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Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction. Results: At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012). Conclusion: Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.
Background: Considerable evidence from twin and adoption studies indicates that genetic and shared environmental factors play a role in the initiation of smoking behavior. Although twin and adoption designs are powerful to detect genetic and environmental influences, they do not provide information on the processes of assortative mating and parent–offspring transmission and their contribution to the variability explained by genetic and/or environmental factors. Methods: We examined the role of genetic and environmental factors in individual differences for smoking initiation (SI) using an extended kinship design. This design allows the simultaneous testing of additive and non-additive genetic, shared and individual-specific environmental factors, as well as sex differences in the expression of genes and environment in the presence of assortative mating and combined genetic and cultural transmission, while also estimating the regression of the prevalence of SI on age. A dichotomous lifetime ‘ever’ smoking measure was obtained from twins and relatives in the ‘Virginia 30,000’ sample and the ‘Australian 25,000’. Results: Results demonstrate that both genetic and environmental factors play a significant role in the liability to SI. Major influences on individual differences appeared to be additive genetic and unique environmental effects, with smaller contributions from assortative mating, shared sibling environment, twin environment, cultural transmission, and resulting genotype-environment covariance. Age regression of the prevalence of SI was significant. The finding of negative cultural transmission without dominance led us to investigate more closely two possible mechanisms for the lower parent–offspring correlations compared to the sibling and DZ twin correlations in subsets of the data: (1) age × gene interaction, and (2) social homogamy. Neither of the mechanism provided a significantly better explanation of the data. Conclusions: This study showed significant heritability, partly due to assortment, and significant effects of primarily non-parental shared environment on liability to SI.
Healthcare-associated infections in veterinary hospitals are commonly attributed to Salmonella enterica, particularly in large animal facilities, and are characteristically associated with widespread environmental contamination. The objective of this study was to investigate factors influencing the likelihood of identifying environmental contamination of a veterinary hospital with S. enterica, while exploring different analytic methods to model complex factors that may influence this ecology. Environmental surveillance samples were collected in a large veterinary hospital as part of a long-term infection control programme. Data were collected retrospectively from the electronic medical records database. Many easily measured variables were complex in nature (i.e., they represented variance that is unmeasured or unidentified as a specific factor) necessitating the use of alternative analytic methods (variable cluster and principal components analyses) to provide perspective regarding the complex data structure and latent factors that may be contributing to this ecology. Subsequently, multivariable logistic regression was performed using generalised estimating equations. Results suggest the probability of detecting Salmonella in the environment increased as demand on personnel increased (e.g., in a busy hospital). Veterinary personnel need to remain vigilant in implementing practices that we believe empirically will mitigate risk for widespread environmental contamination and sustained transmission among patients (i.e., rigorous hygiene for personnel and the environment).
There are no available medications for the management of alcohol dependence for patients with alcoholic liver disease (ALD).
To conduct a multisite, double blind, placebo-controlled, randomised clinical trial of baclofen in the treatment of alcohol dependence, with or without liver disease (trial registration: ClinicalTrials.gov, NCT01711125).
Patients (n = 104) were randomised to placebo, baclofen 30 mg/day or 75 mg/day for 12 weeks. Primary outcomes included survival time to lapse (any drinking), relapse (≥5 drinks per day in men and ≥4 in women), and the composite outcome of drinks per drinking day, number of heavy drinking days, and percentage days abstinent.
There was a significant effect of baclofen (composite groups) on time to lapse (χ2 = 6.44, P<0.05, Cohen's d = 0.56) and relapse (χ2 = 4.62, P<0.05, d = 0.52). A significant treatment effect of baclofen was observed for percentage days abstinent (placebo 43%, baclofen 30 mg 69%, baclofen 75 mg 65%; P<0.05). There was one serious adverse event (overdose) directly related to medication (75 mg).
Baclofen may be an effective treatment option for patients with ALD. However, given the profile of adverse events, the role for this medication might be best limited to specialist services.
Evidence is emerging regarding the influence of meteorological factors on seasonal respiratory syncytial virus outbreaks. Data however, are limited for subtropical regions, especially in the southern hemisphere. We examined whether meteorological data (daily minimum and maximum temperatures, rainfall, relative humidity, dew point, daily global solar exposure) and tourist numbers were associated with the incidence of RSV in children aged <5 years for the Gold Coast region of South-East Queensland, Australia (latitude 28.0°S). RSV cases between 1 July 2007 and 30 June 2016 were identified from the Pathology Queensland Gold Coast Laboratory database. Time-series methods were used to identify seasonal patterns. RSV activity peaked in mid-to-late autumn (April–May), tapering in winter (June–August). While most meteorological variables measured were associated with RSV incidence, rainfall (ρ = 0.40, 95% confidence interval (CI) 0.32–0.48) and humidity (ρ = 0.38, 95% CI 0.29–0.46) 8 weeks earlier had the nearest temporal relationship. Tourist numbers were not correlated with RSV activity. Identifying meteorological conditions associated with seasonal RSV epidemics can improve understanding of virus transmission and assist planning for their impact upon the health sector, including timing of passive RSV immunoprophylaxis for high-risk infants and future public health interventions, such as maternal immunisation with RSV vaccines.
Recent studies have improved our understanding of nearshore marine ecosystems surrounding Ascension Island (central Atlantic Ocean), but little is known about Ascension's benthic environment beyond its shallow coastal waters. Here, we report the first detailed physical and biological examination of the seabed surrounding Ascension Island at 100–1000 m depth. Multibeam swath data were used to map fine scale bathymetry and derive seabed slope and rugosity indices for the entire area. Water temperature and salinity profiles were obtained from five Conductivity, Temperature, Depth (CTD) deployments, revealing a spatially consistent thermocline at 80 m depth. A camera lander (Shelf Underwater Camera System; SUCS) provided nearly 400 images from 21 sites (100 m transects) at depths of 110–1020 m, showing high variability in the structure of benthic habitats and biological communities. These surveys revealed a total of 95 faunal morphotypes (mean richness >14 per site), complemented by 213 voucher specimens constituting 60 morphotypes collected from seven targeted Agassiz trawl (AGT) deployments. While total faunal density (maximum >300 m−2 at 480 m depth) increased with rugosity, characteristic shifts in multivariate assemblage structure were driven by depth and substratum type. Shallow assemblages (~100 m) were dominated by black coral (Antipatharia sp.) on rocky substrata, cup corals (Caryophyllia sp.) and sea urchins (Cidaris sp.) were abundant on fine sediment at intermediate depths (250–500 m), and shrimps (Nematocarcinus spp.) were common at greater depths (>500 m). Other ubiquitous taxa included serpulid and sabellid polychaetes and brittle stars (Ophiocantha sp.). Cold-water corals (Lophelia cf. pertusa), indicative of Vulnerable Marine Ecosystems (VMEs) and representing substantial benthic carbon accumulation, occurred in particularly dense aggregations at <350 m but were encountered as deep as 1020 m. In addition to enhancing marine biodiversity records at this locality, this study provides critical baseline data to support the future management of Ascension's marine environment.
To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.
Cross-sectional self-completion survey and height and weight measurements.
Australian secondary schools.
Students aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).
Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine.
High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.
Background: Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months’ duration. Limited data are available on the long-term outcomes of this chronic disease. The objective of this study was to determine the long-term clinical effectiveness of the management of chronic PDN at tertiary pain centres. Methods: From a prospective observational cohort study of patients with chronic neuropathic non-cancer pain recruited from seven Canadian tertiary pain centres, 60 patients diagnosed with PDN were identified for analysis. Data were collected according to Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines including the Brief Pain Inventory. Results: At 12-month follow-up, 37.2% (95% confidence interval [CI], 23.0-53.3) of 43 patients with complete data achieved pain reduction of ≥30%, 51.2% (95% CI, 35.5-66.7) achieved functional improvement with a reduction of ≥1 on the Pain Interference Scale (0-10, Brief Pain Inventory) and 30.2% (95% CI, 17.2-46.1) had achieved both these measures. Symptom management included at least two medication classes in 55.3% and three medication classes in 25.5% (opioids, antidepressants, anticonvulsants). Conclusions: Almost one-third of patients being managed for PDN in a tertiary care setting achieve meaningful improvements in pain and function in the long term. Polypharmacy including analgesic antidepressants and anticonvulsants were the mainstays of effective symptom management.
A number of sophisticated modelling approaches are available to investigate potential associations between antimicrobial use (AMU) and resistance (AMR) in animal health settings. All have their advantages and disadvantages, making it unclear as to which model is most appropriate. We used advanced regression modelling to investigate AMU-AMR associations in faecal non-type-specific Escherichia coli (NTSEC) isolates recovered from 275 pens of feedlot cattle. Ten modelling strategies were employed to investigate AMU associations with resistance to chloramphenicol, ampicillin, sulfisoxazole, tetracycline and streptomycin. Goodness-of-fit statistics did not show a consistent advantage for any one model type. Three AMU-AMR associations were significant in all models. Recent parenteral tetracycline use increased the odds of finding tetracycline-resistant NTSEC [odds ratios (OR) 1·1–3·2]; recent parenteral sulfonamide use increased the odds of finding sulfisoxazole-resistant NTSEC (OR 1·4–2·5); and recent parenteral macrolide use decreased the odds of recovering ampicillin-resistant NTSEC (OR 0·03–0·2). Other results varied markedly depending on the modelling approach, emphasizing the importance of exploring and reporting multiple modelling methods based on a balanced consideration of important factors such as study design, mathematical appropriateness, research question and target audience.
Jupiter-sized brown dwarfs are found in the solar neighborhood with effective temperature Teff as low as 250 K . Iron, silicates, chlorides and sulfides condense in the atmospheres of the Teff ≈ 2000 K L-type and Teff ≈ 1000 K T-type dwarfs . At the T-/Y-type boundary, Teff ≈ 500 K and atmospheres are clear . The next species to condense are H2O at Teff ≈ 350 K and NH3 at Teff ≈ 200 K .
To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.
Cross-sectional survey of students’ eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.
Australian secondary schools across all states/territories.
Secondary-school students aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 12 188).
Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week (‘frequent snackers’). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m2 were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.
Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.
We report a missed case of otosyphilis presenting as otic capsule lucencies on temporal bone computed tomography.
A 58-year-old woman presented with a 15-year history of bilateral, mixed hearing loss together with otic capsule lucencies, subsequently confirmed as otosyphilis. A literature review of otosyphilis was undertaken based on a PubMed search of studies published between 1988 and 2012, using the key words ‘otosyphilis’, ‘otodystrophy’, ‘otic capsule lucencies’ and ‘luetic osteitis’.
Results and conclusion:
Although rare, otosyphilis is important to recognise as it is one of the few treatable causes of deafness when diagnosed early. The differentiating computed tomography features of luetic osteitis (otosyphilis) of the temporal bone have only rarely been described. We emphasise how these imaging features can be used to distinguish the rare but treatable condition of luetic osteitis from other, more common conditions with similar imaging findings.
The study objective was to use Bayesian latent class analysis to evaluate the accuracy of susceptibility test results obtained from disk diffusion and broth microdilution using bacteria recovered from beef feedlot cattle. Isolates of Escherichia coli and Mannheimia haemolytica were tested for susceptibility to ampicillin, ceftiofur, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Results showed that neither testing method was always or even generally superior to the other. Specificity (ability to correctly classify non-resistant isolates) was extremely high for both testing methods, but sensitivity (ability to correctly classify resistant isolates) was lower, variable in the drugs evaluated, and variable between the two bacterial species. Predictive values estimated using Bayesian Markov chain Monte Carlo models showed that the ability to predict true susceptibility status was equivalent for test results obtained with the two testing methods for some drugs, but for others there were marked differences between results obtained from disk diffusion and broth microdilution tests.
This paper employs the state-space model to reexamine the fundamental issue in finance of whether it is the expected returns or the expected dividends growth that is primarily responsible for stock price variations. We use Bayesian methods to show that there is a substantial uncertainty about the contributions of expected returns and expected dividends to fluctuations in the price–dividend ratio when the aggregate returns and dividends data are used. The substantial uncertainty of the contributions results from the model being weakly identified. Our finding challenges the notion long held in the existing literature that it is the expected returns that contribute most to price–dividend variations.
We analyze the forecasting performance of small mixed-frequency factor models when the observed variables share stochastic trends. The indicators are observed at various frequencies and are tied together by cointegration so that valuable high-frequency information is passed to low-frequency series through the common factors. Differencing the data breaks the cointegrating link among the series and some of the signal leaks out to the idiosyncratic components, which do not contribute to the transfer of information among indicators. We find that allowing for common trends improves forecasting performance over a stationary factor model based on differenced data. The “common-trends factor model” outperforms the stationary factor model at all analyzed forecast horizons. Our results demonstrate that when mixed-frequency variables are cointegrated, modeling common stochastic trends improves forecasts.