Effect of once-yearly zoledronic acid 5 mg on fracture risk and change in femoral neck bone mineral density

Context: In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly - Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly reduced fracture risk. Objective: To identify factors associated with greater efficacy during ZOL 5 mg treatment. Design, Setting and Patients: Subgroup analysis (preplanned and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month trial in 7765 women with postmenopausal osteoporosis. Intervention: Single infusion of ZOL 5 mg or placebo at baseline, 12 and 24 months. Main Outcome Measures: Primary endpoints: new vertebral fracture and hip fracture. Secondary endpoints: non-vertebral fracture, change in femoral neck bone mineral density (BMD). Baseline risk factor subgroups: age, BMD T-score and vertebral fracture status, total hip BMD, race, weight, geographical region, smoking, height loss, history of falls, physical activity, prior bisphosphonates, creatinine clearance, body mass index (BMI), concomitant osteoporosis medications. Results: Greater ZOL induced effects on vertebral fracture risk with younger age (treatment-by-subgroup interaction P=0.05), normal creatinine clearance (P=0.04), and BMI >/=25 kg/m(2) (P=0.02). There were no significant treatment-factor interactions for hip or non-vertebral fracture or for change in BMD. Conclusions: ZOL appeared more effective in preventing vertebral fracture in younger women, overweight/obese women and women with normal renal function. ZOL had similar effects irrespective of fracture risk factors or femoral neck BMD.

A communication and information technology infrastructure for real time monitoring and management of type 1 diabetes patients

This paper is focused on the integration of state-of-the-art technologies in the fields of telecommunications, simulation algorithms, and data mining in order to develop a Type 1 diabetes patient's semi to fully-automated monitoring and management system. The main components of the system are a glucose measurement device, an insulin delivery system (insulin injection or insulin pumps), a mobile phone for the GPRS network, and a PDA or laptop for the Internet. In the medical environment, appropriate infrastructure for storage, analysis and visualizing of patients' data has been implemented to facilitate treatment design by health care experts.

The Spanish impersonal se-construction. Constructional variation and change

The aim of this paper is to analyze, synchronically and diachronically, aspects of the Spanish impersonal se-construction that have not yet been satisfactorily accounted for in Spanish linguistics

The Topology of Auditory and Visual Perception, Linguistic Communication, and Interactive Written Discourse

In this article, it is shown that IWD incorporates topological perceptual characteristics of both spoken and written language, and it is argued that these characteristics should not be ignored or given up when synchronous textual CMC is technologically developed and upgraded.

Book Review of “The Origins of Social Work: Continuity and Change”. Basingstoke: Palgrave Macmillan, 2005, by Malcolm Payne

Malcolm Payne’s latest work proposes to survey the continuity and change in social work from its inception and origins, up until the present day. In order to do justice to the theme, its author could have concentrated on developing a narrative of a national enterprise, or restricted himself to a regional analysis (Western European Social Work) or opt instead for a more narrowly focused cultural exploration, White Anglo-Saxon Social Work (WASSW). One can only infer that limiting himself in this fashion would have struck the author as parochial, or rather, that only a truly global enterprise could satisfy his capacious mind. One is left to marvel at the invocation of Darwin’s great work and wonder what was the process of the author’s “natural” selection of this material.

Edna Chamberlain (1921 -2005): A Leader through Times of Transition and Change

Professor Edna Chamberlain was an outstanding leader in Australian social work. She contributed extensively to social work education at the University of Queensland, the social work profession through her leadership of the Australian Association of Social Workers and to the community through advocacy for progressive social policies. Her life experiences were influential is shaping her career and her particular teaching and research interests. Early in her life, Chamberlain was exposed to individual deprivation as a result of the Great Depression. This provided the incentive for a career in social work. She worked as a social work practitioner for some years and entered the academic world until after the death of her husband. In the university and profession, she was confronted by conflict between traditionalists and those wanting immediate reform. In managing these tensions, she tried to find the common ground but these tensions also moderated and changed her views about the purpose and practice of social work. Her rich practice and later research and teaching background provided a strong basis for her professional leadership, research activities and curriculum initiatives. Whilst social casework methods were influential early in her career she sought in later years to integrate the private pain of individuals with social policy and community planning by focusing on the purpose of social work – demonstrating her commitment to the disadvantaged in the context of social justice.

Combining follow-up and change data is valid in meta-analyses of continuous outcomes: a meta-epidemiological study

OBJECTIVE To investigate whether it is valid to combine follow-up and change data when conducting meta-analyses of continuous outcomes. STUDY DESIGN AND SETTING Meta-epidemiological study of randomized controlled trials in patients with osteoarthritis of the knee/hip, which assessed patient-reported pain. We calculated standardized mean differences (SMDs) based on follow-up and change data, and pooled within-trial differences in SMDs. We also derived pooled SMDs indicating the largest treatment effect within a trial (optimistic selection of SMDs) and derived pooled SMDs from the estimate indicating the smallest treatment effect within a trial (pessimistic selection of SMDs). RESULTS A total of 21 meta-analyses with 189 trials with 292 randomized comparisons in 41,256 patients were included. On average, SMDs were 0.04 standard deviation units more beneficial when follow-up values were used (difference in SMDs: -0.04; 95% confidence interval: -0.13, 0.06; P=0.44). In 13 meta-analyses (62%), there was a relevant difference in clinical and/or significance level between optimistic and pessimistic pooled SMDs. CONCLUSION On average, there is no relevant difference between follow-up and change data SMDs, and combining these estimates in meta-analysis is generally valid. Decision on which type of data to use when both follow-up and change data are available should be prespecified in the meta-analysis protocol.

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

This study investigates predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at one-year follow-up. The predictor x group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp+the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and one-year follow-up after controlling for pre-treatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.