Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30

Aim: To use published literature and experts' opinion to investigate the clinical meaning and magnitude of changes in the Quality of Life (QOL) of groups of patients measured with the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Methods: An innovative method combining systematic review of published studies, expert opinions and meta-analysis was used to estimate large, medium, and small mean changes over time for QLQ-C30 scores. Results: Nine hundred and eleven papers were identified, leading to 118 relevant papers. One thousand two hundred and thirty two mean changes in QOL over time were combined in the meta-analysis, with timescales ranging from four days to five years. Guidelines were produced for trivial, small, and medium size classes, for each subscale and for improving and declining scores separately. Estimates for improvements were smaller than respective estimates for declines. Conclusions: These guidelines can be used to aid sample size calculations and interpretation of mean changes over time from groups of patients. Observed mean changes in the QLQ-C30 scores are generally small in most clinical situations, possibly due to response shift. Careful consideration is needed when planning studies where QOL changes over time are of primary interest; the timing of follow up, sample attrition, direction of QOL changes, and subscales of primary interest are key considerations. (C) 2012 Elsevier Ltd. All rights reserved.

Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives

Primary immunodeficiencies (PIDs) are genetic disorders of the immune system comprising many different phenotypes. Although previously considered rare, recent advances in their clinical, epidemiological, and molecular definitions are revealing how much we still need to learn about them. For example, geographical and ethnic variations as well as the impact of certain practices influence their frequency and presentation, making it necessary to consider their study in terms of regions. The Latin American Society for Immunodeficiencies was established as an organization dedicated to provide scientific support for basic and clinical research and to develop tools and educational resources to promote awareness in the medical community. Initiatives such as these are positively influencing the way PIDs are tackled in these countries, as shown by recent reports and publications. This paper provides a historical compilation and a current view of the many issues faced by scientists studying these diseases in these countries, highlighting the diverse scientific contributions and offering a promising perspective for the further developments in this field in Latin America.

Understanding the mechanical and biodegradation behaviour of poly(hydroxybutyrate)/rubber blends in relation to their morphology

In this work poly(hydroxybutyrate/poly(vinyl butyral)- co-(vinyl alcohol)-co(vinyl acetate) (or ethylene propylene diene monomer rubber) blends were prepared by conventional processing techniques (extrusion and injection moulding). A droplet type morphology was obtained for P(3HB)/PVB blends whereas P(3HB)/EPDM blends presented some extent of co-continuous morphology. In addition, rubbery domains were much smaller in the case of PVB. These differences in morphology are discussed taking into account solubility parameters and rheological behaviours of each component. For both blends, the increase of elastomer ratio led to a decrease of Young's modulus but an increase in elongation at break and impact strength. The latter increased more in the case of P(3HB)/EPDM blends although the rubbery domains were larger. These results are explained in the light of the glass transition of the rubber and the presence of plasticizer in the case of PVB. The addition of elastomer also resulted in an increase of P(3HB) biodegradation rate, especially in the case of EPDM. It is assumed that, in this case, the size and morphology of the rubbery domains induce a geometrical modification of the erosion front which leads to an increase of the interface between P(3HB) phase and the degradation medium and consequently to an apparently faster biodegradation kinetics of PHB/rubber blends. Copyright (C) 2011 Society of Chemical Industry