Nutrition and physical activity programs for obesity treatment (PRONAF study). methodological approach of the project

Este trabajo aborda la metodología seguida para llevar a cabo el proyecto de investigación PRONAF (Clinical Trials Gov.: number NCT01116856.) Background: At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study. Methods/design: One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18–50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29–34% of the total energy intake came from fat, 14–20% from protein, and 50–55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%). Discussion: Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications.

Análisis de las diferencias en el crecimiento vegetativo, en los componentes del rendimiento y en la composición de las uvas y vinos del cv. cabernet sauvignon (vitis vinifera L.), producidos por el déficit hídrico durante pre-envero y post-envero

La presente Tesis Doctoral se realizó con el fin de estimar conjuntamente la respuesta agronómica y fisiológica de la vid (Vitis vinifera L.), así como los efectos sobre la evolución de la maduración, composición y la calidad de la uva y del vino, bajo la aplicación de diferentes déficit hídricos en pre-envero y post-envero, dentro de un marco de referencia de cambio climático. La variación climática que prevén los estudios sobre el cambio climático, resulta un factor decisivo en la eficiencia del uso del agua en la vid. En zonas cálidas, las estrategias de cultivo del viñedo frente al cambio climático deben de ir dirigidas a atenuar sus efectos sobre el crecimiento y el desarrollo de la vid, haciéndose imprescindible el estudio pormenorizado del déficit hídrico como factor decisivo en la obtención de las uvas adecuadas, ya que son la clave indispensable para el éxito en la elaboración del vino, y de forma muy especial en los vinos enfocados a un sector de alta calidad. El ensayo se llevó a cabo en un viñedo comercial de Bodegas Licinia, en la Comunidad de Madrid, durante los años 2010 y 2011. La variedad estudiada fue Cabernet sauvignon / 41 B, plantada a un marco de plantación de 3 m x 1 m, con un guiado vertical de la vegetación. El dispositivo experimental fue totalmente al azar, y se establecieron 4 tratamientos experimentales con 4 grados de disponibilidad hídrica, déficit moderado continuo (T0,45-0,6), déficit severo continuo (T0-0,3), déficit severo después de envero (T0,45-0,3) y déficit severo antes de envero (T0-0,6). En cada tratamiento se distribuyeron 3 repeticiones. El año 2010 fue el más lluvioso de los años de ensayo, con 478 mm de precipitaciones anuales, lo que supuso 146 mm más que en el año 2011. Su distribución a lo largo del ciclo fue más homogénea en el año 2010, mientras que en 2011 las precipitaciones contabilizadas en el período de maduración de la uva fueron nulas. La temperatura media subió 0,9ºC en 2011, respecto a 2010 y en cuanto a la integral térmica eficaz, en 2011 se acumularon, desde el 1 de abril hasta el final de ciclo, 217 grados•día más que en 2010. El déficit hídrico en pre-envero, modificó notablemente el crecimiento vegetativo y la producción de cosecha de la parcela de ensayo, no así la fertilidad de las yemas. El tratamiento con mayor disponibilidad hídrica (T0,45-0,6) obtuvo el mayor peso de baya, y los tratamientos con menor déficit hídrico en pre-envero (T0,45-0,6 y T0,45-0,3) registraron los mayores rendimientos de cosecha, mientras que las menores tasas de cuajado correspondieron al tratamiento con un déficit severo continuo (T0-0,3). La parcela de ensayo se caracterizó por un exceso de vigor y un alto crecimiento vegetativo. El pH del mosto se vio afectado por el déficit hídrico, disminuyendo su valor en el tratamiento de déficit hídrico severo antes de envero (T0-0,6). Organolépticamente, no se percibieron diferencias significativas en los vinos elaborados en función del déficit hídrico, y respecto a su composición físico-química, solo existieron diferencias en la concentración de ácido L-Málico, con mayores concentraciones en los tratamientos sin déficit hídrico en pre-envero, T0,45-0,6 y T0,45-0,3. El déficit hídrico modificó notablemente el color del vino, aumentando los valores de las coordenadas CIELAB a* y b*, la luminosidad (L*), croma (C*) y tonalidad (H*), para los tratamientos con un déficit severo en pre-envero (T0-0,3 y T0-0,6) y disminuyendo estas en el tratamiento con mayor disponibilidad hídrica (T0,45-0,6). Del mismo modo, mediante el análisis de color por métodos tradicionales, IPT e IC de los vinos, aumentó en los tratamientos con mayor déficit hídrico en pre-envero (T0-0,3 y T0-0,6), respecto a los tratamientos de mayor disponibilidad (T0,45-0,6 y T0,45-0,3). La concentración de taninos de la baya en vendimia, no se vio afectada por el déficit hídrico, aunque sí estuvo relacionada positivamente con el tamaño de las bayas. Organolépticamente, los hollejos del año 2011 resultaron con menor frescura, acidez, afrutado, sensación herbácea e intensidad tánica, aunque con mayor astringencia respecto a 2010. Las pepitas fueron más astringentes y aromáticas pero menos crujientes, sin llegar a los niveles de madurez del año 2010. El catador relacionó los taninos con la calidad del vino, asociándolos con un mayor cuerpo, acidez, intensidad, equilibrio gustativo, amargor y menor astringencia en la fase gustativa. La concentración de taninos en los vinos se vio favorecida con el déficit hídrico en pre-envero y post-envero. Los tratamientos con mayor déficit hídrico en pre-envero, T0-0,6 y T0-0,3, obtuvieron las menores concentraciones de potasio en mostos y vinos. Las relaciones entre la concentración de potasio, ácido L-Málico y el porcentaje de color rojo puro (dA(%)) resultaron altamente significativas, de modo que las mayores tasas de potasio en el vino se asociaron a los valores más bajos de color rojo y a los mayores de ácido L-Málico. ABSTRACT The present Doctoral Thesis has been done in order to estimate the grapevine (Vitis vinifera L.) agronomic and physiologic performance or response as well as the impact in the grape and wine maturity, composition and quality evolution, with different water deficits. The variation in climate that the global warming studies for seen is a key factor for the grapevine water use efficiency. In warm areas the farming vineyards strategy to face the climatic change, should be focused on diminish the effects on the grapevine growth and development, so that the water deficit detailed analysis becomes decisive to obtain the appropriate grapes, that are the main subject for a successful wine production and especially for top quality wines. The trial was carried out in a commercial vineyard in Chinchón (Madrid), Licinia winery, during the 2010 and 2011 seasons. The grape variety studied was Cabernet Sauvignon grafted onto 41B with a vine spacing 3m x 1m trained as VSP. Experimental design consisted on 4 irrigation treatments with 3 replications totally randomized. Irrigation treatments were: moderate regulated deficit (T0,45-0,6), severe continuous deficit (T0-0,3), severe post-veraison deficit (T0,45-0,3) and severe pre veraison deficit (T0-0,6). The 2010 was rainier year than the 2011; Total annual rain in 2010 was 478 mm, which resulted in 146 mm more than in 2011. The distribution along the vine cycle was more homogeneous in the 2010, whereas precipitations in 2011 along the grape maturity period were nonexistent. The average temperature in 2011 was 0,9ºC higher than that of the 2010 and regarding to the thermal integral, in the 2011 from 1st April to the end of the growing cycle, was 217 degrees•day higher than that in 2010. Water deficit significantly modified the vegetative growth and yield but, it did not modified bud fertility. The treatment with the highest water availability (T0,45-0,6) got the highest berry size, the lowest berry set rates were found in the severe continuous deficit treatment (T0-0,3). The plot studied in this trial was characterized by both excessive vigour and vegetative growth. Water deficit modified the pH must by, reducing it in the severe water deficit during pre-veraison (T0-0,6). There were not differences in wine tasting between the water deficits treatments. Regarding to the physical-chemical composition, it only existed differences in the L-malic acid concentration, resulting higher concentrations in the water deficit pre-veraison treatments: T0,45-0,6 y T0,45-0,3. Water deficit significantly modified wine colour by, increasing the CIELAB coordinates a* and b*, the brightness (L*), croma (C*) and tonality (H*), in the lower water availability pre-veraison treatments (T0-0,3 y T0-0,6), and reducing them in the in the moderate continuous water deficit ones (T0,45-0,6). By means of traditional wine colour parameters analyses, red colour percentage, TPI, they became higher in the lower water availability pre-veraison treatments (T0-0,3 y T0-0,6), than in those with higher availability (T0,45-0,6 y T0,45-0,3). At harvest, berry tannins concentrations was not affected by the water deficit although it did in a positive way, in the berry size. Berry tasting in 2011, resulted in a lower freshness, acidity, fruity, herbaceous flavour and tannic intensity, but with higher astringency respect to the 2010 season. Seeds, in 2011, were more astringent and aromatic as in the 2010, but less crunchy, without getting to the point of maturity. The taster linked the tannins to wine quality, associating them with a higher bodiest wine, acidity, intensity, taste balance, bitterness and with a lower astringency in the tasting stage. Treatments with a higher water deficit up to veraison T0-0,6 y T0-0,3 got less musts and wines potassium concentration. The relation between L-malic acid and the full red color percentage (dA(%)), were highly related, resulting the higher potassium content the lower wine quality.

Muscarinic acetylcholine receptor expression in memory circuits: Implications for treatment of Alzheimer disease

Cholinergic transmission at muscarinic acetylcholine receptors (mAChR) has been implicated in higher brain functions such as learning and memory, and loss of synapses may contribute to the symptoms of Alzheimer disease. A heterogeneous family of five genetically distinct mAChR subtypes differentially modulate a variety of intracellular signaling systems as well as the processing of key molecules involved in the pathology of the disease. Although many muscarinic effects have been identified in memory circuits, including a diversity of pre- and post-synaptic actions in hippocampus, the identities of the molecular subtypes responsible for any given function remain elusive. All five mAChR genes are expressed in hippocampus, and subtype-specific antibodies have enabled identification, quantification, and localization of the encoded proteins. The m1, m2, and m4 mAChR proteins are most abundant in forebrain regions and they have distinct cellular and subcellular localizations suggestive of various pre- and postsynaptic functions in cholinergic circuits. The subtypes are also differentially altered in postmortem brain samples from Alzheimer disease cases. Further understanding of the molecular pharmacology of failing synapses in Alzheimer disease, together with the development of new subtype-selective drugs, may provide more specific and effective treatments for the disease.

Modulation of Sarco/Endoplasmic Reticulum Ca2+-ATPase 2 (SERCA2) function by acetylation following the treatment with histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA)

Background: Acetylation and deacetylation at specific lysine (K) residues is mediated by histone acetylases (HATs) and deacetylases (HDACs), respectively. HATs and HDACs act on both histone and non-histone proteins, regulating various processes, including cardiac impulse propagation. Aim of the present work was to establish whether the function of the Ca2+ ATPase SERCA2, one of the major players in Ca2+ reuptake during excitation-contraction coupling in cardiac myocytes (CMs), could be modulated by direct K acetylation. Materials and methods: HL-1 atrial mouse cells (donated by Prof. Claycomb), zebrafish and Streptozotocin-induced diabetic rat CMs were treated with the pan-inhibitor of class I and II HDACs suberanilohydroxamic acid (SAHA) for 1.5 hour. Evaluation of SERCA2 acetylation was analyzed by co-immunoprecipitation. SERCA2 activity was measured on microsomes by pyruvate/NADH coupled reaction assay. SERCA2 mutants were obtained after cloning wild-type and mutated sequences into the pCDNA3 vector and transfected into HEK cells. Ca2+ transients in CMs (loading with Fluo3-AM, field stimulation, 0.5 Hz) and in transfected HEK cells (loading with FLUO-4, caffeine pulse) were recorded. Results: Co-Immunoprecipitation experiments performed on HL-1 cells demonstrated a significant increase in the acetylation of SERCA2 after SAHA-treatment (2.5 µM, n=3). This was associated with an increase in SERCA2 activity in microsomes obtained from HL-1 cells, after SAHA exposure (n=5). Accordingly, SAHA-treatment significantly shortened the Ca2+ reuptake time of adult zebrafish CMs. Further, SAHA 2.5 nM restored to control values the recovery time of Ca2+ transients decay in diabetic rat CMs. HDAC inhibition also improved contraction parameters, such as fraction of shortening, and increased pump activity in microsomes isolated from diabetic CMs (n=4). Notably, the K464, identified by bioinformatic tools as the most probable acetylation site on human SERCA2a, was mutated into Glutamine (Q) or Arginine (R) mimicking acetylation and deacetylation respectively. Measurements of Ca2+ transients in HEK cells revealed that the substitution of K464 with R significantly delayed the transient recovery time, thus indicating that deacetylation has a negative impact on SERCA2 function. Conclusions: Our results indicate that SERCA2 function can be improved by pro-acetylation interventions and that this mechanism of regulation is conserved among species. Therefore, the present work provides the basis to open the search for novel pharmacological tools able to specifically improve SERCA2 activity in diseases where its expression and/or function is impaired, such as diabetic cardiomyopathy.

The Perpetration of Spousal Abuse by Male Combat Veterans: Recommendations for Individualized Group Domestic Violence Treatment for Veterans

Recent estimates suggest that spousal abuse is, in fact, on the rise in the U.S. military (The Miles Foundation, 2005). As research specific to the impact of posttraumatic stress disorder (PTSD) on U.S. soldiers has grown since the Vietnam War, clinicians and researchers have begun to investigate how combat-related trauma affects veterans in terms of aggression, hostility and social/emotional functioning. The training and stressors experienced by soldiers in the military are unique and affect all aspects of the veteran's functioning. This paper discusses questions related to why combat veterans may be at increased risk to commit spousal abuse (verbal, psychological, and physical), the relationship between PTSD, substance use, and violence, and the advantages to individualizing group domestic violence (DV) treatment programs for combat veterans. Recommendations will be made for a DV treatment program specifically for combat veterans who also suffer from PTSD.

Recovery from Pediatric Brain Injury: A Preliminary Comparison of Longitudinal Data on Psychological Symptomology and Mental Health Treatment

Objective: To document the course of psychological symptomology, mental health treatment, and unmet psychological needs using caregiver reports in the first 18 months following pediatric brain injury (BI). Method: Participants included 28 children (aged 1-18 years) who were hospitalized at a children's hospital's rehabilitation unit. Caregiver reports of children's psychological symptoms, receipt of mental health treatment, and unmet psychological needs were assessed at one month, six months, 12 months, and 18 months post-BI. Results: Caregivers reported a general increase in psychological symptoms and receipt of mental health treatment over the 18 months following BI; however, there was a substantial gap between the high rate of reported symptoms and low rate of reported treatment. Across all four follow-up time points there were substantial unmet psychological needs (at least 60% of sample). Conclusions: Findings suggest that there are substantial unmet psychological needs among children during the first 18 months after BI. Barriers to mental health treatment for this population need to be addressed.

Evaluating the Effectiveness of Post Fire Emergency Rehabilitation Treatments on Soil Degradation and Erosion Control in Semi-Arid Mediterranean Areas of the Spanish South East

In this study, we seeded a native plant species and applied a mulch of chopped wood originating from the same burned area to avoid the establishment of invasive species. We evaluated four treatments: (1) seeding, (2) mulch, (3) seeding and mulch, and (4) control. Our objective was to increase plant recovery and to minimize the soil erosion and degradation. The study was conducted in Alicante, Spain in Torremanzanas forest of the semi-arid Mediterranean bioclimatic area after the wildfire of November, 2002. During three years of monitoring, we find that combined treatment: seeding and mulch increased the post fire plant recovery 20% approximately more than the rest of treatments and the control plots. We also found that seven months after treating mulch and seeding and mulch treatments presented a gain of soil: +5.18 to + 5.24 mm while the seeding treatment and control plots presented soil loss rates of: −0.48 to −0.49 mm. In addition, mulch treatment significantly decreased soil compaction to the half, and increased the infiltration capacity to 40 ml.mn−1 more than in plots without mulch, as well as increased the soil respiration to the double compared with no mulch plots. Work in progress confirms the positive effect of chopped wood as mulching treatment with or without seeding on the soil protection against soil erosion, and the amelioration of bio-physical properties after wildfires in the Mediterranean semi-arid burned areas.

Wavefront-Guided Laser Treatment Using a High-Resolution Aberrometer to Measure Irregular Corneas: A Pilot Study

PURPOSE: To evaluate in a pilot study the visual, refractive, corneal topographic, and aberrometric changes after wavefront-guided LASIK or photorefractive keratectomy (PRK) using a high-resolution aberrometer to calculate the treatment for aberrated eyes. METHODS: Twenty aberrated eyes of 18 patients undergoing wavefront-guided LASIK or PRK using the VISX STARS4IR excimer laser and the iDesign aberrometer (Abbott Medical Optics, Inc., Santa Ana, CA) were enrolled in this prospective study. Three groups were differentiated: keratoconus post-CXL group including 11 keratoconic eyes (10 patients), post-LASIK group including 5 eyes (5 patients) with previous decentered LASIK treatments, and post-RK group including 4 eyes (3 patients) with previous radial keratotomy. Visual, refractive, contrast sensitivity, corneal topographic, and ocular aberrometric changes were evaluated during a 6-month follow-up. RESULTS: An improvement in uncorrected (UDVA) and corrected visual acuity (CDVA) associated with a reduction in the spherical equivalent was observed in the three groups, but was only statistically significant in the keratoconus post-CXL and post-LASIK groups (P ≤ .04). All eyes gained one or more lines of CDVA after surgery. Improvements in contrast sensitivity were observed in the three groups, but they were only statistically significant in the keratoconus post-CXL and post-LASIK groups (P ≤ .04). Regarding aberrations, a reduction was observed in trefoil aberrations in the keratoconus post-CXL group (P = .05) and significant reductions in higher-order and primary coma aberrations in the post-LASIK group (P = .04). CONCLUSIONS: Wavefront-guided laser enhancements using the evaluated platform seem to be safe and effective to restore the visual function in aberrated eyes.

The socio-economic of exclusion: Re-questioning citizenship in relation to social justice in the post Arab Spring Egypt. Arab Citizenship Review No. 15, 19 February 2016

The most recent official statistics reveal that over a quarter of Egypt’s population still live in poverty, a third of its youth are unemployed and three out of five children are malnourished. Much of the criticism of Egypt’s human rights record, particularly after the Arab Spring, remains focused on the country’s civil and political rights, and freedoms with an intentional (or unintentional) disregard to socioeconomic rights, fuelling widespread poverty, deteriorating living standards, socioeconomic exclusion and unequal and/or degrading treatment. This paper examines the socioeconomic policies of exclusion that are still undermining the enjoyment of basic citizenship rights in Egypt.

Final post-ASAP progress report - Puerto Rico Alcohol Safety Action Project.

National Highway Traffic Safety Commission, Washington, D.C.

Post ASAP analysis of project impact on ultimate measures of performance, level III - analytic study one. 1975-1976 period. Final report.

National Highway Traffic Safety Administration, Office of Driver and Pedestrian Programs, Washington, D.C.

Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders

Background. The present paper describes a component of a large Population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder). Method. Outcome was calculated as averted 'years lived with disability' (YLD), a population summary measure of disability burden. Costs were the direct health care costs in 1997-8 Australian dollars. The cost per YLD averted (efficiency) was calculated for those already in contact with the health system for a mental health problem (current care) and for a hypothetical optimal care package of evidence-based treatment for this same group. Data sources included the Australian National Survey of Mental Health and Well-being and published treatment effects and unit costs. Results. Current coverage was around 40% for most disorders with the exception of social phobia at 21%. Receipt of interventions consistent with evidence-based care ranged from 32% of those in contact with services for social phobia to 64% for post-traumatic stress disorder. The cost of this care was estimated at $400 million, resulting in a cost per YLD averted ranging from $7761 for generalized anxiety disorder to $34 389 for panic/agoraphobia. Under optimal care, costs remained similar but health gains were increased substantially, reducing the cost per YLD to < $20 000 for all disorders. Conclusions. Evidence-based care for anxiety disorders would produce greater population health gain at a similar cost to that of current care, resulting in a substantial increase in the cost-effectiveness of treatment.

An evaluation of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury - A report of 3 cases

Objective: To evaluate the effectiveness of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury (17111). Design: An A-B-A experimental research design. Assessments were conducted prior to commencement of the program, midway, immediately posttreatment, and 1 month after completion of the CPAP therapy program. Participants: Three adults with dysarthria and moderate to severe hypernasality subsequent to TBI. Outcome Measures: Perceptual evaluation using the Frenchay Dysarthria Assessment, the Assessment of Intelligibility of Dysarthric Speech, and a speech sample analysis, and instrumental evaluation using the Nasometer. Results: Between assessment periods, varying degrees of improvement in hypernasality and sentence intelligibility were noted. At the 1-month post-CPAP assessment, all 3 participants demonstrated reduced nasalance values, and 2 exhibited increased sentence intelligibility. Conclusions: CPAP may be a valuable treatment of impaired velopharyngeal function in the TBI population.

Viscosupplementation for the treatment of osteoarthritis of the knee (Review)

Background Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Objectives To assess the effects of viscosupplementation in the treatment of OA of the knee. The products were hyaluronan and hylan derivatives (Adant, Arthrum H, Artz (Artzal, Supartz), BioHy (Arthrease, Euflexxa, Nuflexxa), Durolane, Fermathron, Go-On, Hyalgan, Hylan G-F 20 (Synvisc Hylan G-F 20), Hyruan, NRD-101 (Suvenyl), Orthovisc, Ostenil, Replasyn, SLM-10, Suplasyn, Synject and Zeel compositum). Search strategy MEDLINE (up to January (week 1) 2006 for update), EMBASE, PREMEDLINE, Current Contents up to July 2003, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Specialised journals and reference lists of identified randomised controlled trials (RCTs) and pertinent review articles up to December 2005 were handsearched. Selection criteria RCTs of viscosupplementation for the treatment of people with a diagnosis of OA of the knee were eligible. Single and double-blinded studies, placebo-based and comparative studies were eligible. At least one of the four OMERACT III core set outcome measures had to be reported (Bellamy 1997). Data collection and analysis Each trial was assessed independently by two reviewers for its methodological quality using a validated tool. All data were extracted by one reviewer and verified by a second reviewer. Continuous outcome measures were analysed as weighted mean differences (WMD) with 95% confidence intervals (CI). However, where different scales were used to measure the same outcome, standardized mean differences (SMD) were used. Dichotomous outcomes were analyzed by relative risk (RR). Main results Seventy-six trials with a median quality score of 3 (range 1 to 5) were identified. Follow-up periods varied between day of last injection and eighteen months. Forty trials included comparisons of hyaluronan/hylan and placebo (saline or arthrocentesis), ten trials included comparisons of intra-articular (IA) corticosteroids, six trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs), three trials included comparisons of physical therapy, two trials included comparisons of exercise, two trials included comparisons of arthroscopy, two trials included comparisons of conventional treatment, and fifteen trials included comparisons of other hyaluronans/hylan. The pooled analyses of the effects of viscosupplements against 'placebo' controls generally supported the efficacy of this class of intervention. In these same analyses, differential efficacy effects were observed for different products on different variables and at different timepoints. Of note is the 5 to 13 week post injection period which showed a percent improvement from baseline of 28 to 54% for pain and 9 to 32% for function. In general, comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA corticosteroids. In general, few adverse events were reported in the hyaluronan/hylan trials included in these analyses. Authors' conclusions Based on the aforementioned analyses, viscosupplementation is an effective treatment for OA of the knee with beneficial effects: on pain, function and patient global assessment; and at different post injection periods but especially at the 5 to 13 week post injection period. It is of note that the magnitude of the clinical effect, as expressed by the WMD and standardised mean difference (SMD) from the RevMan 4.2 output, is different for different products, comparisons, timepoints, variables and trial designs. However, there are few randomised head-to-head comparisons of different viscosupplements and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products. The clinical effect for some products, against placebo, on some variables at some timepoints is in the moderate to large effect-size range. Readers should refer to relevant tables to review specific detail given the heterogeneity in effects across the product class and some discrepancies observed between the RevMan 4.2 analyses and the original publications. Overall, the analyses performed are positive for the HA class and particularly positive for some products with respect to certain variables and timepoints, such as pain on weight bearing at 5 to 13 weeks postinjection. In general, sample-size restrictions preclude any definitive comment on the safety of the HA class of products; however, within the constraints of the trial designs employed no major safety issues were detected. In some analyses viscosupplements were comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events. In other analyses HA products had more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.

Use of electropalatography in the treatment of disordered articulation following traumatic brain injury: A case study

Electropalatography (EPG) was used as a biofeedback tool in a case study of a 30-year-old male with disordered articulation following traumatic brain injury (TBI). Based on qualitative measures of the participant's intelligibility, improved articulation of the fricatives /s/ and /integral/ were selected as treatment targets. Therapy was administered three times a week for 5 weeks. Results showed that word and sentence intelligibility increased approximately 10%, and error patterns for lingual articulation indicated that fricative -> stop and other fricative errors decreased considerably. EPG measures for /s/ exhibited a significantly more anterior main focus of articulatory contact post therapy. Consonant durations were significantly longer during weeks 3 and 4, and this finding was associated with the emergence of an articulatory contact pattern with a groove rather than complete closure. This articulatory pattern appeared inconsistently and was found to vary across articulations of /s/ but also within a single consonant production. For /integral/, the amount of contact was significantly reduced post therapy and an increase in duration was noted during week 4, similar to that occurring in the production of /s/. Spatial and timing measures were more variable than in normal speakers of English and indicated a general increase in variability across weeks for both /s/ and /integral/. It was concluded that, although the correct fricative patterns appeared only intermittently during production of the consonants, there seemed to be sufficient information for the listener to be able to classify the sound as a fricative. As a part of an intervention program, visual EPG biofeedback therapy would appear to have a definite role in assisting dysarthric speakers exhibiting difficulties with lingual articulation in understanding their errors, learning how to exploit kinesthetic, and acoustic sources of feedback, and how to make appropriate adjustments in tongue articulation to increase the level of speech intelligibility.