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The aim of this presentation is to summarize the results of the published systematic reviews / meta-analyses of the randomized controlled trials that have investigated the effectiveness of medications for the treatment of obsessive compulsive disorder (OCD) in children/adolescents and adults and to present preliminary results from a new review study using network meta-analytical techniques
Medline, Cochrane database, and the register of controlled trials maintained by the Cochrane Collaboration Depression, Anxiety & Neurosis Group (CCDAN) were searched for relevant trials, systematic reviews and/or meta-analyses.
Regarding the new review study we were able to extract 103 pharmacological arms (preliminary results: 9 for Fluoxetine, 16 for Fluvoxamine, 11 for Paroxetine, 10 for Sertraline, 16 for Clomipramine, 7 for Citalopram / escitalopram, 2 for Venlafaxine, and 32 for Placebo) with a total number of 6572 patients randomized. The previous meta-analyses have confirmed the efficacy for all SSRIs and Clomipramine in all age groups while for other drugs further evidence is required. In the context of this presentation preliminary results of the relative efficacy of each drug, using network meta-analysis techniques will also be reported.
Several antidepressants have established their efficacy and acceptability for the management of non-resistant OCD. The major weakness of the literature so far is that head to head comparisons between antidepressants are few and therefore it is difficult to establish a clear hierarchy of the efficacy and acceptability of the various agents. This gap in the present literature will be filled by the present review.
Validation-study data were analysed to investigate retention interval (RI) and prompt effects on the accuracy of fourth-grade children’s reports of school-breakfast and school-lunch (in 24-h recalls), and the accuracy of school-breakfast reports by breakfast location (classroom; cafeteria). Randomly selected fourth-grade children at ten schools in four districts were observed eating school-provided breakfast and lunch, and were interviewed under one of eight conditions created by crossing two RIs (‘short’ – prior-24-hour recall obtained in the afternoon and ‘long’ – previous-day recall obtained in the morning) with four prompts (‘forward’ – distant to recent, ‘meal name’ – breakfast, etc., ‘open’ – no instructions, and ‘reverse’ – recent to distant). Each condition had sixty children (half were girls). Of 480 children, 355 and 409 reported meals satisfying criteria for reports of school-breakfast and school-lunch, respectively. For breakfast and lunch separately, a conventional measure – report rate – and reporting-error-sensitive measures – correspondence rate and inflation ratio – were calculated for energy per meal-reporting child. Correspondence rate and inflation ratio – but not report rate – showed better accuracy for school-breakfast and school-lunch reports with the short RI than with the long RI; this pattern was not found for some prompts for each sex. Correspondence rate and inflation ratio showed better school-breakfast report accuracy for the classroom than for cafeteria location for each prompt, but report rate showed the opposite. For each RI, correspondence rate and inflation ratio showed better accuracy for lunch than for breakfast, but report rate showed the opposite. When choosing RI and prompts for recalls, researchers and practitioners should select a short RI to maximise accuracy. Recommendations for prompt selections are less clear. As report rates distort validation-study accuracy conclusions, reporting-error-sensitive measures are recommended.
We used the winter of 2009–2010, which had minimal influenza circulation due to the earlier 2009 influenza A(H1N1) pandemic, to test the accuracy of ecological trend methods used to estimate influenza-related deaths and hospitalizations. We aggregated weekly counts of person-time, all-cause deaths, and hospitalizations for pneumonia/influenza and respiratory/circulatory conditions from seven healthcare systems. We predicted the incidence of the outcomes during the winter of 2009–2010 using three different methods: a cyclic (Serfling) regression model, a cyclic regression model with viral circulation data (virological regression), and an autoregressive, integrated moving average model with viral circulation data (ARIMAX). We compared predicted non-influenza incidence with actual winter incidence. All three models generally displayed high accuracy, with prediction errors for death ranging from −5% to −2%. For hospitalizations, errors ranged from −10% to −2% for pneumonia/influenza and from −3% to 0% for respiratory/circulatory. The Serfling and virological models consistently outperformed the ARIMAX model. The three methods tested could predict incidence of non-influenza deaths and hospitalizations during a winter with negligible influenza circulation. However, meaningful mis-estimation of the burden of influenza can still result with outcomes for which the contribution of influenza is low, such as all-cause mortality.
A range of potential concepts for the geological disposal of high level wastes and spent fuel are being studied and considered in the UK. These include concepts that use bentonite as a buffer material around the waste containers. The bentonite will be required to fulfil certain safety functions, the most important being (1) to protect the waste containers from detrimental thermal, hydraulic, mechanical and chemical processes; and (2) to retard the release of radionuclides from any waste container that fails. The bentonite should have a low permeability and a high sorption capacity.
These safety functions could be challenged by certain features, events and processes (FEPs) that may occur during the evolution of the disposal system. A consideration of how these FEPs may affect the safety functions can be used to identify and to prioritize the important areas for research on bentonite. We identify these important areas (which include hydration of compacted bentonite, illitization and erosion of bentonite), and describe how they are being investigated in current international research on bentonite.
The Äspö EBS Task Force is a collaborative international project designed to carry out research on bentonite. In 2011, the Nuclear Decommissioning Authority Radioactive Waste Management Directorate joined the EBS Task Force partly to benefit from its collective experience. The work of the EBS Task Force is split into two research subareas: (1) the THM subarea, which includes tasks to understand homogenization of bentonite as it resaturates, to investigate the hydraulic interaction between bentonite and fractured rock, and to model in situ experiments; and (2) the THC subarea, which includes tasks to investigate the issue of understanding transport through bentonite, and to model in situ experiments. In particular, the bentonite rock interaction experiment is a large-scale in situ experiment concerned with understanding groundwater exchange across bentonite rock interfaces, with the objective of establishing better understanding of bentonite wetting. In this paper, we describe our work to model the spatial and temporal resaturation of bentonite buffer in a fractured host rock.
Data held within administration records of occupational pension schemes yield a rich source of information on mortality rates and the statistical predictors (covariates) of longevity. In this paper we provide, for the first time, a multivariable analysis of post-retirement mortality using the detailed information held within occupational pension scheme records.
Using the extensive dataset of over one million living pensioners and dependants and 530,000 historic deaths collected by Club Vita, we investigate the importance of factors including gender, affluence and lifestyle on the observed period life expectancy of individuals. We describe one approach to constructing a multivariable model for pensioner baseline mortality, showing how such factors explain a variation in observed period life expectancy in excess of ten years. The relative importance of each factor on mortality is analysed and we describe the interactions between these factors and age, answering questions such as whether the impact of a healthy lifestyle or affluence attenuates with age. Further, we highlight the importance of the choice of affluence measure in analysing mortality, and show that the salary at retirement is a better predictor of longevity than the pension amount for male pensioners.
The results of this paper are directly relevant to any pensions actuary advising on an appropriate baseline assumption (i.e. current mortality rates) for use with occupational pension schemes.
We investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007–2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.
Adequate dietary intake during the growth period is critical for bone mineral accretion. In 1997, an adequate intake (AI) of 1300 mg/d Ca was set for North American adolescents aged 9–18 years based on best available data. We determined bone Ca accrual values from age 9 to 18 years taking into account sex and maturity. Furthermore, we used the accrual data to estimate adolescents' Ca requirements. Total body bone mineral content (TBBMC) of eighty-five boys and sixty-seven girls participating in the Saskatchewan Paediatric Bone Mineral Accrual Study were used to determine annual TBBMC accumulation over the pubertal growth period. Using a similar factorial approach as the AI, we estimated Ca requirements of adolescent boys and girls for two age groups: 9–13 and 14–18 years. Between 9 and 18 years, boys accrued 198·8 (sd 74·5) g bone mineral content (BMC) per year, equivalent to 175·4 (sd 65·7) mg Ca per d with the maximum BMC accrual of 335·9 g from age 13 to 14 years. Girls had 138·1 (sd 64·2) g BMC per year, equalling121·8 (sd 56·6) mg Ca per d with the maximum annual BMC accrual of 266·0 g from age 12 to 13 years. Differences were observed between both sex and age groups with respect to Ca needs: boys and girls aged 9–13 years would require 1000–1100 mg/d Ca, and from age 14 to 18 years, the mean Ca requirements would be relatively stable at 1000 mg/d for girls but would rise to 1200 mg/d for boys.
Although an effective whooping cough vaccine has been available in the UK since the 1950s, its current association with neurotoxicity has resulted in poor uptake: as a consequence major epidemics (with significant morbidity and mortality) arc still being experienced.
Component (sub-unit) vaccines, which incorporate those antigens thought to be concerned with generating a protective effect, have been developed and are now available for field testing. This paper addresses how such a vaccine might be evaluated, the organization of a trial and the difficulties to be expected.
Amongst the four common Ha-ras alleles in both controls and cancer patients, we detected the presence of a polymorphic Xho I site associated specifically with the 6·6 and 7·7 kb Bam HI fragments but absent from the 7·1 and 8·2 kb alleles, as recently reported by others. We have extended this study and report here, the consistent appearance of this Xho I site in unusual alleles close in size to the two common alleles of 6·6 and 7·7 kb, in control lymphoblastoid DNA samples in a variety of tumor DNAs. Unusual alleles grouped around the 7·1 and 8·2 kb common alleles on the other hand, did not possess the Xho I site. The consistent presence of the Xho I site polymorphism, in the unusual Ha-ras alleles surrounding the 6·6 and 7·7 kb common alleles and its absence in alleles around the 7·1 and 8·2 kb common alleles, suggests that the unusual ones are derived from the corresponding common alleles to which they are closest in size.
The millennium of Edward the Confessor's birth presents an appropriate occasion for a full-scale, up-to-date reassessment of his life, reign and cult, a reappraisal which is provided in the essays here. After an introduction to the many views of Edward's life, and a reinterpretation of the development of his cult, the volume considers his childhood in England and its influence upon his later life; the time he spent in Normandy and the relationships that developed there; and his later life, including an examination of the role played by Edith, his queen. There is also a particular focus upon Westminster Abbey, and the major new discoveries which have recently been made there. Incorporating both broad surveys and the fruits of detailed new work, this book is essential reading for all those interested in late Saxon and Norman England.
CONTRIBUTORS: RICHARD MORTIMER, SIMON KEYNES, ELISABETH VAN HOUTS, STEPHEN BAXTER, PAULINE STAFFORD, ERIC FERNIE, WARWICK RODWELL, RICHARD GEM, EDINA BOZOKY