Objective: The meta-analysis reported here examined interventions informed by the theory of planned behavior (TPB) or theory of reasoned action (TRA) aimed at reducing heterosexual risk behaviors ...(prevention of STDs and unwanted pregnancy). Methods: Studies were eligible for inclusion if they were either randomized control trials or quasi-experimental studies that compared the TPB-based intervention against a control group. Search strategy consisted of articles identified in previous reviews, keyword search through search engines, examination of key journals, and contacting key experts. Results: Forty-seven intervention studies were included in the meta-analysis. Random effects models revealed that pooled effect sizes for TPB-based interventions had small but significant effects on behavior and other secondary outcomes (i.e., knowledge, attitudes, normative beliefs, perceived behavioral control, and intentions). Significant heterogeneity found between effect sizes was explored using metaregression. Larger effects were found for interventions that provided opportunities for social comparison. Conclusions: The TPB provides a valuable framework for designing interventions to change heterosexual risk behaviors. However, effect sizes varied quite substantially between studies, and further research is needed to explore the reasons why.
Rapid and easy clinical assessments for volumes of infarction and perfusion mismatch are needed. We tested whether simple geometric models generated accurate estimates of these volumes.
Acute ...diffusion-weighted image (DWI) and perfusion (mean transit time MTT) in 63 strokes and established infarct volumes in 50 subacute strokes were measured by computerized planimetry. Mismatch was defined as MTT/DWI > or = 1.2. Observers, blinded to planimetric values, measured lesions in three perpendicular axes A, B, and C. Geometric estimates of sphere, ellipsoid, bicone, and cylinder were compared to planimetric volume by least-squares linear regression.
The ABC/2 formula (ellipsoid) was superior to other geometries for estimating volume of DWI (slope 1.16, 95% confidence interval CI 0.94 to 1.38; R(2) = 0.91, p = 0.001) and MTT (slope 1.11, 95% CI 0.99 to 1.23; R(2) = 0.89, p = 0.001). The intrarater and interrater reliability for ABC/2 was high for both DWI (0.992 and 0.965) and MTT (0.881 and 0.712). For subacute infarct, the ABC/2 formula also best estimated planimetric volume (slope 1.00, 95% CI 0.98 to 1.19; R(2) = 0.74, p = 0.001). In general, sphere and cylinder geometries overestimated all volumes and bicone underestimated all volumes. The positive predictive value for mismatch was 92% and negative predictive value was 33%.
Of the models tested, ABC/2 is reproducible, is accurate, and provides the best simple geometric estimate of infarction and mean transit time volumes. ABC/2 has a high positive predictive value for identifying mismatch greater than 20% and might be a useful tool for rapid determination of acute stroke treatment.
The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the ...Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993–2005. There were 495 postbaseline hip fractures among 5,511 respondents aged ≥69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.
Enhanced implosion stability has been experimentally demonstrated for magnetically accelerated liners that are coated with 70 μm of dielectric. The dielectric tamps liner-mass redistribution from ...electrothermal instabilities and also buffers coupling of the drive magnetic field to the magneto-Rayleigh-Taylor instability. A dielectric-coated and axially premagnetized beryllium liner was radiographed at a convergence ratio CR=Rin,0/Rin(z,t) of 20, which is the highest CR ever directly observed for a strengthless magnetically driven liner. The inner-wall radius Rin(z,t) displayed unprecedented uniformity, varying from 95 to 130 μm over the 4.0 mm axial height captured by the radiograph.
Highlights • Ictal-interictal continuum abnormalities (IICAs) are common after subarachnoid hemorrhage (SAH). • IICAs are associated with higher risk for delayed cerebral ischemia (DCI), especially ...if they emerge late in the acute period after SAH. • Quantification of IICA features may assist in the development of an algorithm to predict DCI risk.
To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. ...A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most consistently significant moderators included matching the gender or ethnicity of the communicator to the intervention recipients, group targeting or tailoring of the intervention, use of a theory to underpin intervention design, providing factual information, presenting arguments designed to change attitudes, and providing condom skills and intrapersonal skills training. The absence of significant effects for intervention duration and expert delivery are also notable. The success of HIV/STI prevention interventions may be enhanced not only by providing skills training and information designed to change attitudes, but also by ensuring that the content is tailored to the target group and delivered by individuals of the same gender and ethnicity as the recipients.
Summary
Status epilepticus causes prolonged or repetitive seizures that, if left untreated, can lead to neuronal injury, severe disability, coma and death in paediatric and adult populations. While ...convulsive status epilepticus can be diagnosed using clinical features alone, non‐convulsive status epilepticus requires confirmation by electroencephalogram. Early seizure control remains key in preventing the complications of status epilepticus. This is especially true for convulsive status epilepticus, which has stronger evidence supporting the benefit of treatment on outcomes. When status epilepticus becomes refractory, often due to gamma‐aminobutyric acid and N‐methyl‐D‐aspartate receptor modulation, anaesthetic drugs are needed to suppress seizure activity, of which there is limited evidence regarding the selection, dose or duration of their use. Seizure monitoring with electroencephalogram is often needed when patients do not return to baseline or during anaesthetic wean; however, it is resource‐intensive, costly, only available in highly specialised centres and has not been shown to improve functional outcomes. Thus, the treatment goals and aggressiveness of therapy remain under debate, especially for non‐convulsive status epilepticus, where prolonged therapeutic coma can lead to severe complications. This review presents an evidence‐based, clinically‐oriented and comprehensive review of status epilepticus and its definitions, aetiologies, treatments, outcomes and prognosis at different stages of the patient’s journey.
The emergence of medical students' professional identity is important. This paper considers this in a snapshot of the early years of undergraduate medical education. From the perspective of social ...identity theory, it also considers self-stereotyping, the extent to which individuals associate with attributes identified as typical of groups.
Paper questionnaires were completed by first and second year medical students following teaching sessions at the beginning (October) and end (April) of the academic year. Questionnaires consisted of scales measuring the strength and importance of identity and self-stereotyping, referent to 'doctors' and 'students'. Linear mixed effects regression considered longitudinal and cross-sectional effects of progress through the course, and differences in responses to 'doctor' and 'student' measures.
In October, responses were received from 99% (n = 102) and 75% (n = 58) of first and second year cohorts respectively, and in April from 81% (n = 83) and 73% (n = 56). Response rates were over 95% of those present. Linear mixed effects regression found that all 'doctor'-referent measures were higher than 'student' measures. Strength of identity and self-stereotyping decreased between beginning and end of the year (across both groups). Men indicated lower importance of identity than women, also across both groups. There were no differences between year groups. Self-stereotyping was predicted more by importance of identification with a group than by strength of identification.
Findings reinforce observations that medical students identify strongly as doctors from early in their studies, and that this identification is greater than as students. Decreases over time are surprising, but may be explained by changing group salience towards the end of the academic year. The lack of a gender effect on strength of identification contrasts with the literature, but may reflect students' lack of 'performance' of professional identity, while the effect on importance is speculated to be linked to social identity complexity. Identification with professional group may have implications for how medical schools treat students. The findings on self-stereotyping have relevance to recruitment if applicant populations are limited to those already internalising a stereotype. There may be consequences for the wellbeing of those who feel they cannot fulfil stereotypes when in training.
Numerous studies have reported an increase in prejudice against Muslims in recent years. Less research has investigated how this increase might be stemmed and relations between non-Muslims and ...Muslims improved. In this article, we address prejudice against Muslims from the perspective of intergroup contact theory. We conducted two cross-sectional studies to examine the relationship between non-Muslim students' experiences of contact with Muslims and their intergroup anxiety, outgroup attitudes, perceptions of outgroup variability and intergroup behavioural intentions. Study 1 (N=58) showed that frequent high-quality contact with Muslims predicted more positive outgroup attitudes, more perceived outgroup variability and more positive behavioural intentions. These associations were mediated by intergroup anxiety. Study 2 (N=60) replicated these effects and additionally showed that anxiety mediates the influence of extended contact on the same outcome measures. Discussion focuses on the implications of the results for strategies aimed at improving relations between non-Muslims and Muslims.
Aims/hypothesis
Type 1 diabetes results from a chronic autoimmune process continuing for years after presentation. We tested whether treatment with teplizumab (a Fc receptor non-binding anti-CD3 ...monoclonal antibody), after the new-onset period, affects the decline in C-peptide production in individuals with type 1 diabetes.
Methods
In a randomised placebo-controlled trial we treated 58 participants with type 1 diabetes for 4–12 months with teplizumab or placebo at four academic centres in the USA. A central randomisation centre used computer generated tables to allocate treatments. Investigators, patients, and caregivers were blinded to group assignment. The primary outcome was a comparison of C-peptide responses to a mixed meal after 1 year. We explored modification of treatment effects in subgroups of patients.
Results
Thirty-four and 29 subjects were randomized to the drug and placebo treated groups, respectively. Thirty-one and 27, respectively, were analysed. Although the primary outcome analysis showed a 21.7% higher C-peptide response in the teplizumab-treated group (0.45 vs 0.371; difference, 0.059 95% CI 0.006, 0.115 nmol/l) (
p
= 0.03), when corrected for baseline imbalances in HbA
1c
levels, the C-peptide levels in the teplizumab-treated group were 17.7% higher (0.44 vs 0.378; difference, 0.049 95% CI 0, 0.108 nmol/l,
p
= 0.09). A greater proportion of placebo-treated participants lost detectable C-peptide responses at 12 months (
p
= 0.03). The teplizumab group required less exogenous insulin (
p
< 0.001) but treatment differences in HbA
1c
levels were not observed. Teplizumab was well tolerated. A subgroup analysis showed that treatment benefits were larger in younger individuals and those with HbA
1c
<6.5% at entry. Clinical responders to teplizumab had an increase in circulating CD8 central memory cells 2 months after enrolment compared with non-responders.
Conclusions/interpretations
This study suggests that deterioration in insulin secretion may be affected by immune therapy with teplizumab after the new-onset period but the magnitude of the effect is less than during the new-onset period. Our studies identify characteristics of patients most likely to respond to this immune therapy.
Trial registration
ClinicalTrials.gov NCT00378508
Funding
This work was supported by grants 2007-502, 2007-1059 and 2006-351 from the JDRF and grants R01 DK057846, P30 DK20495, UL1 RR024139, UL1RR025780, UL1 RR024131 and UL1 RR024134 from the NIH.
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