Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning ...clusters (eg, providers) to "favor" a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design.
Agreeable providers were randomized to "favor" either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate.
All four institutional review boards waived documentation of patient consent. Providers (n=18) followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients). In the "favor hydrochlorothiazide" group, there was 99% adherence to that strategy. In the "favor chlorthalidone" group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25-50 mg/day) and 100% for chlorthalidone (12.5-25.0 mg/day). Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information letter, and interactions with the site investigator were identified as most helpful in reminding providers of their study drug strategy.
Providers prescribed according to an assigned drug-choice strategy most of the time for the purpose of a comparative effectiveness study. This simple design could facilitate research participation and behavior change in non-research clinicians. Waiver of patient consent can broaden the representation of patients, providers, and settings.
SuperB Technical Design Report Collaboration, SuperB; Sapor, M; Diacono, D ...
arXiv.org,
06/2013
Paper, Journal Article
Odprti dostop
In this Technical Design Report (TDR) we describe the SuperB detector that was to be installed on the SuperB e+e- high luminosity collider. The SuperB asymmetric collider, which was to be constructed ...on the Tor Vergata campus near the INFN Frascati National Laboratory, was designed to operate both at the Upsilon(4S) center-of-mass energy with a luminosity of 10^{36} cm^{-2}s^{-1} and at the tau/charm production threshold with a luminosity of 10^{35} cm^{-2}s^{-1}. This high luminosity, producing a data sample about a factor 100 larger than present B Factories, would allow investigation of new physics effects in rare decays, CP Violation and Lepton Flavour Violation. This document details the detector design presented in the Conceptual Design Report (CDR) in 2007. The R&D and engineering studies performed to arrive at the full detector design are described, and an updated cost estimate is presented. A combination of a more realistic cost estimates and the unavailability of funds due of the global economic climate led to a formal cancelation of the project on Nov 27, 2012.
Breeding territory selection in Prothonotary Warblers (Protonotaria citrea (Boddaert, 1783)) is thought to hinge on standing water, with a strong preference for low-lying areas prone to seasonal ...flooding. However, we have observed this species nesting in much drier areas than previously reported. We recently initiated a study of the Carolina Wren (Thryothorus ludovicianus (Latham, 1790)) using wooden nest boxes, and nearly 60% of all nests produced in these boxes during the initial study year were produced by Prothonotary Warblers, despite this species being absent from our field site during the year preceding nest-box availability. Most nests were produced in dense, closed-canopy forest with a thick shrub layer >100 m from any water body. There was no difference in the mean distance from water between nests of the Prothonotary Warbler and those of the Carolina Wren, a habitat generalist that does not nest over water. We then observed a 60% increase in the number of Prothonotary Warbler nests the following year, along with significant increases in breeding productivity. Although they nested on sites that they are not thought to prefer, our observations suggest that Prothonotary Warblers may nest in drier areas than usual if appropriate nest cavities are provided.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Milk thistle extracts have been used as a “liver tonic” for centuries. In recent years, silibinin, the active ingredient in milk thistle extracts, has been studied both in vitro and in vivo to ...evaluate the beneficial effects in hepatic disease. Silibinin increases antioxidant concentrations and improves outcomes in hepatic diseases resulting from oxidant injury. Silibinin treatment has been associated with protection against hepatic toxins, and also has resulted in decreased hepatic inflammation and fibrosis. Limited information currently is available regarding silibinin use in veterinary medicine. Future study is justified to evaluate dose, kinetics, and treatment effects in domestic animals.
•Cognitive dysfunction is a prominent clinical symptom in Parkinson’s disease.•Intra-network frontoparietal connectivity was linked with cognitive impairment in PD.•PDMCI impaired salience, default ...mode, and basal ganglia inter-network connectivity.
Parkinson’s disease (PD) is a neurodegenerative disease with cognitive as well as motor impairments. While much is known about the brain networks leading to motor impairments in PD, less is known about the brain networks contributing to cognitive impairments. Here, we leveraged resting-state functional magnetic resonance imaging (rs-fMRI) data from the Parkinson’s Progression Marker Initiative (PPMI) to examine network dysfunction in PD patients with cognitive impairment. We focus on canonical cortical networks linked to cognition, including the salience network (SAL), frontoparietal network (FPN), and default mode network (DMN), as well as a subcortical basal ganglia network (BGN). We used the Montreal Cognitive Assessment (MoCA) as a continuous index of coarse cognitive function in PD. In 82 PD patients, we found that lower MoCA scores were linked with lower intra-network connectivity of the FPN. We also found that lower MoCA scores were linked with lower inter-network connectivity between the SAL and the BGN, the SAL and the DMN, as well as the FPN and the DMN. These data elucidate the relationship of cortical and subcortical functional connectivity with cognitive impairments in PD.
Background: The quality of histopathology slides of endoscopic biopsies from different laboratories varies, but the effect of biopsy quality on outcome is unknown.
Hypothesis: The ability to ...demonstrate a histologic lesion in the stomach or duodenum of a dog or cat is affected by the quality of endoscopic biopsy samples submitted. More endoscopic samples are needed to find a lesion in poor‐quality tissue specimens.
Animals: Tissues from 99 dogs and 51 cats were examined as clinical cases at 8 veterinary institutions or practices in 5 countries.
Methods: Histopathology slides from sequential cases that underwent endoscopic biopsy were submitted by participating institutions. Quality of the histologic section of tissue (inadequate, marginal, adequate), type of lesion (lymphangiectasia, crypt lesion, villus blunting, cellular infiltrate), and severity of lesion (normal, mild, moderate, severe) were determined. Sensitivity of different quality tissue samples for finding different lesions was determined.
Results: Fewer samples were required from dogs for diagnosis as the quality of the sample improved from inadequate to marginal to adequate. Duodenal lesions in cats displayed the same trend except for moderate duodenal infiltrates for which quality of tissue sample made no difference. Gastric lesions in dogs and mild gastric lesions in cats had the same trend, whereas the number of tissue samples needed to diagnose moderately severe gastric lesions in cats was not affected by the quality of tissue sample.
Conclusions and Clinical Importance: The quality of endoscopically obtained tissue samples has a profound effect on their sensitivity for identifying certain lesions, and there are differences between biopsies of canine and feline tissues.
Objective-To report use of thoracoscopic lung lobectomy (TLL) for treatment of lung tumors (LT) in dogs. Study Design-Retrospective study. Animals-Nine dogs. Methods-Dogs that had TLL for tumor ...removal were included. Using general anesthesia and 1-lung ventilation, TLL was performed using a 30-60 mm endoscopic gastrointestinal anastomosis stapler. If the visual field was obscured, lobe resection was completed via thoracotomy. Results-Metastatic and primary LT were resected by thoracoscopic lobectomy in 9 dogs (6 male, 3 female; mean (+/- SD) weight, 29 +/- 7 kg; mean age, 10.7 +/- 1.9 years). Six dogs had a solitary mass and 3 dogs had 2 masses within a single lobe. The left caudal lobe was removed in 3 dogs. In 5 dogs, TLL was used alone whereas conversion to thoracotomy was required in 4 dogs because of poor visibility. There were 7 metastatic LT and 2 primary LT. Mean duration of thoracoscopic surgery was 108.8 +/- 30.3 minutes compared with 150.75 +/- 55.4 minutes in dogs requiring conversion to thoracotomy. Mean hospitalization was 3.1 +/- 1.3 days. Conclusion-Provided the visual field is not obscured, TLL can be performed effectively in dogs. Clinical Relevance-Dogs with metastatic or primary LTs should be considered for TLL, particularly for small masses positioned away from the hilus in the left caudal lung lobe.
We used data collected during surveys of seven North American Breeding Bird Survey routes in eastern Texas to estimate avian populations within Big Thicket National Preserve. On only 61 of the 350 ...count locations located along these routes did observers monitor birds within the boundaries of this preserve. On selected routes, we recorded initial bird detections during the 3-min bird count within 1-min time intervals and within two distance classes (≤50 or >50 m). We used these data, combined with data collected using standard Breeding Bird Survey protocols during 2009–2016, to estimate detection probabilities and effective detection radii for commonly detected species. For species often detected in flocks, we estimated these parameters for group detections. From these parameters, we estimated regional densities for 60 species. Because habitat within Big Thicket National Preserve differed from habitat along surveyed routes, for each species we adjusted the projected population estimate to account for the relationship between density of detected birds and habitat descriptors from the National Land Cover database. On the basis of our estimates of regional density of each species, and accounting for differences in habitat availability, we estimated that commonly detected avian species comprises a population of 192,201 breeding birds (95% confidence interval = 144,269–340,790) within Big Thicket National Preserve. Utilizamos datos recopilados durante estudios de siete rutas del North American Breeding Bird Survey en el este de Texas para estimar las poblaciones de aves dentro de Big Thicket National Preserve. Observadores monitorearon a las aves dentro de esta reserva en solo 61 de los 350 lugares de conteo ubicados a lo largo de estas rutas . En rutas seleccionadas, detecciones iniciales de aves durante 3 minutos se registraron en intervalos de tiempo de 1 minuto y dentro de 2 clases de distancia (≤ 50 m o > 50 m). Utilizamos estos datos, combinados con los datos recopilados utilizando el método estándar del Breeding Bird Survey durante 2009–2016 para estimar probabilidades de detección y radios de detección para especies comúnmente detectadas. Para las especies detectadas a menudo en bandadas, estimamos estos parámetros para las detecciones de grupo. A partir de estos parámetros, estimamos las densidades regionales para 60 especies. Debido a que el hábitat dentro de Big Thicket National Preserve difería del hábitat a lo largo de las rutas monitoreadas, para cada especie ajustamos su población estimada proyectada para tener en cuenta la relación entre la densidad de aves detectadas y los descriptores de hábitat de la base de datos National Land Cover. Con base en nuestras estimaciones de la densidad regional de cada especie, y teniendo en cuenta diferencias en la disponibilidad de hábitat, estimamos que las especies de aves comúnmente detectadas comprenden una población de 192,201 aves reproductoras (IC95% = 144,269–340,790) dentro de Big Thicket National Preserve.
Dogs with chronic giardiasis, histoplasmosis, or histiocytic ulcerative colitis, among other primary gastrointestinal diseases, may have similar results to the dogs labeled as “CE/IBD” and may have ...even been part of that group of dogs. ...cohorts have been studied in detail, the authors' suggestion that a combination of ACA, ACNA, and AGA could aid in IBD diagnosis is unfounded or potentially even detrimental to the dogs diagnosed based on these biomarkers. While the work-up mentioned did include a minimum database and fecal examination for endoparasites, a standardized diagnostic work-up, including the outcome of broad-spectrum anthelminthic therapy or dietary trials, or tissue diagnosis, all essential for a diagnosis of IBD, are missing. ...all we can conclude from the current study is that the panel of the three markers described has a 90% sensitivity and a 96% specificity in differentiating dogs with a variety of signs of chronic gastrointestinal disease from dogs that have signs of chronic gastrointestinal disease due to hypoadrenocorticism, EPI, possible pancreatitis, possible lymphoma, or healthy control dogs. ...the authors state that the markers described in their study have been used as clinical tools for the diagnosis of gastrointestinal conditions in humans for decades.
•The wireless motility capsule was tolerated by all dogs while at home.•It provided data from the different sections of the gastrointestinal tract (GIT).•A minimally invasive tool to assess GIT solid ...phase transit times, pressures and pH.•Smaller dog size may represent a limitation.
The aim of this study was to describe the feasibility of using a gastrointestinal tract wireless motility capsule (WMC) that measured intraluminal pressure, pH and transit time through the gastrointestinal tract, in dogs in their home environment. Forty-four adult healthy dogs, eating a standard diet, were prospectively enrolled.
The WMC was well tolerated by all dogs and provided data from the different sections of the gastrointestinal tract. Median gastric emptying time was 20h (range, 6.3–119h), demonstrating a large range. The gastric pressure pattern and pH depended on the phase of food consumption. The small bowel transit time was 3.1h (range, 1.6–5.4h) with average contraction pressures of 6.5mmHg (range, 1.1–21.4mmHg) and pH 7.8 (range, 7–8.9). The large bowel transit time was 21h (range, 1–69h) with average contractions pressures of 0.9mmHg (range, 0.3–2.7mmHg) and pH 6.4 (range, 5.3–8.2). There was considerable individual variation in motility patterns and transit times between dogs. No difference was observed between the sexes. No relationships between any transit time, bowel pH or pressure pattern and bodyweights were identified. The WMC likely represents movement of a large non-digestible particle rather than normal ingesta. Due to its large size, the WMC should not be use in smaller dogs. The WMC is a promising minimally invasive tool to assess GIT solid phase transit times, pressures and pH. However, further studies are necessary due to the current limitations observed.
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