or @ BM .


This benefit did not extend to patients with lower GPA .


Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted .


Drug development and clinical decision making for patients with metastatic prostate cancer ( PC ) have been hindered by a lack of quantitative methods of assessing changes in bony disease burden that are associated with overall survival ( OS ) .


Bone scan index ( BSI ) , a quantitative imaging biomarker of bone tumor burden , is prognostic in men with metastatic PC .


We evaluated an automated method for BSI calculation for the association between BSI over time with clinical outcomes in a randomized double-blind trial of tasquinimod ( TASQ ) in men with metastatic castration-resistant PC ( mCRPC ) .


Bone scans collected during central review from the TASQ trial were analyzed retrospectively using EXINIbone ( BSI ) , an automated software package for BSI calculation .


Associations between BSI and other prognostic biomarkers , progression-free survival , OS , and treatment were evaluated over time .


Of @ men ( @ TASQ and @ placebo ) , @ contributed scans at baseline and week @ of sufficient quality .


Baseline BSI correlated with prostate-specific antigen and alkaline phosphatase levels and was associated with OS in univariate ( hazard ratio -LSB- HR -RSB- = @ , P = @ ) and multivariate ( HR = @ , P < @ ) analyses .


BSI worsening at @ weeks was prognostic for progression-free survival ( HR = @ per BSI doubling , P < @ ) and OS ( HR = @ , P = @ ) in multivariate analyses including baseline BSI and TASQ treatment .


TASQ delayed BSI progression .


BSI and BSI changes over time were independently associated with OS in men with mCRPC .


A delay in objective radiographic bone scan progression with TASQ is suggested ; prospective evaluation of BSI progression and response criteria in phase @ trials of men with mCRPC is warranted .


Mortality following hip hemiarthroplasty is in the range of @-@ % in the first year , with much attributed to post-operative complications .


One such complication is surgical site infection ( SSI ) , which at the start of this trial affected @ % of patients in the UK having this operation .


Compared to SSI rates of elective hip surgery , at less than @ % , this figure is elevated .


The aim of this quasi randomised controlled trial ( RCT ) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at @-months after hemiarthroplasty for intracapsular fractured neck of femur .


@ patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT .


Participants were recruited before surgery and quasi randomised to standard care or intervention group .


Participants , statistician and outcome assessors were blind to treatment allocation throughout the study .


The intervention consisted of high dose antibiotic impregnated cement consisting of @ gram Clindamycin and @ gram of Gentamicin .


The primary outcome is Health Protection Agency ( HPA ) defined deep surgical site infection at @ months .


Secondary outcomes include HPA defined superficial surgical site infection at @ days , @ and @-day mortality , length of hospital stay , critical care stay , and complications .


Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon , particularly in the speciality of orthopaedics .


The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty .


If high dose antibiotic impregnated cement is found to be an effective intervention , implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty .


To examine the influence of mechanical bowel preparation on surgical field visualization during laparoscopic hysterectomy .


The study 's primary outcome was the percentage of operations rated `` good '' or `` excellent '' in terms of surgical field visualization at the outset of the case by the primary surgeon .


Additional measures included assessment of visualization during the case and patient perioperative comfort .


The study was powered to detect a @ % absolute difference in the proportion of cases rated as `` good '' or `` excellent . ''


Seventy-three patients were assigned to mechanical bowel preparation and @ to no mechanical bowel preparation .


The groups were comparable regarding patient and surgery characteristics .


No differences were found for this rating between groups ( mechanical bowel preparation , @ of @ patients -LSB- @ % -RSB- , compared with no mechanical bowel preparation , @ of @ patients -LSB- @ % -RSB- , P = @ ) .


Surgeons guessed patient assignment correctly @ % of the time ( @ of @ patients ) with mechanical bowel preparation and @ % of the time ( @ of @ patients ) with no mechanical bowel preparation .


Mechanical bowel preparation is well-tolerated but does not influence surgical field visualization for laparoscopic hysterectomy .


Idiotypes ( Ids ) , the unique portions of tumor immunoglobulins , can serve as targets for passive and active immunotherapies for lymphoma .


We performed a multicenter , randomized trial comparing a specific vaccine ( MyVax ) , comprising Id chemically coupled to keyhole limpet hemocyanin ( KLH ) plus granulocyte macrophage colony-stimulating factor ( GM-CSF ) to a control immunotherapy with KLH plus GM-CSF .


Patients with previously untreated advanced-stage follicular lymphoma ( FL ) received eight cycles of chemotherapy with cyclophosphamide , vincristine , and prednisone .


Those achieving sustained partial or complete remission ( n = @ -LSB- @ % -RSB- ) were randomly assigned at a ratio of @:@ to receive one injection per month for @ months of MyVax or control immunotherapy .


Anti-Id antibody responses ( humoral immune responses -LSB- IRs -RSB- ) were measured before each immunization .


The primary end point was progression-free survival ( PFS ) .


Secondary end points included IR and time to subsequent antilymphoma therapy .


At a median follow-up of @ months , no significant difference was observed in either PFS or time to next therapy between the two arms .


In the MyVax group ( n = @ ) , anti-Id IRs were observed in @ % of patients , with a median PFS of @ months , significantly exceeding the median PFS observed in patients without such Id-induced IRs and in those receiving control immunotherapy .


This trial failed to demonstrate clinical benefit of specific immunotherapy .


The subset of vaccinated patients mounting specific anti-Id responses had superior outcomes .


Whether this reflects a therapeutic benefit or is a marker for more favorable underlying prognosis requires further study .


The poly ( ADP-ribose ) polymerase inhibitor olaparib has shown antitumour activity in patients with platinum-sensitive , recurrent , high-grade serous ovarian cancer with or without BRCA@ or BRCA@ mutations .


The aim of this study was to assess the efficacy and tolerability of olaparib in combination with chemotherapy , followed by olaparib maintenance monotherapy , versus chemotherapy alone in patients with platinum-sensitive , recurrent , high-grade serous ovarian cancer .


In this randomised , open-label , phase @ study , adult patients with platinum-sensitive , recurrent , high-grade serous ovarian cancer who had received up to three previous courses of platinum-based chemotherapy and who were progression free for at least @ months before randomisation received either olaparib ( @ mg capsules twice daily , administered orally on days @-@ of each @-day cycle ) plus paclitaxel ( @ mg/m ( @ ) , administered intravenously on day @ ) and carboplatin ( area under the curve -LSB- AUC -RSB- @ mg/mL per min , according to the Calvert formula , administered intravenously on day @ ) , then olaparib monotherapy ( @ mg capsules twice daily , given continuously ) until progression ( the olaparib plus chemotherapy group ) , or paclitaxel ( @ mg/m ( @ ) on day @ ) and carboplatin ( AUC @ mg/mL per min on day @ ) then no further treatment ( the chemotherapy alone group ) .


Randomisation was done by an interactive voice response system , stratified by number of previous platinum-containing regimens received and time to disease progression after the previous platinum regimen .


The primary endpoint was progression-free survival according to Response Evaluation Criteria in Solid Tumors version @ , analysed by intention to treat .


Prespecified exploratory analyses included efficacy by BRCA mutation status , assessed retrospectively .


This study is registered with ClinicalTrials.gov , number NCT@ , and has been completed .


Between Feb @ and July @ , @ , @ patients at @ investigational sites in @ countries were enrolled into the study , of whom @ were eligible and were randomly assigned to the two treatment groups ( @ to the olaparib plus chemotherapy group and @ to the chemotherapy alone group ) .


Of these randomised patients , @ were treated in the combination phase ( @ in the olaparib plus chemotherapy group and @ in the chemotherapy alone group ) and @ continued to the maintenance or no further treatment phase ( @ in the olaparib plus chemotherapy group and @ in the chemotherapy alone group ) .


BRCA mutation status was known for @ patients ( either at baseline or determined retrospectively ) : @ ( @ % ) of @ had a BRCA mutation ( @ in the olaparib plus chemotherapy group and @ in the chemotherapy alone group ) .


Progression-free survival was significantly longer in the olaparib plus chemotherapy group ( median @ months -LSB- @ % CI @-@ @ -RSB- ) than in the chemotherapy alone group ( median @ months -LSB- @ % CI @-@ @ ) ( HR @ -LSB- @ % CI @-@ @ -RSB- ; p = @ ) , especially in patients with BRCA mutations ( HR @ -LSB- @-@ @ -RSB- ; p = @ ) .


In the combination phase , adverse events that were reported at least @ % more frequently with olaparib plus chemotherapy than with chemotherapy alone were alopecia ( @ -LSB- @ % -RSB- of @ vs @ -LSB- @ % -RSB- of @ ) , nausea ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , neutropenia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , diarrhoea ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , headache ( @ -LSB- @ % -RSB- vs seven -LSB- @ % -RSB- ) , peripheral neuropathy ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , and dyspepsia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) ; most were of mild-to-moderate intensity .


The most common grade @ or higher adverse events during the combination phase were neutropenia ( in @ -LSB- @ % -RSB- of @ patients in the olaparib plus chemotherapy group vs @ -LSB- @ % -RSB- of @ in the chemotherapy alone group ) and anaemia ( seven -LSB- @ % -RSB- vs five -LSB- @ % -RSB- ) .


Serious adverse events were reported in @ ( @ % ) of @ patients in the olaparib plus chemotherapy group and @ of @ ( @ % ) patients in the chemotherapy alone group .


Olaparib plus paclitaxel and carboplatin followed by maintenance monotherapy significantly improved progression-free survival versus paclitaxel plus carboplatin alone , with the greatest clinical benefit in BRCA-mutated patients , and had an acceptable and manageable tolerability profile .


Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis ( CRS ) .


The standard for prescribing budesonide is via impregnated nasal saline irrigation ( INSI ) , although recently the mucosal atomization device ( MAD ) has emerged as a theoretically superior method of distributing medication into the sinuses .


The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability .


However , no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression .


The objective of this study is to determine whether budesonide via MAD affects the hypothalamic-pituitary-adrenal ( HPA ) axis .


Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide ( @ mg ) via MAD or via INSI twice a day for @ days .


The adrenocorticotropic hormone ( ACTH ) stimulation test and @-item Sinonasal Outcomes Test ( SNOT-@ ) questionnaire were administered on days @ , @ , and @ of the study .


Plasma budesonide and cortisol levels were simultaneously quantified using a high-performance liquid chromatography-tandem mass spectrometry technique .


There was no indication of adrenal suppression in either group ( n = @ ) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group .


Quality of life , as indicated by SNOT-@ , did not differ between groups at @ days ( p = @ ; @ % confidence interval -LSB- CI -RSB- , -@ to @ ) , but SNOT-@ scores for patients using MAD did show statistically significant improvement at @ days compared to baseline ( p = @ ) .


The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term .


The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C ( CysC ) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acute decompensated heart failure ( ADHF ) .


Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure .


CysC levels were measured in sequential plasma samples from @ subjects with ADHF who were enrolled in the ASCEND-HF ( Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure ) biomarker sub-study ( randomized to nesiritide therapy vs. placebo ) , and followed for all-cause death ( @ days ) and recurrent hospital stay ( @ days ) .


Median CysC levels were @ ( interquartile range -LSB- IQR -RSB- : @ to @ ) mg/l at baseline , @ ( IQR : @ to @ ) mg/l at @ to @ h , and @ ( IQR : @ to @ ) mg/l at @ days .


Higher baseline ( but not follow-up ) CysC levels were associated with increased risk of @-day adverse events and less improvement in dyspnea after @ h as well as @-day mortality , although not incremental to blood urea nitrogen .


Worsening renal function ( defined as a @ mg/l increase in CysC ) occurred in @ of @ ( @ % ) patients , but it was not predictive of adverse events .


Changes in CysC levels were similar between the nesiritide and placebo groups .


Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF .


However , worsening renal function based on CysC rise was not predictive of adverse events .


Nesiritide did not worsen renal function compared with placebo .


Pharmacokinetic ( PK ) and pharmacodynamic ( PD ) data are limited for artesunate ( AS ) and amodiaquine ( AQ ) in uncomplicated Plasmodium falciparum .


From @-@ , @ P. falciparum-infected , Kenyan adults were assigned randomly fixed dose ( FD ) ASAQ ( n = @ ) or non-fixed ( NF ) ASAQ ( n = @ ) .


Total doses were @ mg AS ( both arms ) + @,@ mg ( FD ) or @,@ mg ( NF ) AQ .


Follow-up extended over @ days .


PK data were collected for AS , dihydroartemisinin ( DHA ) , AS + DHA combined as DHA equivalents ( DHAeq ) , AQ , desethylamodiaquine ( DAQ ) , and their relationships assessed against the PD collected data consisting of parasitological efficacy , adverse events ( AEs ) , and the Bazett 's corrected QTinterval ( QTcB ) .


Mean AUC @-@ of dihydroartemisinin equivalents ( DHAeq ) when administered as a fixed dose ( FD ) compared to NF dose were similar : @ @ vs @ mol * h/L ( p = @ ) Parasite clearance rates were also similar after @ hrs : @/@ ( @ % ) vs @/@ ( @ % ) ( p = @ ) , as well as at @ hrs : @/@ ( @ % ) vs @ ( @ % ) / @ ( p = @ ) .


Mean FD vs NF DAQ AUC@-@ were @ vs @ mg * h/L ( p = @ ) .


Two PCR-proven new infections occurred on Day ( D ) @ for estimated , in vivo , DAQ minimum inhibitory concentrations of @ and @ ng/mL .


Combining the FD and NF arms , the mean QTcB at D@ +@ hrs increased significantly ( p = @ ) vs baseline : @ vs@ ms ( = @ ( @ % confidence interval @-@ @ ms ) , explained by falling heart rates , increasing DAQ concentrations and female sex in a general linear mixed effects model .


Ten of @ ( @ % ) AEs ( @/arm ) reported by @/@ ( @ % ) patients were possibly or probably drug related .


Severe , asymptomatic neutropaenia developed in @/@ ( @ % ) patients on D@ : @/L ( vsD@ : @,@ / L ) , and @/L ( vsD@ : @,@ / L ) .


Tolerability of both formulations was good .


For QTcB , a parameter for ECG modifications , increases were modest and due to rising DAQ concentrations and falling heart rates as malaria resolved .


Rapid parasite clearance rates and no resistant infections suggest effective pharmacokinetics of both formulations .


To compare the operative outcomes of patients undergoing either single-port or multiport laparoscopic hysterectomy ( LH ) .


Two hundred fifty-six women scheduled for LH for symptomatic myoma and/or adenomyosis from @ tertiary teaching hospitals were randomized to single-port or multiport groups .


Primary outcome was conversion and/or complication proportion of the planned procedure to determine whether the success proportion of the single-port approach was not inferior to that of the multiport approach .


Secondary outcomes were postoperative pain and operative scar .


Demographic parameters including age , body mass index , parity , and history of vaginal and cesarean delivery were comparable between the @ groups .


The primary outcome of a combined conversion and/or complication rate was similar between the single-port and multiport groups at @ % and @ % , respectively .


Conversions were similar between the groups with @ % of single-port cases and @ % of multiport cases .


Transfusions were the most frequent complication required in @ % of single-port cases and @ % of multiport cases , with no difference between the groups .


Concerning secondary outcomes , postoperative pain score and patient and observer scar assessment were not different between the @ groups .


Although not a specific outcome measure , there was no difference between the groups in blood loss , operative time , and postoperative hospital stay .


Single-port LH is not inferior to multiport LH in terms of conversion and/or complications rates , including transfusion .


However , the single-port approach did not have any advantage over multiport LH with regard to pain or cosmetic outcomes .


These findings were demonstrated by multi-institutional surgeons in Korea .


In Europe , gastric cancer remains diagnosed at advanced stage ( serosal and/or lymph node involvement ) .


Despite curative management combining perioperative systemic chemotherapy and gastrectomy with D@-D@ lymph node dissection , @-year survival rates of T@ and/or N + patients remain under @ % .


More than @ % of recurrences are peritoneal and/or locoregional .


The use of adjuvant hyperthermic intraperitoneal chemotherapy that eliminates free cancer cells that can be released into peritoneal cavity during the gastrectomy and prevents peritoneal carcinomatosis recurrences , was extensively evaluated by several randomized trials conducted in Asia .


Two meta-analysis reported that adjuvant hyperthermic intraperitoneal chemotherapy significantly reduces the peritoneal recurrences and significantly improves the overall survival .


As it was previously done for the evaluation of the extension of lymph node dissection , it seems very important to validate on European or caucasian patients the results observed in trials performed in Asia .


GASTRICHIP is a prospective , open , randomized multicenter phase III clinical study with two arms that aims to evaluate the effects of hyperthermic intraperitoneal chemotherapy with oxaliplatin on patients with gastric cancer involving the serosa and/or lymph node involvement and/or with positive cytology at peritoneal washing , treated with perioperative systemic chemotherapy and D@-D@ curative gastrectomy .


Peroperatively , at the end of curative surgery , patients will be randomized after preoperatively written consent has been given for participation .


Primary endpoint will be overall survival from the date of surgery to the date of death or to the end of follow-up ( @ years ) .


Secondary endpoint will be @ - and @-year recurrence-free survival , site of recurrence , morbidity , and quality of life .


An ancillary study will compare the incidence of positive peritoneal cytology pre - and post-gastrectomy in two arms of the study , and assess its impact on @-year survival .


The number of patients to be randomized was calculated to be @ .


Transoral esophagogastric fundoplication ( TF ) can decrease or eliminate features of gastroesophageal reflux disease ( GERD ) in some patients whose symptoms persist despite proton pump inhibitor ( PPI ) therapy .


We performed a prospective , sham-controlled trial to determine if TF reduced troublesome regurgitation to a greater extent than PPIs in patients with GERD .


We screened @ patients with troublesome regurgitation despite daily PPI use with @ validated GERD-specific symptom scales , on and off PPIs .


Those with at least troublesome regurgitation ( based on the Montreal definition ) on PPIs underwent barium swallow , esophagogastroduodenoscopy , @-hour esophageal pH monitoring ( off PPIs ) , and high-resolution esophageal manometry analyses .


Patients with GERD and hiatal hernias @ cm were randomly assigned to groups that underwent TF and then received @ months of placebo ( n = @ ) , or sham surgery and @ months of once - or twice-daily omeprazole ( controls , n = @ ) .


Patients were blinded to therapy during follow-up period and reassessed at @ , @ , and @ weeks .


At @ months , patients underwent @-hour esophageal pH monitoring and esophagogastroduodenoscopy .


By intention-to-treat analysis , TF eliminated troublesome regurgitation in a larger proportion of patients ( @ % ) than PPIs ( @ % ) ( P = @ ) .


A larger proportion of controls had no response at @ months ( @ % ) than subjects that received TF ( @ % ; P = @ ) .


Control of esophageal pH improved after TF ( mean @ % before and @ % after ; P < @ ) , but not after sham surgery ( mean @ % before and @ % after ) .


Subjects from both groups who completed the protocol had similar reductions in GERD symptom scores .


Severe complications were rare ( @ subjects receiving TF and @ receiving the sham surgery ) .


TF was an effective treatment for patients with GERD symptoms , particularly in those with persistent regurgitation despite PPI therapy , based on evaluation @ months after the procedure .


Clinicaltrials.gov no : NCT@ .


To compare @ short-term , community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low resources .


Low resource was defined by the US Department of Housing and Urban Development low-income index or @ `` indicator , '' ( e.g. , Medicaid eligibility ) .


Child outcomes focused on joint engagement , joint attention , and play .


Participants included @ families of a child who had Autism Spectrum Disorder who met criteria for being low-resourced and who were randomly assigned to @ of @ @-month interventions , group caregiver education or individualized caregiver-mediated intervention ( CMM ) .


Children were assessed for social communication skills pre - and post-treatment , and followed up at @ months .


All children improved in joint engagement and initiating joint attention , with significantly greater improvement by the CMM group .


Outcomes on play skills were mixed , with improvement of symbolic play for the CMM group and no change in functional play skills .


Joint engagement maintained over time for the CMM group , and initiating joint attention maintained for both groups over time .


This study is among the first randomized trials comparing @ active interventions with a large sample of low-resourced families .


Results suggest improvements in core autism deficits of joint engagement , joint attention , and symbolic play with relatively brief , caregiver-mediated interventions , but additional support is necessary to maintain and generalize these gains over time .


Appetitive and aversive processes share a number of features such as their relevance for action and learning .


On a neural level , reward and its predictors are associated with increased firing of dopaminergic neurons , whereas punishment processing has been linked to the serotonergic system and to decreases in dopamine transmission .


Recent data indicate , however , that the dopaminergic system also responds to aversive stimuli and associated actions .


In this pharmacological functional magnetic resonance imaging study , we investigated the contribution of the dopaminergic system to reward and punishment processing in humans .


Two groups of participants received either placebo or the dopamine precursor levodopa and were scanned during alternating reward and punishment anticipation blocks .


Levodopa administration increased striatal activations for cues presented in punishment blocks .


In an interaction with individual personality scores , levodopa also enhanced striatal activation for punishment-predictive compared with neutral cues in participants scoring higher on the novelty-seeking dimension .


These data support recent indications that dopamine contributes to punishment processing and suggest that the novelty-seeking trait is a measure of susceptibility to drug effects on motivation .


These findings are also consistent with the possibility of an inverted U-shaped response function of dopamine in the striatum , suggesting an optimal level of dopamine release for motivational processing .


Internet-based interventions ( IBI ) are effective in treating depression .


However , uptake rates in routine care are still limited .


Hence , this study aimed to ( @ ) assess the acceptance of IBIs in primary care patients with depressive symptoms and to ( @ ) examine the effects of a brief acceptance facilitating intervention in the form of an informational video on patients ' acceptance of IBIs .


Primary care patients ( N = @ ) with Minor or Major Depression were randomly assigned to an intervention ( IG ) or control group ( CG ) .


Patients in the IG were shown a brief informational video about IBIs before receiving a questionnaire that assessed their acceptance of IBIs and other secondary outcomes .


Patients of the CG filled out the questionnaire immediately .


Baseline acceptance of IBIs in the CG was high for @ % , moderate for @ % and low for @ % of patients .


Acceptance of IBIs was significantly higher in the IG when compared to the CG ( d = @ , @ % - CI : @ -@ ) .


Except for social influence and the general attitude towards psychological treatment , all secondary outcomes were also significantly improved ( e.g. effort - ( d = @ ) and performance-expectancy : d = @ ; knowledge about Internet interventions d = @ ) .


Depression of the participants was only assessed using a self-report measure ( PHQ-@ ) .


Primary care patients ' acceptance of IBIs for depressive symptoms was low but could be increased significantly using a brief acceptance facilitating intervention on the basis of an informational video .


Future studies should further examine the potential of acceptance facilitating interventions for patients and health care providers to exploit the public health impact of IBIs .


Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions .


We tested a train-the-trainer ( TTT ) dissemination model for the treatment of posttraumatic stress disorder ( PTSD ) .


We randomly assigned widowed or orphaned survivors of the @ Rwandan genocide with a PTSD diagnosis to narrative exposure therapy ( NET ) treatment ( NET-@ , n = @ ) or to a @-month waiting list ( WL ) condition to be followed by treatment ( WL/NET -@ , n = @ ) .


Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by @ sessions of interpersonal psychotherapy modules .


Under the supervision of the experts , these Rwandan psychologists ( a ) provided NET to the NET-@ participants and ( b ) subsequently trained and supervised a second generation of local psychologists .


This second dissemination generation provided treatment to the WL/NET -@ group .


The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at @ - and @-month follow-ups .


At the @-month follow-up , the NET-@ participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group .


The treatment gains of NET-@ were maintained and increased at follow-up , with a within-group effect size of Cohen 's d = @ at the @-month follow-up .


After treatment by the second dissemination generation of therapists , the WL/NET -@ participants improved to an extent similar to that of the NET-@ group at follow-ups , with an effect size of Cohen 's d = @ at the @-month follow-up .


A TTT model of PTSD treatment dissemination can be effective in resource-poor postconflict societies .


This trial evaluated the efficacy of maintenance erlotinib , an epidermal growth factor receptor ( EGFR ) tyrosine kinase inhibitor , after first-line chemotherapy .


Eligible patients had high-risk International Federation of Gynecology and Obstetrics stage I or stage II to IV epithelial ovarian , primary peritoneal , or fallopian tube cancer and were not selected for EGFR expression .


All patients underwent first-line platinum-based chemotherapy ( CT ) and showed no signs of progression at the end of CT. .


Patients were randomly assigned to maintenance erlotinib @ mg orally daily for @ years or to observation .


EGFR immunohistochemistry ( IHC ) , fluorescent in situ hybridization ( FISH ) , and mutation analyses were performed in @ patients .


Between October @ and February @ , @ patients were randomly assigned ( median follow-up , @ months ) .


Twenty-six percent of the patients stopped erlotinib as a result of adverse effects ( of these , @ % were due to rash ) .


For erlotinib and observation , respectively , the median progression-free survival was @ and @ months ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ) , and the median overall survival was @ and @ months ( HR , @ ; @ % CI , @ to @ months ) , respectively .


No subgroup could be identified with improved effect of erlotinib , based on IHC or FISH for EGFR , or mutations in genes related to the EGFR pathway , or on rash during erlotinib therapy .


However , patients with a positive FISH EGFR score had a worse overall survival ( @ months ) than those with a negative score ( @ months ; HR , @ ; @ % CI , @ to @ ; P = @ ) .


Global health/quality-of-life scores showed a significant difference during the first year ( P = @ ) in favor of the observation arm .


Maintenance erlotinib after first-line treatment in ovarian cancer did not improve progression-free or overall survival .


To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation ( APBI ) using @-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID ( Randomized Trial of Accelerated Partial Breast Irradiation ) trial .


Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at @years .


Adverse cosmesis was defined as a score of fair or poor .


Cosmetic deterioration was defined as any adverse change in score from baseline to @years .


The analysis is based on data from the previously reported interim analysis .


Logistic regression models were used to assess the association ofrisk factors for these outcomes among all patients and those treated with APBI only .


Clinicopathologic characteristics were similar between subjects randomized to APBI ( n = @ ) or whole-breast irradiation ( n = @ ) .


For all subjects , factors associated with adverse cosmesis at @years were older age , central/inner tumor location , breast infection , smoking , seroma volume , breast volume , and use of APBI ; factors associated with cosmetic deterioration were smoking , seroma volume , and use of APBI ( P < @ ) .


For APBI subjects , tumor location , smoking , age , and seroma volume were associated with adverse cosmesis ( P < @ ) , and smoking was associated with cosmetic deterioration ( P = @ ) .


An independent association between the V@/whole-breast volume ratio and adverse cosmesis ( P = @ ) or cosmetic deterioration ( P = @ ) was not detected .


On further exploration a V@/whole-breast volume ratio < @ was associated with a lower risk of cosmetic deterioration ( p = @ ) , but this accounted for only @ % of patients .


In the RAPID trial , a number of patient tumor and treatment-related factors , including the use of APBI , were associated with adverse cosmesis and cosmetic deterioration .


For patients treated with APBI alone , the high-dose treatment volume was not independently associated with an adverse cosmetic outcome , and a useful clinical threshold could not be identified .


Oral mucositis ( OM ) is a painful complication of radiation therapy ( RT ) for head and neck cancer ( H&NC ) .


OM can compromise nutrition , require opioid analgesics and hospitalization for pain control , and lead to treatment interruptions .


Based on the role of inflammatory pathways in OM pathogenesis , we investigated effect of cyclooxygenase-@ ( COX-@ ) inhibition on severity and morbidity of OM .


In this double-blind placebo-controlled trial , @ H&NC patients were randomized to daily use of @ mg celecoxib or placebo , for the duration of RT. .


Clinical OM , normalcy of diet , pain scores , and analgesic use were assessed @-@ times/week by blinded investigators during the @-@ week RT period , using validated scales .


Twenty subjects were randomized to each arm , which were similar with respect to tumor location , radiation dose , and concomitant chemotherapy .


In both arms , mucositis and pain scores increased over course of RT. .


Intention-to-treat analyses demonstrated no significant difference in mean Oral Mucositis Assessment Scale ( OMAS ) scores at @ cGy ( primary endpoint ) .


There was also no difference between the two arms in mean OMAS scores over the period of RT , mean worst pain scores , mean normalcy of diet scores , or mean daily opioid medication use in IV morphine equivalents .


There were no adverse events attributed to celecoxib use .


Daily use of a selective COX-@ inhibitor , during period of RT for H&NC , did not reduce the severity of clinical OM , pain , dietary compromise or use of opioid analgesics .


These findings also have implications for celecoxib use in H&NC treatment regimens ( NCT@ ) .


A proportion of HIV-positive people have condomless sex .


Antiretroviral treatment ( ART ) reduces infectiousness , but a substantial proportion of HIV-diagnosed people are not yet on ART .


We describe baseline self-reported risk behaviours in ART-nave Strategic Timing of AntiRetroviral Treatment ( START ) trial participants .


All START participants completed a risk behaviour questionnaire .


Data were collected on sociodemographics , lifestyle factors , health and wellbeing status and clinical status .


Recent sexual behaviour and HIV transmission beliefs in the context of ART were also assessed .


The primary interest was in condomless sex with serodifferent partners ( CLS-D ) in the past two months .


A total of @ of @ HIV-positive participants ( @ % ) completed the questionnaire -LSB- @ men who have sex with men ( MSM ) , @ heterosexual men and @ women -RSB- .


Region of recruitment was Europe/Israel , @ % ; South America/Mexico , @ % ; Africa , @ % ; other , @ % .


Median age was @ years -LSB- interquartile range ( IQR ) @ , @ years -RSB- .


Forty-five per cent reported white ethnicity and @ % black ethnicity .


Two per cent had HIV viral load < @ HIV-@ RNA copies/mL .


Seventeen per cent ( @ of @ ) reported CLS-D ; @ % of MSM compared with @ % of heterosexual men and @ % of women .


MSM were also more likely to report multiple CLS-D partners .


Possible risk limitation measures ( reported by more than half of those who had CLS-D ) were seropositioning ( receptive anal CLS-D only ) or withdrawal ( insertive anal CLS-D always without ejaculation ) .


CLS-D was more commonly reported by participants from South America/Mexico and North America compared with Europe ; among heterosexual men and women CLS-D was also more commonly reported among participants from Africa compared with Europe .


Knowledge of ART impact on transmission risk was low .


A substantial minority recruited to the START study reported CLS-D at baseline .


CLS-D reporting was higher in MSM than heterosexuals and varied significantly according to region of recruitment .


A substantial proportion of MSM reporting CLS-D appear to take transmission risk limitation measures .


It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction .


It is controversial how big an impact the flap innervation has on the muscle activity of the flap .


The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction .


Between @ and @ , @ breast reconstructions were performed and randomly divided into denervation group ( surgical denervation by excision of @ cm of proximal thoracodorsal nerve , n = @ ) and innervation group ( thoracodorsal nerve saved intact , n = @ ) .


Patients were clinically evaluated and a questionnaire considering functional and aesthetic outcome was filled @-year after operation .


Muscular twitching , pain , tightness , shape and symmetry of the breasts were evaluated .


In addition , the mobility of the shoulder joint on the operated side was evaluated and the patients self-estimated the activities of daily living .


There was no significant difference in latissimus dorsi flap twitching , pain and tightness of the breast and symmetry and shape of the breasts between denervated and innervated groups .


The shoulder joint mobility was not found to be changed significantly in either of the groups and there were no limitations in activities of daily living .


Thoracodorsal nerve division or preservation does not significantly affect muscle contraction activity of the latissimus dorsi flap and distortion of the breast when latissimus dorsi muscle humeral insertion is also detached .


Therefore , both cutting and saving the nerve are justified in latissimus dorsi flap breast reconstruction depending on whether the humeral insertion of the muscle is preserved intact or divided and the flap islanded .


The study shows that there is no tangible benefit in dividing the nerve when the flap is islanded .


Clinical trial has been registered in public trials registry .


Trial registry name is ` The significance of latissimus dorsi flap innervation in delayed breast reconstruction ' .


Registration number is NCT@ and URL is https://register.clinicaltrials.gov .


We examined the effect of caffeine ingestion on muscle torque production and muscle activity at different contraction speeds in trained men .


@ men ( mean age SD = @ @ years ) volunteered to participate .


A double-blind , randomized cross-over design was used .


Sixty minutes postingestion of caffeine ( @ mg kg ( -@ ) ) or placebo , participants completed @ repetitions of isokientic knee extension at @ angular velocities ( @s ( -@ ) , @s ( -@ ) , @s ( -@ ) ) from which peak torque was determined .


Electromyographic activity of the vastus medialis was also collected .


Repeated measures analysis of variance indicated that muscle torque production was significantly higher ( P = @ ) with caffeine compared with placebo .


A significant ( P = @ ) substance by velocity interaction for muscle activity indicated significantly higher vastus medialis muscle activity in the presence of caffeine versus placebo , and this difference was amplified as angular velocity increased .


Acute caffeine ingestion improves muscle performance and increases muscle activity during short-duration maximal dynamic contractions .


Performance improvements after caffeine ( CAF ) ingestion are well documented when using a @-d protocol .


In numerous competitions such as the Tour de France , Tour de Ski , world championships , and National College Athletic Association championships , athletes compete for several days in a row .


To date , no studies have investigated the effects of CAF when competing for consecutive days in a row .


This study aimed to investigate the effects of placebo ( PLA ) and two different CAF doses ( @ and @ mgkg body mass ) on performance in a @-min all-out , cross-country , double poling ergometer test ( C-PT ) @ d in a row .


Eight highly trained male cross-country skiers ( VO@max-run , @ @ mLkgmin ) participated in the study , which was a randomized , double-blind , PLA-controlled , crossover design .


Performance was assessed as distance covered during a @-min all-out C-PT .


Oral ingestion of CAF or PLA was consumed @ min before the all-out C-PT .


Poling distance was improved after CAF ingestions compared with that after PLA on both days .


The improvements on day @ were @ % ( @ % confidence limits , @ ) and @ % @ % for both CAF doses , respectively ( P < @ ) , whereas improvements on day @ were @ % @ % and @ % @ % for CAF@ and CAF@ @ , respectively , compared with those for PLA .


Improved performance was associated with increased HR , adrenaline concentration , blood lactate concentration , and VO@ consumption after CAF ingestion .


Furthermore , performance was elevated despite higher creatine kinase concentration and muscular pain at arrival on day @ for both CAF doses .


Both CAF doses improved performance in the @-min all-out C-PT compared with PLA over two consecutive days .


Therefore , CAF seems useful for athletes competing over consecutive days despite higher muscle damage occurring after enhanced performance on the first day .


When compared with more traditional instructional methods , Game-based e-learning ( GbEl ) promises a higher motivation of learners by presenting contents in an interactive , rule-based and competitive way .


Most recent systematic reviews and meta-analysis of studies on Game-based learning and GbEl in the medical professions have shown limited effects of these instructional methods .


To compare the effectiveness on the learning outcome of a Game-based e-learning ( GbEl ) instruction with a conventional script-based instruction in the teaching of phase contrast microscopy urinalysis under routine training conditions of undergraduate medical students .


A randomized controlled trial was conducted with @ medical students in their third year of training in the Department of Urology at the University Medical Center Freiburg , Germany .


@ subjects where allocated for training with an educational adventure-game ( GbEl group ) and @ subjects for conventional training with a written script-based approach ( script group ) .


Learning outcome was measured with a @ item single choice test .


Students ' attitudes were collected by a questionnaire regarding fun with the training , motivation to continue the training and self-assessment of acquired knowledge .


The students in the GbEl group achieved significantly better results in the cognitive knowledge test than the students in the script group : the mean score was @ for the GbEl group and @ for the script group of a total of @ points with a Cohen 's d effect size of @ ( ITT analysis ) .


Attitudes towards the recent learning experience were significantly more positive with GbEl .


Students reported to have more fun while learning with the game when compared to the script-based approach .


Game-based e-learning is more effective than a script-based approach for the training of urinalysis in regard to cognitive learning outcome and has a high positive motivational impact on learning .


Game-based e-learning can be used as an effective teaching method for self-instruction .


Depression is a high prevalence disorder , displaying high rates of lifetime incidence , early age onset , high chronicity , and role impairment .


In Ireland @-month prevalence of depression has been reported to be @ % .


A large percentage of affected individuals have no medical diagnosis nor seek treatment .


Cognitive Behavior Therapy ( CBT ) has established itself as an option for the treatment of depression .


Many Irish adults with depression find it difficult to access evidence-based CBT , this is due to several factors , like stigma and costs .


However , systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.Stepped-care can increase access to evidence-based CBT .


One option is tailored internet-delivered treatment programs .


Preliminary research from Ireland needs now to include large-scale studies on effectiveness .


Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample .


The study is a randomized controlled trial of an online CBT ( iCBT ) program for the treatment of adults with depressive symptoms .


The trial will include an active treatment group and a waiting-list control group .


The active condition will consist of @ weekly modules of iCBT , with post-session feedback support .


Participants in the waiting list will receive access to the treatment at week @ .


Participants will complete the Beck Depression Inventory ( BDI-II ) and eligibility criteria will also apply .


Primary outcomes are depressive symptoms .


Secondary outcomes include quality of life indicators , significant events and satisfaction with online treatment .


Data will be collected at baseline and at post-treatment , week @ , and at follow-up week @ ( @-months ) and week @ ( @-months ) .


Analysis will be conducted on the intention-to-treat basis .


The study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression .


The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms .


Regular breakfast consumption may protect against type @ diabetes risk in adults but little is known about its influence on type @ diabetes risk markers in children .


We investigated the associations between breakfast consumption ( frequency and content ) and risk markers for type @ diabetes ( particularly insulin resistance and glycaemia ) and cardiovascular disease in children .


We conducted a cross-sectional study of @,@ UK primary school children aged @-@ years .


Participants provided information on breakfast frequency , had measurements of body composition , and gave fasting blood samples for measurements of blood lipids , insulin , glucose , and glycated haemoglobin ( HbA@c ) .


A subgroup of @,@ children also completed a @-hour dietary recall .


Among @,@ children studied , @,@ ( @ % ) ate breakfast daily , @ ( @ % ) most days , @ ( @ % ) some days , and @ ( @ % ) not usually .


Graded associations between breakfast frequency and risk markers were observed ; children who reported not usually having breakfast had higher fasting insulin ( percent difference @ % , @ % CI @ % -@ % ) , insulin resistance ( percent difference @ % , @ % CI @ % -@ % ) , HbA@c ( percent difference @ % , @ % CI @ % -@ % ) , glucose ( percent difference @ % , @ % CI @ % -@ % ) , and urate ( percent difference @ % , @ % CI @ % -@ % ) than those who reported having breakfast daily ; these differences were little affected by adjustment for adiposity , socioeconomic status , and physical activity levels .


When the higher levels of triglyceride , systolic blood pressure , and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity , the differences were no longer significant .


Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types ( p for heterogeneity < @ ) .


Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type @ diabetes markers .


Children who ate breakfast daily , particularly a high fibre cereal breakfast , had a more favourable type @ diabetes risk profile .


Trials are needed to quantify the protective effect of breakfast on emerging type @ diabetes risk .


Please see later in the article for the Editors ' Summary .


The goal of this study was to determine if a robotic dry laboratory curriculum for gynecology and urology residents improved their basic robotic skills .


After the institution-specific institutional review board approval or exemption , @ residents from @ gynecology and/or urology programs were enrolled .


Residents underwent standardized robotic orientation followed by dry laboratory testing on @ unique robotic tasks .


Residents were block randomized by program to unstructured or structured training programs .


Regardless of group , residents were expected to practice for @ minutes twice monthly over @ months .


Errors , time to completion , and objective structured assessment of technical skills global rating scores were recorded for each task before and after the training period .


Statistics were calculated using the Student t tests , Pearson correlation , and analysis of variance with STATA systems ( version @ ) .


A total of @ residents completed both the pretraining and posttraining testing .


A mean of @ ( range , @-@ ) @-minute training sessions per resident was self-reported .


The structured group had faster posttraining times on the transection task , although the unstructured group had higher posttraining scores on the knot-tying task .


Overall , the residents ' robotic skills improved after participating in a dry laboratory curriculum ; however , robotic availability , duty hour restrictions , and clinical responsibilities limit the curriculum implementation .


More than @ % of children in Nepal are malnourished .


Economic growth and poverty reduction are not always sufficient to improve the health and nutritional status of children .


Heifer Nepal uses livestock training as a tool for community development and poverty alleviation but does not directly address child health and nutrition .


To systematically assess the effects of Heifer activities on child health and nutrition .


The study was a @-year , longitudinal , randomized , controlled trial in six communities in Nepal ( both Terai and hills ) , pair-matched for specific characteristics , randomly assigned to receive Heifer community development activities at baseline ( intervention ) or @ year ( control ) .


At @-month intervals over a period of @ years , child anthropometric and comprehensive household surveys were performed .


Four hundred fifteen households were enrolled containing @ children @ months to @ years of age .


The intervention and control communities were equivalent for baseline socioeconomic status , household size , ownership of land and animals , and child nutrition and health .


At @ months ( prior to animal donations ) , the Terai intervention group had improved child weight ( p = @ ) , improved child height ( p = @ ) , and reduced sick days ( p = @ ) , as well as increased household income ( p = @ ) , increased ownership of animals ( p = @ ) and land ( p = @ ) , and improved sanitation practices ( p < @ ) .


In all districts , longer participation in Heifer activities corresponded to more improvement in child height-for-age z-scores .


Heifer interventions resulted in improved socioeconomic status and household income per family member .


Children under @ months of age in the intervention group had greater incremental improvement in height-for-age and weight-for-age z-scores than children in the control group , and longer participation in Heifer activities was associated with better growth .


Poverty alleviation programs , such as Heifer , may indirectly benefit child growth .


To evaluate whether anticholinergic medication contributes to early recovery of continence and improvement of other voiding symptoms after radical prostatectomy ( RP ) .


A total of @ patients with clinically localized prostate cancer who had incontinence at @ week after RP were enrolled prospectively .


The patients were allocated to one of the @ groups : group @ ( - adrenergic agonist -LSB- midodrine -RSB- plus an anticholinergic -LSB- solifenacin -RSB- ) or group @ ( - adrenergic agonist only ) .


A urodynamic study and the International Continence Society male Short Form questionnaire were completed preoperatively and @ months after RP .


One-hour pad test and @-day frequency volume chart at @ and @ months after medication were also analyzed .


The rate of continence , defined as being pad free , did not differ between the groups at @ months ( both @ % ; P > @ ) .


However , the decreased value of mean weight of daily pads worn by groups @ and @ were @ vs @ g , respectively ( P = @ ) .


The incontinence ( P = @ ) and quality of life ( P = @ ) subscale scores significantly worsened in group @ , whereas they remained unchanged in group @ .


Maximal detrusor pressure and maximal urethral closure pressure significantly decreased in both groups , whereas maximal cystometric capacity increased significantly in group @ only ( @-@ @ cm H@O ; P < @ ) .


Anticholinergics may facilitate early recovery from incontinence and prevent worsening of quality of life , which might be attributed to increased cystometric capacity after their use .


Endoscopic biliary sphincterotomy ( EBS ) results in permanent loss of sphincter function and its long-term complications are unknown .


Endoscopic papillary balloon dilation ( EPBD ) is an alternative procedure that preserves sphincter function , although it is associated with a higher risk of pancreatitis than is EBS .


The aim of this study was to evaluate the safety and outcomes of EPBD with limited indications for removal of common bile duct ( CBD ) stones combined with gallstones in patients younger than @ years .


Young ( age < @ years ) patients who had CBD stones combined with gallstones on imaging studies were enrolled in this study .


A total of @ patients were randomly divided into the EPBD group ( n = @ ) or the EBS group ( n = @ ) for extraction of CBD stones .


The ballooning size of EPBD ranged from @ to @ mm .


Complete bile duct clearance was achieved in @ % ( @/@ ) of the EPBD group and @ % ( @/@ ) of the EBS group .


Mechanical lithotripsy was required in @ % ( @/@ ) of the EPBD group and @ % ( @/@ ) of the EBS group .


The early complication rates were @ % ( @/@ ) ( five pancreatitis ) in the EPBD group and @ % ( @/@ ) ( five -LSB- @ % -RSB- pancreatitis , two bleeding and one perforation ) in the EBS group .


The recurrence rates of CBD stones were @ % ( @/@ ) in the EPBD group and @ % ( @/@ ) in the EBS group .


EPBD with limited indications was safe and effective as EBS for removal of CBD stones combined with gallstones in young patients who had a longer life expectancy .


We tested the efficacy of an adapted evidence-based HIV-sexually transmitted infection ( STI ) behavioral intervention ( Providing Opportunities for Women 's Empowerment , Risk-Reduction , and Relationships , or POWER ) among incarcerated women .


We conducted a randomized trial with @ women aged @ to @ years in @ correctional facilities in North Carolina in @ and @ .


Intervention participants attended @ POWER sessions ; control participants received a single standard-of-care STI prevention session .


We followed up at @ and @ months after release .


We examined intervention efficacy with mixed-effects models .


POWER participants reported fewer male sexual partners than did control participants at @ months , although this finding did not reach statistical significance ; at @ months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner .


POWER participants also reported significantly fewer condom barriers , and greater HIV knowledge , health-protective communication , and tangible social support .


The intervention had no significant effects on incident STIs .


POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities .


We compared the efficacy of IV valproate with metoclopramide and with ketorolac in patients presenting to an emergency department ( ED ) with acute migraine .


This was a double-blind comparative efficacy trial .


Patients were randomized to @,@ mg sodium valproate , @ mg metoclopramide , or @ mg ketorolac , each administered as an IV drip over @ minutes .


The primary outcome was improvement in headache by @ hour , measured on a verbal @ to @ scale , at baseline and @ minutes later .


Important secondary outcomes included ( @ ) need for rescue medication in the ED , and ( @ ) sustained headache freedom .


Three hundred thirty patients were enrolled over @ months beginning in October @ .


Baseline characteristics were comparable among the @ arms .


On the primary outcome , patients receiving IV valproate improved by a mean of @ ( @ % confidence interval -LSB- CI -RSB- : @ , @ ) on the @ to @ scale ; those receiving IV metoclopramide improved by @ ( @ % CI : @ , @ ) ; and those receiving IV ketorolac improved by @ ( @ % CI : @ , @ ) .


On the secondary endpoints , @ % ( @ % CI : @ % , @ % ) of patients receiving valproate required rescue medication , compared with @ % ( @ % CI : @ % , @ % ) of metoclopramide patients and @ % ( @ % CI : @ % , @ % ) of those assigned to ketorolac .


Sustained headache freedom was achieved in @ % ( @ % CI : @ % , @ % ) of those randomized to valproate , @ % ( @ % CI : @ % , @ % ) of metoclopramide patients , and @ % ( @ % CI : @ % , @ % ) receiving ketorolac .


In the metoclopramide arm , @ % ( @ % CI : @ % , @ % ) of patients reported feeling `` very restless '' after investigational medication administration .


Valproate was less efficacious than either metoclopramide or ketorolac .


Metoclopramide demonstrated superiority to ketorolac on several endpoints .


This study provides Class I evidence that in ED patients with acute migraine , IV valproate is inferior to metoclopramide or ketorolac in improving headache outcomes .


To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer ( NSCLC ) .


Randomised controlled trial .


Teaching hospital .


One hundred and thirty-one subjects with NSCLC admitted for curative surgery .


Participants were randomised to usual care or a hospital plus home exercise programme .


The primary outcome was the between-group difference in physical activity @ weeks after surgery .


Secondary outcomes were the difference in quadriceps strength , exercise tolerance and quality of life -LSB- Short Form-@ ( SF-@ ) and European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-LC@ -RSB- from pre-operatively ( baseline ) to @ weeks after surgery .


The participants ( n = @ ) had a mean age of @ -LSB- standard deviation ( SD ) @ -RSB- years and mean forced expiratory volume in @ second of @ ( SD @ ) l.


There were no significant differences in physical activity between the groups @ weeks after surgery -LSB- mean difference adjusted for baseline @minutes/day , @ % confidence interval ( CI ) -@ to @ -RSB- .


In addition , there were no significant differences in total SF-@ or EORTC QLQ-LC@ scores from baseline to @ weeks after surgery .


Both groups had recovered their pre-operative walking distance @ weeks after surgery , and there were no differences between the groups ( mean difference in Incremental Shuttle Walk Test from baseline to @ weeks after surgery ( -@ m , @ % CI -@ to @ ) .


A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery .


Regardless of group allocation , the patients had recovered their pre-operative exercise tolerance levels by @ weeks after surgery .


The aim of this study was to investigate the influence of symptom duration on treatment response and on the correlation between improvements in patient reported outcomes ( PRO ) and objective inflammation in patients with axial spondylarthritis ( SpA ) treated with etanercept ( ETA ) or adalimumab ( ADA ) .


Data from @ patients with axial SpA originally enrolled in two randomized controlled clinical trials were pooled and analyzed after one year of treatment with ETA ( n = @ ) or ADA ( n = @ ) .


Patients with < @ years and @ years of disease were compared for improvement in Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , C-reactive protein ( CRP ) and magnetic resonance imaging ( MRI ) score for sacroiliac joints ( SIJ ) .


Patients with < @ years of disease showed a significantly better improvement than longer diseased patients in BASDAI ( @ ( @ % confidence interval ( CI ) : @ to @ ) vs. @ ( @ to @ ) ) , BASFI , BASMI and ASDAS ( @ ( @ to @ ) vs. @ ( @ to @ ) ) .


The change in BASDAI showed a significant correlation with the change in SIJ score ( Spearman 's rank correlation coefficient ( rho ) = @ , P = @ ) and the change in CRP ( rho = @ , P = @ ) in patients with < @ years of disease .


For long diseased patients this correlation was poor and did not achieve statistical significance ( rho = @ , P = @ ; rho = @ , P = @ respectively ) .


The low correlation between change of PROs and change of objective signs of inflammation seen in axial SpA patients with longer symptom duration treated with tumor necrosis factor-blocker seems to indicate that inflammation is not the only cause of the patients ' symptoms , while inflammation seems to be the major cause in short diseased patients .


Patients scheduled to invasive medical procedures experience high levels of anxiety , which may lead to increased perceptions of pain and vital sign instability throughout .


To examine the effect of a music intervention ( MI ) on stress hormones , physiologic parameters , pain , and anxiety state before and during port catheter placement procedures ( PCPPs ) .


We conducted a prospective , randomized , controlled study in @ oncology patients , who were randomly assigned to an MI group ( n = @ ) or a control group ( n = @ ) .


The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone ( ACTH ) levels , heart and respiratory rate ( HR , RR ) and systolic and diastolic blood pressure ( SBP , DBP ) , on arrival in the surgical intervention room , as well as immediately prior to and immediately after the PCPP , in both groups .


Furthermore , pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales .


On arrival , there were no differences between the patients in terms of serum cortisol and ACTH levels , HR , RR , SBP , DBP and anxiety levels .


There were significant reductions in hormone levels ( p < @ for all ) , HR ( p < @ ) , RR ( p < @ ) , SBP ( p < @ ) and DBP ( p < @ ) , immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group .


Furthermore , music led to a significant reduction in pain ( p < @ ) and anxiety scores ( p < @ ) in the MI group compared to control group .


During invasive medical procedures , MI significantly decreases stress hormone levels , physiological parameters , acute procedural pain and anxiety .


To assess development of fatigue during chest compressions ( CCs ) in simulated neonatal cardiopulmonary resuscitation ( CPR ) .


Prospective randomized manikin crossover study .


Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using ( i ) @:@ compression : ventilation ( C : V ) ratio , ( ii ) continuous CC with asynchronous ventilation ( CCaV ) at a rate of @ CC per min and ( iii ) CCaV at @ CC per min for a duration of @ min on a neonatal manikin .


Changes in peak pressure ( a surrogate of fatigue ) and CC rate were continuously recorded and fatigue among groups was compared .


Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial .


Compared with baseline , a significant decrease in peak pressure was observed after @ , @ and @ s in group CCaV-@ , CCaV-@ and @:@ C : V , respectively .


CC depth decreased by @ % within the first @ min during CCaV-@ , @ % during CCaV-@ and @ % during @:@ C : V. Moreover , @:@ C : V and CCaV were similarly preferred by healthcare professionals .


Similarly , @:@ C : V and CCaV CPR were also fatiguing .


We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR .


Biliary atresia is the most common cause of end-stage liver disease in children .


Controversy exists as to whether use of steroids after hepatoportoenterostomy improves clinical outcome .


To determine whether the addition of high-dose corticosteroids after hepatoportoenterostomy is superior to surgery alone in improving biliary drainage and survival with the native liver .


The multicenter , double-blind Steroids in Biliary Atresia Randomized Trial ( START ) was conducted in @ infants ( mean age , @ months ) between September @ and February @ in the United States ; follow-up ended in January @ .


Participants were randomized to receive intravenous methylprednisolone ( @ mg/kg/d for @ weeks ) and oral prednisolone ( @ mg/kg/d for @ weeks ) followed by a tapering protocol for @ weeks ( n = @ ) or placebo ( n = @ ) initiated within @ hours of hepatoportoenterostomy .


The primary end point ( powered to detect a @ % absolute treatment difference ) was the percentage of participants with a serum total bilirubin level of less than @ mg/dL with his/her native liver at @ months posthepatoportoenterostomy .


Secondary outcomes included survival with native liver at @ months of age and serious adverse events .


The proportion of participants with improved bile drainage was not statistically significantly improved by steroids at @ months posthepatoportoenterostomy ( @ % -LSB- @/@ -RSB- of steroids group vs @ % -LSB- @/@ -RSB- of placebo group ; adjusted relative risk , @ -LSB- @ % CI , @ to @ -RSB- ; P = @ ) .


The adjusted absolute risk difference was @ % ( @ % CI , -@ % to @ % ) .


Transplant-free survival was @ % in the steroids group vs @ % in the placebo group ( adjusted hazard ratio , @ -LSB- @ % CI , @ to @ -RSB- ; P = @ ) at @ months of age .


The percentage of participants with serious adverse events was @ % -LSB- @/@ -RSB- of the steroids group and @ % -LSB- @/@ -RSB- of the placebo group ( P > @ ) ; however , participants receiving steroids had an earlier time of onset of their first serious adverse event by @ days posthepatoportoenterostomy ( @ % -LSB- @ % CI , @ % to @ % -RSB- of steroids group vs @ % -LSB- @ % CI , @ % to @ % -RSB- of placebo group ; P = @ ) .


Among infants with biliary atresia who have undergone hepatoportoenterostomy , high-dose steroid therapy following surgery did not result in statistically significant treatment differences in bile drainage at @ months , although a small clinical benefit could not be excluded .


Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia .


A previous randomized , placebo-controlled study showed that infliximab maintenance therapy prevented recurrence of Crohn 's disease @ year after an ileocolonic resection .


We evaluated recurrence of Crohn 's disease , on the basis of endoscopic examination and/or the need for additional surgical resection , beyond the first postoperative year .


In a prospective , open-label , long-term follow-up study , @ patients previously randomly assigned to receive infliximab for @ year after an ileocolonic resection were given the option to continue , stop , or start infliximab therapy .


The primary end point was the time to recurrence of Crohn 's disease , on the basis of endoscopic evidence ( endoscopic recurrence ) , from the initial assignment to postoperative infliximab or placebo .


Secondary end points were rate of endoscopic recurrence , time to reoperation , and rate of surgical recurrence in relation to the total time on infliximab .


All patients were followed for at least @ years after surgery .


Patients assigned to the infliximab group in the first year after surgery had a longer mean time to first endoscopic recurrence ( @ @ days ) than patients originally assigned to the placebo group ( @ @ days , P = @ ) .


Colonoscopies identified Crohn 's disease recurrence in @ % of patients who received long-term infliximab and in @ % of those not on infliximab ( P < @ ) .


Compared with no infliximab , the adjusted rate ratio for being in endoscopic remission while on infliximab was @ ( @ % confidence interval , @-@ @ ; P = @ ) .


Patients originally assigned to the infliximab group had a mean longer time to surgery ( @ @ days ) than patients originally assigned to the placebo group ( @ @ days , P = @ ) .


The rate of surgical recurrence ( required additional surgical resection ) was significantly lower among patients who received infliximab for most of the follow-up period than patients who received it for shorter periods ( @ % vs @ % , P = @ ) .


Postoperative infliximab maintenance beyond @ year prevents recurrence of Crohn 's disease .


A web-based followup assessment may be a feasible , cost-saving alternative of tracking patient outcomes after total joint arthroplasty .


However , before implementing a web-based program , it is important to determine patient satisfaction levels with the new followup method .


Satisfaction with the care received is becoming an increasingly important metric , and we do not know to what degree patients are satisfied with an approach to followup that does not involve an in-person visit with their surgeons .


We determined ( @ ) patient satisfaction and ( @ ) patients ' preferences for followup method ( web-based or in-person ) after total joint arthroplasty .


We randomized patients who were at least @ months after primary THA or TKA to complete a web-based followup or to have their appointment at the clinic .


There were @ eligible patients contacted for the study during the recruitment period .


Of these , @ agreed to participate , and a total of @ patients completed the study ( @ % of those enrolled , @ % of those potentially eligible ; @ in the usual-care group , @ in the web-based group ) .


Their mean age was @ years ( range , @-@ years ) .


There was no crossover between groups .


All @ patients completed a satisfaction questionnaire at the time of their followup appointments .


Patients in the web-based group also completed a satisfaction and preference questionnaire @ year later .


Only patients from the web-based group were asked to indicate preference as they had experienced the web-based and in-person followup methods .


We used descriptive statistics to summarize the satisfaction questionnaires and compared results using Pearson 's chi-square test .


Ninety-one patients ( @ % ) in the usual-care group indicated that they were either extremely or very satisfied with the followup process compared with @ patients ( @ % ) who were in the web-based group ( p < @ ; odds ratio -LSB- OR -RSB- = @ ; @ % CI , @-@ @ ) .


Similarly , patients in the usual care group were more satisfied with the care they received from their surgeon , compared with patients in the web-based group ( @ % versus @ % ; p < @ , OR = @ ; @ % CI , @-@ @ ) .


Forty-four percent of patients preferred the web-based method , @ % preferred the usual method , and @ % had no preference ( p = @ ) .


Our results show moderate to high satisfaction levels with a web-based followup assessment .


Patients who completed the usual method of in-person followup assessment reported greater satisfaction ; however , the difference was small and may not outweigh the additional cost and time-saving benefits of the web-based followup method .


Level I , therapeutic study .


See the Instructions for Authors for a complete description of levels of evidence .


Endocannabinoid system ( ECS ) activation promotes obesity-associated metabolic disease .


Increased dietary fat intake increases blood endocannabinoids and alters adipose and skeletal muscle ECS gene expression in human .


Two weeks isocaloric low - ( LFD ) and high-fat diets ( HFD ) in obese ( n = @ ) and normal-weight ( n = @ ) subjects in a randomized cross-over study were compared .


Blood endocannabinoids were measured in the fasting condition and after food intake using mass spectrometry .


Adipose and skeletal muscle gene expression was determined using real-time RT-PCR .


Baseline fasting plasma endocannabinoids were similar with both diets .


Anandamide decreased similarly with high - or low-fat test meals in both groups .


Baseline arachidonoylglycerol plasma concentrations were similar between groups and diets , and unresponsive to eating .


In subcutaneous adipose tissue , DAGL - mRNA was upregulated and fatty acid amide hydrolase ( FAAH ) and monoacylglycerol lipase ( MAGL ) mRNAs were down-regulated in obese subjects , but the diets had no influence .


In contrast , the HFD produced pronounced reductions in skeletal muscle CB@-R and MAGL mRNA expression , whereas obesity did not affect muscular gene expression .


Weight-neutral changes in dietary fat intake can not explain excessive endocannabinoid availability in human obesity .


Obesity and dietary fat intake affect ECS gene expression in a tissue-specific manner .


To study protective effect of ulinastatin on perioperative cardiac function in elderly patients undergoing major gastrointestinal surgery .


Sixty elderly patients ( @ male and @ female patients ) aged @-@ years scheduled for major gastrointestinal surgery were randomized into ulinastatin group and control group .


The patients in ulinastatin group received @ ( @ ) U ulinastatin rapidly administered via a intravenous pump immediately before operation with subsequent continuous infusion at the rate of @ ( @ ) U until the completion of surgery , and those in the control group received the same amount of saline instead .


In both groups , the mean arterial pressure ( MAP ) , heart rate ( HR ) , left ventricular ejection fraction ( LVEF ) , and cardiac output ( CO ) were monitored immediately before surgery ( T@ ) and at @ h ( T@ ) , @ h ( T@ ) and @ h ( T@ ) after the start of surgery .


The total dopamine dose used was recorded at the end of surgery , and blood samples were collected at T@ and at @ h ( T@ ) and @ h ( T@ ) after the operation for determination of serum levels of cTn , CK-MB and BNP .


In both groups , MAP , LVEF and CO were significantly decreased at T@ and T@ ( P < @ ) and serum levels of cTn , CK-MB and BNP significantly increased at T@ and T@ compared to those at T@ ( P < @ ) .


Compared with the control group , the patients in ulinastatin group showed significantly higher MAP , LVEF and CO at T@ and T@ and lower serum levels of cTn , CK-MB and BNP at T@ and T@ .


Ulinastatin offers effective perioerative cardiac protection in elderly patients undergoing major gastrointestinal surgery .


To determine the @-month cost-effectiveness of a collaborative care ( CC ) program for treating depression following coronary artery bypass graft ( CABG ) surgery versus physicians ' usual care ( UC ) .


We obtained @ continuous months of Medicare and private medical insurance claims data on @ patients who screened positive for depression following CABG surgery , met criteria for depression when reassessed by telephone @ weeks following hospitalization ( nine-item Patient Health Questionnaire @ ) and were randomized to either an @-month centralized , nurse-provided and telephone-delivered CC intervention for depression or to their physicians ' UC .


At @ months following randomization , CC patients had $ @ lower but statistically similar estimated median costs compared to UC ( P = @ ) and a variety of sensitivity analyses produced no significant changes .


The incremental cost-effectiveness ratio of CC was - $ @ ( - $ @,@ to - $ @ ) per additional quality-adjusted life-year ( QALY ) , and there was @ % probability it would be cost-effective at the willingness to pay threshold of $ @,@ per additional QALY .


A bootstrapped cost-effectiveness plane also demonstrated a @ % probability of CC `` dominating '' UC ( more QALYs at lower cost ) .


Centralized , nurse-provided and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care .


To evaluate the relative pain and the relative amount of contact lens loss experienced using two different base curvatures ( BCs ) of the Acuvue Oasys bandage soft contact lens ( BSCL ) after photorefractive keratectomy ( PRK ) .


One hundred forty patients undergoing PRK on either the Allegretto or the VISX laser at the Joint Warfighter Refractive Surgery Center in Lackland AFB , TX , were randomized to one of the two different BCs of the Acuvue Oasys BSCL : @ or @ mm .


Patients were evaluated on postoperative days @ and @ during which they completed a survey rating absolute pain in each eye on a visual analog pain scale .


Lens loss was recorded throughout the study .


Patients treated on the Allegretto laser preferred the @-mm BC lens , whereas comfort after treatment on the VISX depended on corneal shape .


For VISX , patients with very flat corneas ( steep K @ preoperative or @ postoperatively ) preferred an @-mm BC lens while patients with very steep corneas ( steep K > @ preoperative or > @ postoperative ) preferred an @-mm BC lens , though these results were largely not statistically significant .


Patients who lost their lenses prematurely tended to be those whose corneal curvature did not match their contact lens BC .


Individuals treated with the Allegretto laser or individuals with more prolate corneas should likely be fit with an @-mm BC Acuvue Oasys BSCL while individuals with more oblate corneas should likely be fit with an @-mm BC lens to minimize postoperative pain and premature BSCL loss .


We tested the efficacy of a brief intervention to promote correct and consistent use of condoms among Black male youths attending sexually transmitted infection ( STI ) clinics in @ southern US cities .


In @ to @ , we screened ( n = @ ) and enrolled ( n = @ ) youths aged @ to @ years who identified as Black and reported recent ( past @ months ) sexual activity and randomized them to a private , brief , interactive intervention ( n = @ ) or an attention-equivalent control condition ( n = @ ) .


Assessments occurred at baseline and @ and @ months after the intervention .


At @ months , with adjustment for age and pretest nonequivalence of the outcome variable , an estimated odds ratio ( EOR ) of @ ( @ % confidence interval -LSB- CI -RSB- = @ , @ ; P = @ ) indicated efficacy for correct condom use .


An adjusted generalized estimating equations model with both @ - and @-month condom use variables produced an EOR of @ ( @ % CI = @ , @ ; P = @ ) .


We did not observe significant effects on chlamydia and gonorrhea incidence .


This brief intervention , delivered as part of STI clinical care , could help alleviate the disproportionate STI-HIV burden among young Black men .


Vaso-occlusive episodes ( VOEs ) are the most common complication of sickle cell disease in children .


Treatment with magnesium seems to improve cellular hydration and may result in reduced vaso-occlusion .


This study aimed to determine if intravenous ( IV ) magnesium sulfate ( MgSO@ ) reduces length of stay ( LOS ) in hospital , pain scores , and cumulative analgesia when compared with placebo .


Randomized , double-blind , placebo-controlled trial in children aged @ to @ years requiring admission to hospital with a sickle cell disease VOE requiring IV analgesia .


Participating children received IV MgSO@ ( @ mg/kg ) every @ hours or placebo in addition to standard therapy .


We used a t test or Mann-Whitney test ( continuous variables ) , Fisher 's exact test , or @ test ( frequencies ) .


P values were considered significant if < @ , and @ % confidence intervals were calculated for the difference between groups .


One hundred six children were randomly assigned to the study , and @ were included .


Fifty-one ( @ % ) received MgSO@ .


Children 's mean age was @ years ( range : @-@ years ; SD : @ years ) , and @ ( @ % ) were females .


There was no significant difference in the primary outcome measure , LOS in hospital , with a mean of @ and @ hours in the MgSO@ and placebo groups , respectively ( P = @ ) .


There was no significant difference between groups for the secondary outcomes of mean pain scores ( @ @ vs @ @ , respectively ; P = @ ) or analgesic requirements ( continuous morphine infusion -LSB- P = @ -RSB- , boluses of IV morphine -LSB- P = @ -RSB- , acetaminophen -LSB- P = @ -RSB- , ibuprofen -LSB- P = @ -RSB- , naproxen -LSB- P = @ -RSB- ) .


Only minor adverse events were recorded in both groups .


Pain at the infusion site was more common in the MgSO@ group .


IV MgSO@ was well tolerated but had no effect on the LOS in hospital , pain scores , or cumulative analgesia use in admitted children with a VOE .


Detecting paroxysmal atrial fibrillation ( AF ) in patients with ischemic strokes presenting in sinus rhythm is challenging because episodes are often short , occur randomly , and are frequently asymptomatic .


If AF is detected , recurrent thromboembolism can be prevented efficiently by oral anticoagulation .


Numerous uncontrolled studies using various electrocardiogram ( ECG ) devices have established that prolonged ECG monitoring increases the yield of AF detection , but most established procedures are time-consuming and costly .


The few randomized trials are mostly limited to cryptogenic strokes .


The optimal method , duration , and patient selection remain unclear .


Repeated prolonged continuous Holter ECG monitoring to detect paroxysmal AF within an unspecific stroke population may prove to be a widely applicable , effective secondary prevention strategy .


Find-AFRANDOMISED is a randomized and controlled prospective multicenter trial .


Four hundred patients @ years or older with manifest ( symptoms @ hours or acute computed tomography/magnetic resonance imaging lesion ) and acute ( symptoms @ days ) ischemic strokes will be included at @ certified stroke centers in Germany .


Those with previously diagnosed AF/flutter , indications/contraindications for oral anticoagulation , or obvious causative blood vessel pathologies will be excluded .


Patients will be randomized @:@ to either enhanced and prolonged Holter ECG monitoring ( @ days at baseline and after @ and @ months ) or standard of care ( @-hour continuous ECG monitoring , according to current stroke guidelines ) .


All patients will be followed up for at least @ months .


The primary end point is newly detected AF ( @ seconds ) after @ months , confirmed by an independent adjudication committee .


We plan to complete recruitment in autumn @ .


First results can be expected by spring @ .


Newcomers at high altitude ( > @,@ m ) experience periodic breathing , sleep disturbances , and impaired cognitive performance .


Whether similar adverse effects occur at lower elevations is uncertain , although numerous lowlanders travel to moderate altitude for professional or recreational activities .


We evaluated the hypothesis that nocturnal breathing , sleep , and cognitive performance of lowlanders are impaired at moderate altitude .


Randomized crossover trial .


University hospital at @ m , Swiss mountain villages at @,@ m and @,@ m.


Fifty-one healthy men , median ( quartiles ) age @ y ( @-@ y ) , living below @ m.


Studies at Zurich ( @ m ) and during @ consecutive days at @,@ m and @,@ m , respectively , @ days each .


The order of altitude exposure was randomized .


Polysomnography , psychomotor vigilance tests ( PVT ) , the number back test , several other tests of cognitive performance , and questionnaires were evaluated .


The median ( quartiles ) apnea-hypopnea index at @ m was @ / h ( @ ; @ ) , values at @,@ and @,@ m , day @ and @ , respectively , were @ / h ( @ ; @ ) , @ / h ( @ ; @ ) , @ / h ( @ ; @ ) , and @ / h ( @ ; @ ) ; corresponding values of mean nocturnal oxygen saturation were @ % ( @ ; @ ) , @ % ( @ ; @ ) , @ % ( @ ; @ ) , @ % ( @ ; @ ) , @ % ( @ ; @ ) , P < @ versus @ m , all instances .


Slow wave sleep on the first night at @,@ m was @ % ( @ ; @ ) versus @ % ( @ ; @ ) at @ m ( P < @ ) .


Psychomotor vigilance and various other measures of cognitive performance did not change significantly .