34 resultados para 13077-047


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Background: Bevacizumab has been suggested to have similar effectiveness to ranibizumab for treatment of neovascular age-related macular degeneration. The Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial was designed to compare these drugs and different regimens. Here, we report the findings at the prespecified 2-year timepoint. Methods: In a multicentre, 2×2 factorial, non-inferiority randomised trial, we enrolled adults aged at least 50 years with active, previously untreated neovascular age-related macular degeneration and a best corrected distance visual acuity (BCVA) of at least 25 letters from 23 hospitals in the UK. Participants were randomly assigned (1:1:1:1) to intravitreal injections of ranibizumab (0·5 mg) or bevacizumab (1·25 mg) in continuous (every month) or discontinuous (as needed) regimens, with monthly review. Study participants and clinical assessors were masked to drug allocation. Allocation to continuous or discontinuous treatment was masked up to 3 months, at which point investigators and participants were unmasked. The primary outcome was BCVA at 2 years, with a prespecified non-inferiority limit of 3·5 letters. The primary safety outcome was arterial thrombotic event or hospital admission for heart failure. Analyses were by modified intention to treat. This trial is registered, number ISRCTN92166560. Findings: Between March 27, 2008, and Oct 15, 2010, 628 patients underwent randomisation. 18 were withdrawn; 610 received study drugs (314 ranibizumab; 296 bevacizumab) and were included in analyses. 525 participants reached the visit at 2 years: 134 ranibizumab in continuous regimen, 137 ranibizumab in discontinuous regimen, 127 bevacizumab in continuous regimen, and 127 bevacizumab in discontinuous regimen. For BCVA, bevacizumab was neither non-inferior nor inferior to ranibizumab (mean difference -1·37 letters, 95% CI -3·75 to 1·01; p=0·26). Discontinuous treatment was neither non-inferior nor inferior to continuous treatment (-1·63 letters, -4·01 to 0·75; p=0·18). Frequency of arterial thrombotic events or hospital admission for heart failure did not differ between groups given ranibizumab (20 [6%] of 314 participants) and bevacizumab (12 [4%] of 296; odds ratio [OR] 1·69, 95% CI 0·80-3·57; p=0·16), or those given continuous (12 [4%] of 308) and discontinuous treatment (20 [7%] of 302; 0·56, 0·27-1·19; p=0·13). Mortality was lower with continuous than discontinuous treatment (OR 0·47, 95% CI 0·22-1·03; p=0·05), but did not differ by drug group (0·96, 0·46-2·02; p=0·91). Interpretation: Ranibizumab and bevacizumab have similar efficacy. Reduction in the frequency of retreatment resulted in a small loss of efficacy irrespective of drug. Safety was worse when treatment was administered discontinuously. These findings highlight that the choice of anti-VEGF treatment strategy is less straightforward than previously thought.

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A novel tubular cell structure for a direct methanol fuel cell (DMFC) is proposed based on a tubular Ti mesh and a Ti mesh anode. A dip coating method has been developed to fabricate the cell. The characterization of the tubular MEA has been analyzed by scanning electron microscopy (SEM), energy dispersive X-ray (EDX), half cell and single cell testing. The tubular DMFC single cell comprises: a Ti mesh, a cathode diffusion layer and catalyst layer, a Nafion recast membrane and a PtRuO/Ti anode. Half cell tests show that the optimum catalyst loading, Ru/(Ru + Pt) atomic ratio and the Nafion loading of a PtRuO/Ti mesh anode are: 4 mg cm, 38% and 0.6 mg cm, respectively. Single cell tests show that the Nafion loading of the recast Nafion membrane and the concentration of the methanol in the electrolyte have a major influence on cell performance. © 2006 Elsevier B.V. All rights reserved.

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Carboxyl-functionalized multiwalled carbon nanotubes (MWCNTs) have been successfully radiolabelled with cobalt-57 (57Co) (T1/2 = 270 days) via the attachment of the bifunctional caged ligand MeAMN3S3sar. In this study MeAMN3S3sar has been synthesized and coupled to MWCNTs to form the conjugate MWCNT–MeAMN3S3sar. Synthesis was confirmed with nuclear magnetic resonance. X-ray photoelectron spectroscopy (XPS) confirmed the conjugation. Non-radioactive labelling of this conjugate was completed with Cu(II) ions to confirm the stability of the MeAMN3S3sar after coupling with the MWCNTs. The complexation of the Cu(II) was also confirmed with XPS. Transmission electron microscopy was used to demonstrate that the coupling reaction had a negligible effect on the size and shape of the MWCNTs. Radiolabelling of the MWCNT–MeAMN3S3sar conjugate and pristine (untreated) MWCNTs (non-specific) with the gamma-emitting radioactive isotope 57Co were compared. The radiolabelling efficiency of the MWCNT–MeAMN3S3sar conjugate was significantly higher (95% vs. 0.1%) (P ⩽ 0.001) than for the unconjugated pristine MWCNTs. This will allow for the potential tracking of nanoparticle movement in vitro and in vivo.

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Identifying rare, highly penetrant risk mutations may be an important step in dissecting the molecular etiology of schizophrenia. We conducted a gene-based analysis of large (>100kb), rare copy number variants (CNVs) in the Wellcome Trust Case Control Consortium 2 (WTCCC2) schizophrenia sample of 1,564 cases and 1,748 controls all from Ireland, and further extended the analysis to include an additional 5,196 UK controls. We found association with duplications at chr20p12.2 (P=0.007) and evidence of replication in large independent European schizophrenia (P=0.052) and UK bipolar disorder case-control cohorts (P=0.047). A combined analysis of Irish/UK subjects including additional psychosis cases (schizophrenia and bipolar disorder) identified 22 carriers in 11,707 cases and 10 carriers in 21,204 controls (meta-analysis CMH P value=2x10(-4) (odds ratio (OR)=11.3, 95% CI=3.7, ∞)). Nineteen of the 22 cases and 8 of the 10 controls carried duplications starting at 9.68Mb with similar breakpoints across samples. By haplotype analysis and sequencing we identified a tandem ∼149kb duplication overlapping the gene p21 Protein-Activated Kinase 7 (PAK7, also called PAK5) which was in linkage disequilibrium with local haplotypes (P=2.5x10(-21)), indicative of a single ancestral duplication event. We confirmed the breakpoints in 8/8 carriers tested and found co-segregation of the duplication with illness in two additional family members of one of the affected probands. We demonstrate that PAK7 is developmentally co-expressed with another known psychosis risk gene (DISC1) suggesting a potential molecular mechanism involving aberrant synapse development and plasticity.

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Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study's aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8Gy vs 35.5 ± 4.2Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4Gy vs 35.5 ± 4.2Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to deliverable apertures, particularly for plans that emphasize avoidance of critical structures. Minimizing these differences would result in better quality treatments for patients with prostate cancer who were treated with radiotherapy using MCO plans.

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The ability of a gold palladium bimetallic catalyst to selectively oxidise toluene has been used to enhance the hydrocarbon selective catalytic reduction of NOx, a reaction in which the interaction of partial oxidation intermediates is considered important. The combination of gold with palladium has a synergistic effect, producing a catalyst that is more active for NOx conversion than the arithmetic sum of the corresponding mono-metallic materials. Three regimes in the conversion profile of the AuPd catalyst are proposed relating to production and consumption of toluene derived species, such as benzaldehyde and benzonitrile. The possible role of these reaction intermediates in the toluene HC-SCR reaction is examined. Using 15NO, the formation of N2 and N2O is observed via the direct interaction between the nitrogen atom of benzonitrile and 15NO. The higher activity of the bimetallic catalyst for the NOx reduction reaction by toluene is discussed in the context of these partial oxidation intermediates.

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Chili powder is a globally traded commodity which has been found to be adulterated with Sudan dyes from 2003 onwards. In this study, chili powders were adulterated with varying quantities of Sudan I dye (0.1-5%) and spectra were generated using near infrared reflectance spectroscopy (NIRS) and Raman
spectroscopy (on a spectrometer with a sample compartment modified as part of the study). Chemometrics were applied to the spectral data to produce quantitative and qualitative calibration models and prediction statistics. For the quantitative models coefficients of determination (R2) were found to be
0.891-0.994 depending on which spectral data (NIRS/Raman) was processed, the mathematical algorithm used and the data pre-processing applied. The corresponding values for the root mean square error of calibration (RMSEC) and root mean square error of prediction (RMSEP) were found to be 0.208-0.851%
and 0.141-0.831% respectively, once again depending on the spectral data and the chemometric treatment applied to the data. Indications are that the NIR spectroscopy based models are superior to the models produced from Raman spectral data based on a comparison of the values of the chemometric
parameters. The limit of detection (LOD) based on analysis of 20 blank chili powders against each calibration model gave 0.25% and 0.88% for the NIR and Raman data, respectively. In addition, adopting a qualitative approach with the spectral data and applying PCA or PLS-DA, it was possible to discriminate
between adulterated chili powders from non-adulterated chili powders.

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An yttrium aluminum (YAl2) intermetallic compound ingot was prepared in an induction furnace under vacuum. The microstructure of YAl2 ingot was characterized by optical microscopy, scanning electron microscopy, and X-ray diffraction. The load bearing response of YAl2 intermetallic was investigated and compared with SiC ceramic by indentation combined with optical microscopy and scanning electron microscopy. Additionally, the tensile properties of the Mg–Li matrix composites reinforced with ultrafine YAl2 particles fabricated by planet ball milling were tested. The results show that the intermetallic compound ingot in this experiment is composed of a main face-centered-cubic structure YAl2 phase, a small amount of YAl phase, and minor Y and Al-rich phases. YAl2 intermetallic compound has excellent stability and shows better capability in crack resistance than SiC ceramic. The YAl2 intermetallic compound has better deformation compatibility with the Mg–14Li–3Al matrix than SiC reinforcement with the matrix, which leads to the superior resistance to crack for YAl2p/Mg–14Li–3Al composite compared to SiCp/Mg–14Li–3Al composite.

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Background: Patient reported outcome measures (PROMs) are used to evaluate lifestyle interventions but littleis known about differences between patients returning valid and invalid responses, or of potential for bias inevaluations. We aimed to examine the characteristics of patients who returned valid responses to lifestylequestionnaires compared to those whose responses were invalid for evaluating lifestyle change. 
Methods: We conducted a secondary data analysis from the SPHERE Study, a trial of an intervention to improveoutcomes for patients with coronary heart disease in primary care. Postal questionnaires were used to assessphysical activity (Godin) and diet (DINE) among study participants at baseline and 18 month follow-up. Three binaryresponse variables were generated for analysis: (1) valid Godin score; (2) valid DINE Fibre score; and (3) validDINE Total Fat score. Multivariate analysis comprised generalised estimating equation regression to examine theassociation of patients’ characteristics with their return of valid responses at both timepoints. 
Results: Overall, 92.1% of participants (832/903) returned questionnaires at both baseline and 18 months. Relativelyfewer valid Godin scores were returned by those who left school aged <15 years (36.5%) than aged 18 and over(50.5%), manual workers (39.5%) than non-manual (49.5%) and those with an elevated cholesterol (>5 mmol)(34.7%) than those with a lower cholesterol (44.4%) but multivariate analysis identified that only school leaving age(p = 0.047) was of statistical significance.Relatively fewer valid DINE scores were returned by manual than non-manual workers (fibre: 80.8% v 86.8%;fat: 71.2% v 80.0%), smokers (fibre: 72.6% v 84.7%; fat: 67.5% v 76.9%), patients with diabetes (fibre: 75.9% v 82.9%;fat: 66.9% v 75.8%) and those with cholesterol >5 mmol (fat: 68.2% v 76.2%) but multivariate analysis showedstatistical significance only for smoking (fibre: p = 0.013; fat: p = 0.045), diabetes (fibre: p = 0.039; fat: p = 0.047), andcholesterol (fat: p = 0.039). 
Conclusions: Our findings illustrate the importance of detailed reporting of research methods, with clearinformation about response rates, respondents and valid outcome data. Outcome measures which are relevant to astudy population should be chosen carefully. The impact of methods of outcome measurement and valid responserates in evaluating healthcare requires further study.

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The study assessed the effect of heating vermiculites on extractability of phosphorus, iron, zinc and manganese with respect to their potential agricultural use. Of these elements, phosphorus was from apatite and monazite that occur as accessory minerals in vermiculites. Vermiculites were heated at 15-800 degrees C and digested by acetic acid for extracting phosphorus and diethylene triamine pentaacetic acid (DTPA) for extracting zinc, iron and manganese. Phosphorus in the extract was analysed by a flow injection method while zinc, iron and manganese were measured by atomic absorption spectrometry. The results showed that heating vermiculites to 400 C enhanced extractability of phosphorus from apatite and monazite to a level of 335 mg kg(-1). Further heating to 800 degrees C reduced extractable phosphorus to less than 75 mg kg(-1). Maximum extractable zinc, iron and manganese found were 2.7, 19.1 and 22.9 mg kg(-1), respectively, values that are beneficial and tolerable by most plants. Thus, it was concluded that heating vermiculites to

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Introduction: proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda.

Methods: patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients.

Results: the prevalence of missed appointments was 42% (95%CI=35-49%). The factors associated with missed appointments were: monthly income ?30US Dollars (OR=2.56, CI=1.25–5.26), affording less than half of prescribed drugs (OR=3.92, CI=1.64–9.40), not experiencing adverse events (OR=2.66, CI=1.26–5.61), not sure if treatment helps (OR=2.84, CI=1.047.77), not having a medicines administration schedule (OR=6.77, CI=2.11–21.68), and increasing number of drugs (OR=0.72, CI=0.53–0.98). Conclusion: patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services.

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Because of the requirements for the damage tolerance and fatigue life of commercial aircraft components, the high cycle fatigue (HCF) properties of Ti–5Al–5Mo–5V–1Cr–1Fe titanium alloy forgings are important. The effects of microstructure types of the α+β titanium alloy on fatigue properties need to be understood. In this paper, by analysing the fracture surfaces of the titanium alloy having four types of microstructure, the effects of microstructure are investigated. The differences of initiation areas and crack propagation among different microstructures were studied. It was found that the area of the initiation region decreases in the order of coarse basketweave, fine basketweave, Widmanstätten, and bimodal microstructure.

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BACKGROUND: Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes.

OBJECTIVE: The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group.

METHODS: A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants' views of the Web-based program.

RESULTS: Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean -3.41, 95% CI -4.70 to -2.13 kg vs mean -0.52, 95% CI -1.55 to 0.52 kg, P<.001), at 6 months (mean -3.47, 95% CI -4.95 to -1.98 kg vs mean -0.81, 95% CI -2.23 to 0.61 kg, P=.02), but not at 12 months (mean -2.38, 95% CI -3.48 to -0.97 kg vs mean -1.80, 95% CI -3.15 to -0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained.

CONCLUSIONS: Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes.


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Aims: Preterm infants are deprived of the normal intra-uterine exposure to maternal melatonin and may benefit from replacement therapy. We conducted a pharmacokinetic study to guide potential therapeutic trials. Methods: Melatonin was administered to 18 preterm infants in doses ranging from 0.04-0.6μgkg-1 over 0.5-6h. Pharmacokinetic profiles were analyzed individually and by population methods. Results: Baseline melatonin was largely undetectable. Infants receiving melatonin at 0.1μgkg-1h-1 for 2h showed a median half-life of 15.82h and median maximum plasma concentration of 203.3pgml-1. On population pharmacokinetics, clearance was 0.045lh-1, volume of distribution 1.098l and elimination half-life 16.91h with gender (P = 0.047) and race (P < 0.0001) as significant covariates. Conclusions: A 2h infusion of 0.1μgkg-1h-1 increased blood melatonin from undetectable to approximately peak adult concentrations. Slow clearance makes replacement of a typical maternal circadian rhythm problematic. The pharmacokinetic profile of melatonin in preterm infants differs from that of adults so dosage of melatonin for preterm infants cannot be extrapolated from adult studies. Data from this study can be used to guide therapeutic clinical trials of melatonin in preterm infants. © 2013 The British Pharmacological Society.

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In a recent paper (Automatica 49 (2013) 2860–2866), the Wirtinger-based inequality has been introduced to derive tractable stability conditions for time-delay or sampled-data systems. We point out that there exist two errors in Theorem 8 for the stability analysis of sampled-data systems, and the correct theorem is presented.