Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis

OBJECTIVE: To compare the effectiveness and safety of intraarticular high-molecular hylan with standard preparations of hyaluronic acids in osteoarthritis of the knee. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials comparing hylan with a hyaluronic acid in patients with knee osteoarthritis. Trials were identified by systematic searches of Central, Medline, EMBase, Cinahl, the Food and Drug Administration, and Science Citation Index supplemented by hand searches of conference proceedings and reference lists (last update November 2006). Literature screening and data extraction were performed in duplicate. Effect sizes were calculated from differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled standard deviation. Trials were combined using random-effects meta-analysis. RESULTS: Thirteen trials with a pooled total of 2,085 patients contributed to the meta-analysis. The pooled effect size was -0.27 (95% confidence interval [95% CI] -0.55, 0.01), favoring hylan, but between-trial heterogeneity was high (I(2) = 88%). Trials with blinded patients, adequate concealment of allocation, and an intent-to-treat analysis had pooled effect sizes near null. The meta-analyses on safety revealed an increased risk associated with hylan for any local adverse events (relative risk [RR] 1.91; 95% CI 1.04, 3.49; I(2) = 28%) and for flares (RR 2.04; 95% CI 1.18, 3.53; I(2) = 0%). CONCLUSION: Given the likely lack of a superior effectiveness of hylan over hyaluronic acids and the increased risk of local adverse events associated with hylan, we discourage the use of intraarticular hylan in patients with knee osteoarthritis in clinical research or practice.

Gender-specific usage of intramyocellular lipids and glycogen during exercise

PURPOSE: Gender-specific differences in substrate utilization during exercise have been reported, typically such that women rely more on fat than men. This study investigated whether gender differences exist in the utilization of intramyocellular lipids (IMCL) and glycogen. METHODS: IMCL and glycogen, as well as total fat and carbohydrate (CHO) oxidation were measured in nine males and nine females before, during, and after an endurance exercise. The trained subjects exercised on a bicycle ergometer at 50% maximal workload for 3 h. IMCL and glycogen were determined in the thigh by magnetic resonance spectroscopy. Oxygen uptake (VO(2)) and carbon dioxide production were determined by open circuit spirometry to calculate total fat and CHO oxidation. Relative power output, percent of maximum heart rate, VO(2peak), and respiratory exchange ratio were the same. RESULTS: Average fat oxidation was the same, whereas CHO oxidation was significantly higher in males compared with females. The relative contribution of these fuels to total energy used were similar in males and females. Males and females depleted IMCL and glycogen significantly (P < 0.001) during the 3-h exercise. IMCL levels at rest (P < 0.05) and its depletion during exercise (P < 0.001) were significantly higher in males compared with females, whereas glycogen was stored and used in the same range by both genders. CONCLUSION: During this 3-h exercise, energy supplies from fat and CHO were similar in both genders, and males as well as females reduced their IMCL stores significantly. The larger contribution of IMCL during exercise in males compared with females could either be a result of gender-specific substrate selection, or different long-term training habit.

Seasonal variation of VO 2 max and the VO2-work rate relationship in elite Alpine skiers

PURPOSE: Alpine ski performance relates closely to both anaerobic and aerobic capacities. During their competitive season, skiers greatly reduce endurance and weight training, and on-snow training becomes predominant. To typify this shift, we compared exhaustive ramp cycling and squat (SJ) and countermovement jumping (CMJ) performance in elite males before and after their competitive season. RESULTS: In postseason compared with preseason: 1) maximal oxygen uptake (VO 2 max) normalized to bodyweight was higher (55.2 +/- 5.2 vs 52.7 +/- 3.6 mL x kg(-1) x min(-1), P < 0.01), but corresponding work rate (W) was unchanged; 2) at ventilatory thresholds (VT), absolute and relative work rates were similar but heart rates were lower; 3) VO2/W slope was greater (9.59 +/- 0.6 vs 9.19 +/- 0.4 mL O2 x min(-1) x W(-1), P = 0.02), with similar flattening (P < 0.01) above V T1 at both time points; and 4) jump height was greater in SJ (47.4 +/- 4.4 vs 44.7 +/- 4.3 cm, P < 0.01) and CMJ (52.7 +/- 4.6 vs 50.4 +/- 5.0 cm, P < 0.01). DISCUSSION: We believe that aerobic capacity and leg power were constrained in preseason and that improvements primarily reflected an in-season recovery from a fatigued state, which was caused by incongruous preseason training. Residual adaptations to high-altitude exposure in preseason could have also affected the results. Nonetheless, modern alpine skiing seemingly provides an ample cardiovascular training stimulus for skiers to maintain their aerobic capacities during the racing season. CONCLUSIONS: We conclude that aerobic fitness and leg explosiveness can be maintained in-season but may be compromised by heavy or excessive preseason training. In addition, ramp test V O2/W slope analysis could be useful for monitoring both positive and negative responses to training.

Soil Erosion and Conservation in Global Agriculture

About one-sixth of the world’s land area, that is, about one-third of the land used for agriculture, has been affected by soil degradation in the historic past. While most of this damage was caused by water and wind erosion, other forms of soil degradation are induced by biological, chemical, and physical processes. Since the 1950s, pressure on agricultural land has increased considerably owing to population growth and agricultural modernization. Small-scale farming is the largest occupation in the world, involving over 2.5 billion people, over 70% of whom live below the poverty line. Soil erosion, along with other environmental threats, particularly affects these farmers by diminishing yields that are primarily used for subsistence. Soil and water conservation measures have been developed and applied on many farms. Local and science-based innovations are available for most agroecological conditions and land management and farming types. Principles and measures developed for small-scale as well as modern agricultural systems have begun to show positive impacts in most regions of the world, particularly in wealthier states and modern systems. Much more emphasis still needs to be given to small-scale farming, which requires external support for investment in sustainable land management technologies as an indispensable and integral component of farm activities.

Eccentric exercise in coronary patients: central hemodynamic and metabolic responses

With lengthening (eccentric) muscle contractions, the magnitude of locomotor-muscle mass and strength increase has been demonstrated to be greater compared with shortening (concentric) muscle contractions. In healthy subjects, energy demand and heart rate responses with eccentric exercise are small relative to the amount of muscle force produced. Thus, eccentric exercise may be an attractive alternative to resistance exercise for patients with limited cardiovascular exercise tolerance.

ICOMF: Towards a Multi-cloud Ecosystem for Dynamic Resource Composition and Scaling

Modern cloud-based applications and infrastructures may include resources and services (components) from multiple cloud providers, are heterogeneous by nature and require adjustment, composition and integration. The specific application requirements can be met with difficulty by the current static predefined cloud integration architectures and models. In this paper, we propose the Intercloud Operations and Management Framework (ICOMF) as part of the more general Intercloud Architecture Framework (ICAF) that provides a basis for building and operating a dynamically manageable multi-provider cloud ecosystem. The proposed ICOMF enables dynamic resource composition and decomposition, with a main focus on translating business models and objectives to cloud services ensembles. Our model is user-centric and focuses on the specific application execution requirements, by leveraging incubating virtualization techniques. From a cloud provider perspective, the ecosystem provides more insight into how to best customize the offerings of virtualized resources.

The quiet eye and tasks demands: Do tougher shots need a quieter eye?

The Quiet Eye (QE; Vickers 1996) has been shown to underpin successful performance, differentiating both expertise (inter-individual) and proficiency (intra-individual), with experts and successful attempts characterised by longer QE durations. The QE is proposed to reflect the time needed to organise and fine tune the parameters of movement (e.g. force and direction). In order to examine this prediction and build upon previous research we experimentally manipulated the difficulty of a golf putting task; we hypothesised that if the QE is related to motor programming then a more difficult task should be associated with longer QE durations. 33 golfers (M age= 21.16, SD= 3.98) with an average handicap of 6.5 (SD= 6.02) performed putts in 4 conditions of increasing difficulty. We manipulated the length of the golf putt (short-4ft, long-8ft) and the contact point of the putter head (large-1.7cm, small-0.5cm,) giving increasingly difficult putting conditions of short-large [1], short-small [2], long-large [3] and long-small [4]. We measured performance (radial error from hole in cm) and QE (in ms) for 10 putts in each condition. A repeated measures ANOVA was performed on the performance and QE data. The performance data suggest that we were successful in increasing the difficulty of the task (F (3,93) = 26.46. p = .000), with the best performance in condition [1] (8.57cm), followed by [2] (9.10cm) followed by [3] (16.11cm) and finally the worst performance was in condition [4] (23.40cm). The QE data suggest that, in keeping with our hypothesis, the QE was lengthened as task difficulty increased (F (3,87) = 11.91, p = .043). The QE was shortest in condition [1] (1787.85ms) and increased to condition [2] (1939.78ms) and condition [3] (2076.51ms), with the longest QE in condition [4] (2164.08ms). More detailed analysis of the QE reveal that it was the proportion of the QE that occurred before movement initiation (pre-QE) which increased with shot difficulty, rather than the proportion that occurred during the swing (Online-QE; see Vine et al., 2013). Results support the notion that more complex tasks are associated with a longer QE duration, specifically participants appear to spend longer fixating the target prior to movement. This likely reflects the time needed to process visual information gathered in a pre-performance routine, to inhibit external distraction, and to pre-programme the increasingly difficult parameters of the movement. Vickers, J.N. (1996). Visual control when aiming at a far target. Journal of Experimental Psychology: Human Perception and Performance, 22, 342-354. Vine, S.J. et al. (2013). Quiet eye and choking: Online control breaks down at the point of performance failure. Medicine and Science in Sports and Exercise, 45, 1988-1994.

Reactivity to Accelerometer Measurement of Children and Adolescents

PURPOSE: Awareness of being monitored can influence participants' habitual physical activity (PA) behavior. This reactivity effect may threaten the validity of PA assessment. Reports on reactivity when measuring the PA of children and adolescents have been inconsistent. The aim of this study was to investigate whether PA outcomes measured by accelerometer devices differ from measurement day to measurement day and whether the day of the week and the day on which measurement started influence these differences. METHODS: Accelerometer data (counts per minute [cpm]) of children and adolescents (n = 2081) pooled from eight studies in Switzerland with at least 10 h of daily valid recording were investigated for effects of measurement day, day of the week, and start day using mixed linear regression. RESULTS: The first measurement day was the most active day. Counts per minute were significantly higher than on the second to the sixth day, but not on the seventh day. Differences in the age-adjusted means between the first and consecutive days ranged from 23 to 45 cpm (3.6%-7.1%). In preschoolchildren, the differences almost reached 10%. The start day significantly influenced PA outcome measures. CONCLUSIONS: Reactivity to accelerometer measurement of PA is likely to be present to an extent of approximately 5% on the first day and may introduce a relevant bias to accelerometer-based studies. In preschoolchildren, the effects are larger than those in elementary and secondary schoolchildren. As the day of the week and the start day significantly influence PA estimates, researchers should plan for at least one familiarization day in school-age children and randomly assign start days.

Recommendations for sex/gender neuroimaging research: Key principles and implications for research design, analysis and interpretation

Neuroimaging (NI) technologies are having increasing impact in the study of complex cognitive and social processes. In this emerging field of social cognitive neuroscience, a central goal should be to increase the understanding of the interaction between the neurobiology of the individual and the environment in which humans develop and function. The study of sex/gender is often a focus for NI research, and may be motivated by a desire to better understand general developmental principles, mental health problems that show female-male disparities, and gendered differences in society. In order to ensure the maximum possible contribution of NI research to these goals, we draw attention to four key principles—overlap, mosaicism, contingency and entanglement—that have emerged from sex/gender research and that should inform NI research design, analysis and interpretation. We discuss the implications of these principles in the form of constructive guidelines and suggestions for researchers, editors, reviewers and science communicators.

Religious Diversity and Religious Vitality: New Measuring Strategies and Empirical Evidence

Quantitative studies of the conditions and consequences of religious diversity are based mostly on indices that measure the variety of religious membership in a particular region. However, this line of research has become stagnant, and the question of whether diversity affects religious vitality remains unanswered. This article attempts to shed new light on the discussion by measuring religious diversity differently and capturing religious vitality independently of membership figures. In particular, it contrasts the Herfindahl-Hirschman Index based on membership proportions with a second measure of diversity: an index of organizational diversity. Conversely, the dependent variable religious vitality is measured not by using rates of participation in religious organizations but via the Centrality of Religion Scale. Based on ecological and individual level data of forty-three local regions in Finland, Germany, and Slovenia and using multilevel analysis, our results suggest that religious diversity is related to religious vitality. However, the nature of this association differs across subgroups.

What Is behind God’s Name? Martin Buber’s and Franz Rosenzweig’s Reflections on the Name of God

What meaning does God’s name convey? This was a question Martin Buber and Franz Rosenzweig had to answer when working on their translation of the Bible. They noticed that, as certain crucial biblical verses suggest, there is indeed a meaning behind God’s name in the Bible. Thus, an important moment in their joint translation was their account of the self-revelation of God in Exod. III, together with the question of how best to translate the tetragrammaton YHWH— the name of God. This article will explore their decisions, based both on their dialogue concerning the translation of the Bible, and on their papers, especially Rosenzweig’s well-known article ‘Der Ewige’ (‘The Eternal’) and Buber’s response to it. Less well known is the fact that there exist two unpublished typescripts by Martin Buber reflecting on the name of God, which will also be taken into consideration. Contrary to the received view that the choice of the personal pronoun to transliterate the name of God in the Bible translation was mainly Rosenzweig’s, I will show that it was actually a joint decision in which both thinkers’ philosophies,1 and a question that had haunted Buber since his youth, played an important part. The choice of the personal pronoun is an answer to this question, addressing the omnipresent God, the eternal Thou, in a kind of cultic acclamation.

Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology

In this consensus document we summarize the current knowledge on major asthma, rhinitis, and atopic dermatitis endotypes under the auspices of the PRACTALL collaboration platform. PRACTALL is an initiative of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology aiming to harmonize the European and American approaches to best allergy practice and science. Precision medicine is of broad relevance for the management of asthma, rhinitis, and atopic dermatitis in the context of a better selection of treatment responders, risk prediction, and design of disease-modifying strategies. Progress has been made in profiling the type 2 immune response-driven asthma. The endotype driven approach for non-type 2 immune response asthma, rhinitis, and atopic dermatitis is lagging behind. Validation and qualification of biomarkers are needed to facilitate their translation into pathway-specific diagnostic tests. Wide consensus between academia, governmental regulators, and industry for further development and application of precision medicine in management of allergic diseases is of utmost importance. Improved knowledge of disease pathogenesis together with defining validated and qualified biomarkers are key approaches to precision medicine.