Premature Discontinuation of Randomized Trials in Critical and Emergency Care: A Retrospective Cohort Study.

OBJECTIVES: Randomized clinical trials that enroll patients in critical or emergency care (acute care) setting are challenging because of narrow time windows for recruitment and the inability of many patients to provide informed consent. To assess the extent that recruitment challenges lead to randomized clinical trial discontinuation, we compared the discontinuation of acute care and nonacute care randomized clinical trials. DESIGN: Retrospective cohort of 894 randomized clinical trials approved by six institutional review boards in Switzerland, Germany, and Canada between 2000 and 2003. SETTING: Randomized clinical trials involving patients in an acute or nonacute care setting. SUBJECTS AND INTERVENTIONS: We recorded trial characteristics, self-reported trial discontinuation, and self-reported reasons for discontinuation from protocols, corresponding publications, institutional review board files, and a survey of investigators. MEASUREMENTS AND MAIN RESULTS: Of 894 randomized clinical trials, 64 (7%) were acute care randomized clinical trials (29 critical care and 35 emergency care). Compared with the 830 nonacute care randomized clinical trials, acute care randomized clinical trials were more frequently discontinued (28 of 64, 44% vs 221 of 830, 27%; p = 0.004). Slow recruitment was the most frequent reason for discontinuation, both in acute care (13 of 64, 20%) and in nonacute care randomized clinical trials (7 of 64, 11%). Logistic regression analyses suggested the acute care setting as an independent risk factor for randomized clinical trial discontinuation specifically as a result of slow recruitment (odds ratio, 4.00; 95% CI, 1.72-9.31) after adjusting for other established risk factors, including nonindustry sponsorship and small sample size. CONCLUSIONS: Acute care randomized clinical trials are more vulnerable to premature discontinuation than nonacute care randomized clinical trials and have an approximately four-fold higher risk of discontinuation due to slow recruitment. These results highlight the need for strategies to reliably prevent and resolve slow patient recruitment in randomized clinical trials conducted in the critical and emergency care setting.

Preparación y propiedades de una arcilla montmorillonita pilareada con polihidroxicationes de aluminio

Montmorillonite clay from Brazil was pillared with aluminium polyhydroxications. The influence of Al/Mont ratio and calcination temperature in the properties of the prepared materials was studied. Results showed that the pillarization process increases the basal spaces of the natural clay from 9,7 to 18,5Å and the superficial area from 41 to ~230m2/g. The calcination process at different temperatures showed that the pillared material was stable until 600oC but the adequate temperature for calcination was 450oC. Materials prepared with different Al/Mont ratios showed the maximum Al incorporation for ratios >10meq Al/g and a good distribution for rations >15meq Al/g.

Materiales laminares pilareados: preparación y propiedades

The structure of several types of layered materials will be described. These include clays, layered double hydroxides, group IV metal phosphates and other layered materials. The preparation of the pillared materials and pillaring agents will be presented along with a description of the properties and applications of the products.

La Religió ibèrica en el territori de la Indigècia

Aquest treball parteix de la pregunta: quines eren les característiques principals de la religió ibèrica? A partir d’aquesta pregunta, n’han sorgit d’altres que han permès concretar aspectes més específics de la religió en aquest territori: quins llocs de culte utilitzaven?, quines divinitats veneraven?, qui s’encarregava de dur a terme el culte?, com es manifestava aquesta religió?, creien en el més enllà?, quins ritus o pràctiques cultuals realitzaven?

Preparación y caracterización de la zeolita MCM-22 y de su precursor laminar

The layered precursor of MCM-22 was prepared with different Si/Al ratios: 15, 25, 50, 100 and ¥. Upon heat treatment these precursors form MCM-22 zeolite. Both layered precursor and MCM-22 zeolite were characterized by several techniques: Chemical Analysis by Atomic Absorption Spectroscopy (AAS), X-Ray Diffraction (XRD), Thermo-gravimetric Analysis (TGA), Pore Analysis by N2 and Ar adsorption, Scanning Electron Microscopy (SEM), Infrared Spectroscopy (IR) and Temperature Programmed Desorption of ammonium (TPD).

Evaluación de la estructura porosa de los materiales MCM-22, MCM-36 e ITQ-2 empleando el test catalitico del n-decano

The void structure of zeolites MCM-22, MCM-36 and ITQ-2 were discussed on the bases of catalytic reaction tests. The hydromerization of n-decane on bifunctional Pt/Zeolite Catalysts have been used as model reactions. Beta and ZSM-5 zeolites were used for comparison. It is concluded that all materials show features of 10MR zeolites and have also pores bigger than 12MR in this order MCM-22

Remoção de Cu+2 de soluções aquosas em zeólita NaX: efeito da granulometria

The present study consists in evaluating the NaX zeolite efficiency in removing Cu2+ from aqueous solutions, for future use of NaX in removing metals from wastewaters. The experiments were performed in batch systems (with shaking and continous stirring) and for different time intervals (1 to 24 h). Three particle sizes were employed: < 850 µm, 850 µm - 1 mm and 3 mm. It has been concluded that it is possible to employ the NaX zeolite for metal removal and the particle size plays an important role in the adsorption process. Specifically, NaX zeolites of smaller particle size achieved the maximum adsorption capacity of 152.36 mg of Cu2+/g of zeolite at pH = 4.5.

Materiais magnéticos baseados em diferentes zeólitas para remoção de metais em água

In this work the adsorption features of zeolites (NaY, Beta, Mordenite and ZSM-5) have been combined with the magnetic properties of iron oxides in a composite to produce a magnetic adsorbent. These magnetic composites can be used as adsorbents for contaminants in water and subsequently removed from the medium by a simple magnetic process. The magnetic zeolites were characterized by XRD, magnetization measurements, chemical analyses, N2 adsorption isotherms and Mössbauer spectroscopy. These magnetic adsorbents show remarkable adsorption capacity for metal ion contaminants in water.

Health-related quality-of-life instruments for Alzheimer's disease and mixed dementia

BACKGROUND: Over the last 20 years, a number of instruments developed for the assessment of health-related quality of life (HRQL) in dementia have been introduced. The aim of this review is to synthesize evidence from published reviews on HRQL measures in dementia and any new literature in order to identify dementia specific HRQL instruments, the domains they measure, and their operationalization. METHODS: An electronic search of PsycINFO and PubMed was conducted, from inception to December 2011 using a combination of key words that included quality of life and dementia. RESULTS: Fifteen dementia-specific HRQL instruments were identified. Instruments varied depending on their country of development/validation, dementia severity, data collection method, operationalization of HRQL in dementia, psychometric properties, and the scoring. The most common domains assessed include mood, self-esteem, social interaction, and enjoyment of activities. CONCLUSIONS: A number of HRQL instruments for dementia are available. The suitability of the scales for different contexts is discussed. Many studies do not specifically set out to measure dementia-specific HRQL but do include related items. Determining how best to operationalize the many HRQL domains will be helpful for mapping measures of HRQL in such studies maximizing the value of existing resources.

Uma nova síntese de alfa-bromo-acetofenonas e sua aplicação na obtenção de 2-benzoil-benzofuranas

alpha-Bromoacetophenones are important in organic synthesis. They have been widely used as precursors of several natural products. Several methods of bromination aiming at their synthesis have been described, however they furnish a mixture of starting material 10, mono 8 and dibromide 11 products. We developed a novel, simple and efficient synthesis of these compounds with applications in the synthesis of benzoylbenzofurans 9, compounds with important pharmacological properties, such as the ability of dilating the coronary artery and analgesic action. Such compounds have also been used as key intermediates to obtain quinone systems.

Estudo da síntese da zeólita ZSM-5 a partir de argilas naturais

The synthesis of ZSM-5 zeolite was studied by three synthesis methods: standard synthesis, three day synthesis and synthesis employing clays (kaolin and montmorillonite). The raw materials and prepared materials were characterized by Chemical Analysis by X-Ray Fluorescence (XRF) and X-Ray Diffraction (XRD). The results show that it is possible to synthesized ZSM-5 zeolite using clays as raw materials. Kaolin gives phases of higher crystalinity than montmorillonite.

Compósitos magnéticos baseados em hidrotalcitas para a remoção de contaminantes aniônicos em água

In this work the adsorption features of hydrotalcites (Al, Mg- CO3) and the magnetic properties of iron oxides have been combined in a composite to produce a magnetic adsorbent. These magnetic composites can be used as adsorbents for anionic contaminants in water and subsequently removed from the medium by a simple magnetic process. The magnetic hydrotalcites were characterized by XRD, magnetization measurements, N2 adsorption isotherms and Mössbauer spectroscopy. These magnetic adsorbents show remarkable adsorption capacity for anionic contaminants in water.

Mineral and vitamin content of beef, chicken, and turkey hydrolysates mineral and vitamin content of protein hydrolysates

The purpose of this study was to assess the concentration of vitamins and minerals in meat protein hydrolysates. Calcium, phosphorus and iron were analyzed by inductively coupled-plasma atomic emission spectrophotometry; vitamin C was analyzed by the reduction of cupric ions and vitamins B1 and B2 by fluorescence. Regarding minerals, the beef hydrolysate (BH) had more iron than the turkey hydrolysate (TH) and the chicken hydrolysate (CH); TH had a little more phosphorus. BH had the largest amount of vitamin C, and similar amounts of vitamins B1 and B2. The amount of these nutrients found in the hydrolysates suggests that it is possible to use them to enrich special dietary formulations.

Sílica quimicamente modificada com os grupos p-anisidina, p-fenitidina e p-fenilenodiamina usada como adsorvente para Pb2+, Cu2+, Cd2+ e Ni2+ em soluções aquosa e etanólica

Silica gel was chemically modified with the aromatic amines p-anisidine, p-phenytidine and p-phenylenediamine, using grafting reactions. The resulting modified silicas were characterized by infrared spectroscopy and N2 adsorption/desorption isotherms. The organic groups were covalently immobilized in a monolayer form. These modified silicas were investigated as adsorbents for Pb2+, Cu2+, Cd2+ and Ni2+ in aqueous and ethanol solutions. In a general way, the adsorption capacity values for all adsorbents presented the following sequence: Pb2+ >> Cu2+ @Cd2+ @ Ni2+. Adsorption studies for all adsorbents, in competitive medium, showed better selectivity for Cu2+ and Pb2+ in aqueous medium and for Pb2+ in ethanol solution. Desorption studies were carried out using HCl and HNO3 as eluents.

Um novo procedimento de síntese da zeólita A empregando argilas naturais

This work proposes the synthesis of zeolite A by IZA standard proceedures starting from a natural clay. The clay was used in its natural form and after calcination at 900ºC. The resulting materials were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) and porosity analysis by nitrogen adsorption. Results showed low surface area for Na-A zeolite in sodium form, but a higher one in CaA based on the nitrogen accessibility. The presence of cubic crystals for the A phase was observed in the SEM micrographies. The new procedure starting from natural clay favors the formation of sodalite while that using the calcinated clay gives A.