Development of a management algorithm for post-operative pain (MAPP) after total knee and total hip replacement: study rationale and design

Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described.

Protocol and rationale-the efficacy of minocycline as an adjunctive treatment for major depressive disorder: a double blind, randomised, placebo controlled trial

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functional recovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation of novel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotective properties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctive trial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctive treatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (with a 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational Functioning Assessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient Global Impression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool (LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide new treatment targets, both by showing efficacy with a new class of 'antidepressant' but also through the analysis of biomarkers that may further inform our understanding of the pathophysiology of unipolar depression.

Design and rationale of a 16-week adjunctive randomized placebo-controlled trial of mitochondrial agents for the treatment of bipolar depression

Objective: Bipolar disorder places a significant burden on individuals, caregivers and family, and the broader community. Current treatments are believed to be more effective against manic symptoms, leaving a shortfall in recovery during the depressive phase of the illness. The current study draws on recent evidence suggesting that, in addition to increased oxidative load, alterations in mitochondrial function occur in bipolar disorder. Methods: This 16-week study aims to explore the potential benefits of N-acetylcysteine (NAC) alone or in combination (CT) with selected nutraceuticals believed to enhance mitochondrial function. The study includes adults diagnosed with bipolar disorder currently experiencing an episode of depression. Participants are asked to take NAC, CT, or placebo in addition to any usual treatments. A post-discontinuation visit is conducted 4 weeks following the treatment phase. Results: The primary outcome of the study will be mean change on the Montgomery-Asberg Depression Rating Scale. Secondary outcomes include functioning, substance use, mania ratings, and quality of life. Blood samples will be collected at baseline and week 16 to explore biochemical alterations following treatment. Conclusion: This study may provide a novel adjunctive treatment for bipolar depression. Analysis of biological samples may assist in understanding the therapeutic benefits and the underlying etiology of bipolar depression. Trial registration: Australian and New Zealand Clinical Trial Registry ACTRN12612000830897.

Motivation and cognitive load in the flipped classroom : definition, rationale and a call for research

Flipped classroom approaches remove the traditional transmissive lecture and replace it with active in-class tasks and pre-/post-class work. Despite the popularity of these approaches in the media, Google search, and casual hallway chats, there is very little evidence of effectiveness or consistency in understanding what a flipped classroom actually is. Although the flipped terminology is new, some of the approaches being labelled ‘flipped’ are actually much older. In this paper, we provide a catch-all definition for the flipped classroom, and attempt to retrofit it with a pedagogical rationale, which we articulate through six testable propositions. These propositions provide a potential agenda for research about flipped approaches and form the structure of our investigation. We construct a theoretical argument that flipped approaches might improve student motivation and help manage cognitive load. We conclude with a call for more specific types of research into the effectiveness of the flipped classroom approach.

Effect of exercise training on left ventricular remodeling in diabetic patients with diastolic dysfunction: rationale and design

This study will examine the effects of combined aerobic and resistance training on left ventricular remodeling in diabetic patients with diastolic dysfunction. This is the first randomized controlled trial to look for effects of combined strength training and aerobic exercise on myocardial function as well as other clinical, functional, or psychological parameters in diabetic patients with isolated diastolic dysfunction, and will provide important insights into the potential management strategies for heart failure with preserved ejection fraction.

Youth Depression Alleviation-Augmentation with an anti-inflammatory agent (YoDA-A): protocol and rationale for a placebo-controlled randomized trial of rosuvastatin and aspirin

AIM: There is growing support for the role of inflammation and oxidative stress in the pathophysiology of major depressive disorder (MDD). This has led to the development of novel strategies targeting inflammation in the treatment of depression. Rosuvastatin and aspirin have well-documented, anti-inflammatory and antioxidant properties. The aim of the Youth Depression Alleviation: Augmentation with an anti-inflammatory agent (YoDA-A) study is to determine whether individuals receiving adjunctive anti-inflammatory agents, aspirin and rosuvastatin experience a reduction in the severity of MDD compared with individuals receiving placebo. METHODS: YoDA-A is a 12-week triple-blind, randomized controlled trial funded by the National Health and Medical Research Council, Australia. Participants aged 15-25, with moderate-to-severe MDD, are allocated to receive either 10 mg/day rosuvastatin, 100 mg/day aspirin, or placebo, in addition to treatment as usual. Participants are assessed at baseline and at weeks 4, 8, 12 and 26. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. RESULTS: The study is planned to be completed in 2017. At date of publication, 85 participants have been recruited. CONCLUSION: Timely and targeted intervention for youth MDD is crucial. Given the paucity of new agents to treat youth MDD, adjunctive trials are not only pragmatic and 'real-world', but additionally aim to target shortfalls in conventional medications. This study has the potential to first provide two new adjunctive treatment options for youth MDD; aspirin and rosuvastatin. Second, this study will serve as proof of principle of the role of inflammation in MDD.

Rationale for the use of DC microgrids: feasibility, efficiency and protection analysis

Electrical power systems are undergoing highly significant changes in their structures. The emergence of renewable energy units in the power generation sector, the use of high-voltage DC in the power transmission sector, and the prevalence of islanded or integrated microgrids in the distribution sector are the strongest evidence supporting this claim. These changes are mostly the consequences of the increasing energy demand rate, climate change, and environmental challenges, as well as the high investment and maintenance cost of the previous structures. Considering these new conditions and according to the recent development in DC/DC conversion topologies and control techniques, different studies have been conducted on how and why DC microgrids outperform AC microgrids. This study discusses the feasibility of the DC microgrid system according to recent developments in power systems. The efficiency and power loss reduction in DC distribution systems are then analyzed, some of the common strategies and devices for protection systems in such networks are reviewed, and the possible and existing challenges in developing the DC microgrids are highlighted. The mathematical calculations and theories for this evaluation are presented to determine the reliable justification for selecting the appropriate microgrid systems.

Is 'tagging' a rationale for affirmative action in education?

In this paper, we try to rationalize the existence of one of the most common affirmative action policies: educational quotas. We model a two period economy with asymmetric information and endogenous human capital formation. Individuals may be from two different groups in the population, where each group is defined by an observable and exogenous characteristic. The distribution of skills differ across groups. We introduce educational quotas into the model by letting the planner reduce the effort cost that a student from one of the groups has to endure in order to be accepted into a university. Affirmative action policies can be interpreted as a form of ``tagging" since group characteristics are used as proxies for productivity. We find that although educational quotas are usually efficient, they need not subsidize the education of the low skill group.

Apoio à gerência de requisitos de software utilizando Design Rationale

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The study of cardiovascular risk in adolescents - ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A review of existing and potential New World and Australasian vertebrate pesticides with a rationale for linking use patterns to registration requirements

Registration is a necessarily sophisticated evaluation process applied to vertebrate pesticide products. Although conducted to minimize any potential impacts upon public health, the environment and food production, the all-encompassing process of registration can stifle innovation. Vertebrate pesticides are rarely used to control pest animals in food crops. In contrast to agrochemicals, relatively small amounts of vertebrate pesticides are used (50.1%), usually in solid or paste baits, and generally by discrete application methods rather than by broad-scale spray applications. We present a hierarchy or sliding scale of typical data requirements relative to application techniques, to help clarify an evolving science-based approach which focuses on requiring data to address key scientific questions while allowing waivers where additional data have minor value. Such an approach will facilitate the development and delivery of increasingly humane, species-targeted, low residue pesticides in the New World, along with the phasing out of less desirable chemicals that continue to be used due to a lack of alternatives.