Comparison of treatment effect sizes associated with surrogate and final patient relevant outcomes in randomised controlled trials: meta-epidemiological study

Objective To quantify and compare the treatment effect and risk of bias of trials reporting biomarkers or intermediate outcomes (surrogate outcomes) versus trials using final patient relevant primary outcomes. Design Meta-epidemiological study. Data sources All randomised clinical trials published in 2005 and 2006 in six high impact medical journals: Annals of Internal Medicine, BMJ, Journal of the American Medical Association, Lancet, New England Journal of Medicine, and PLoS Medicine. Study selection Two independent reviewers selected trials. Data extraction Trial characteristics, risk of bias, and outcomes were recorded according to a predefined form. Two reviewers independently checked data extraction. The ratio of odds ratios was used to quantify the degree of difference in treatment effects between the trials using surrogate outcomes and those using patient relevant outcomes, also adjusted for trial characteristics. A ratio of odds ratios >1.0 implies that trials with surrogate outcomes report larger intervention effects than trials with patient relevant outcomes. Results 84 trials using surrogate outcomes and 101 using patient relevant outcomes were considered for analyses. Study characteristics of trials using surrogate outcomes and those using patient relevant outcomes were well balanced, except for median sample size (371 v 741) and single centre status (23% v 9%). Their risk of bias did not differ. Primary analysis showed trials reporting surrogate endpoints to have larger treatment effects (odds ratio 0.51, 95% confidence interval 0.42 to 0.60) than trials reporting patient relevant outcomes (0.76, 0.70 to 0.82), with an unadjusted ratio of odds ratios of 1.47 (1.07 to 2.01) and adjusted ratio of odds ratios of 1.46 (1.05 to 2.04). This result was consistent across sensitivity and secondary analyses. Conclusions Trials reporting surrogate primary outcomes are more likely to report larger treatment effects than trials reporting final patient relevant primary outcomes. This finding was not explained by differences in the risk of bias or characteristics of the two groups of trials.

Learning from the past to predict the future: an historical analysis of grass invasions in northern Australia

An important focus of biosecurity is anticipating future risks, but time lags between introduction, naturalisation, and (ultimately) impact mean that future risks can be strongly influenced by history. We conduct a comprehensive historical analysis of tropical grasses (n = 155) that have naturalised in Australia since European settlement (1788) to determine what factors shaped historical patterns of naturalisation and future risks, including for the 21 species that cause serious negative impacts. Most naturalised species were from the Old World (78 %), were introduced for use in pasture (64.5 %), were first recorded prior to 1940 (84.5 %) and naturalised before 1980 (90.3 %). Patterns for high-impact species were similar, with all being first recorded in Australia by 1940, and only seven naturalised since then-five intentionally introduced as pasture species. Counter to expectations, we found no evidence for increased naturalisation with increasing trade, including for species introduced unintentionally for which the link was expected to be strongest. New pathways have not emerged since the 1930s despite substantial shifts in trading patterns. Furthermore, introduction and naturalisation rates are now at or approaching historically low levels. Three reasons were identified: (1) the often long lag phase between introduction and reported naturalisation means naturalisation rates reflect historical trends in introduction rates; (2) important introduction pathways are not directly related to trade volume and globalisation; and (3) that species pools may become depleted. The last of these appears to be the case for the most important pathway for tropical grasses, i.e. the intentional introduction of useful pasture species. Assuming that new pathways don't arise that might result in increased naturalisation rates, and that current at-border biosecurity practices remain in place, we conclude that most future high-impact tropical grass species are already present in Australia. Our results highlight the need to continually test underlying assumptions regarding future naturalisation rates of high-impact invasive species, as conclusions have important implications for how best to manage future biosecurity risks.

The host range of three biotypes of Dactylopius tomentosus (Lamarck) (Hemiptera: Dactylopiidae) and their potential as biological control agents of Cylindropuntia spp. (Cactaceae) in Australia

The host range of two newly imported biotypes of Dactylopius tomentosus and their potential as biological control agents of Cylindropuntia spp. were investigated. A third biotype (imbricata) of D. tomentosus previously released in Australia to control C. imbricata was also screened to determine if it will feed on other species of Cylindropuntia occurring in Australia. Efficacy trials were conducted to evaluate the ability of the biotypes to retard the growth or kill those plant species supporting development of four or more individuals in the host test trials. The host range of the three biotypes of D. tomentosus was restricted to the genus Cylindropuntia. However, the biotypes showed varying degrees of specificity within this genus. The imbricata biotype was the only biotype to develop on Australian C. rosea provenances, albeit with a range of developmental success on all C. rosea provenances tested. The Spanish provenance supported the highest development success followed by Grawin (NSW), Lorne Station (NSW) while the least preferred was the Mexican provenance. The rosea and cholla biotypes were unsuitable candidates to control C. rosea in Australia. However, the efficacy trials showed that the cholla biotype had a high impact on four of the eight naturalised Cylindropuntia species in Australia. This biotype established rapidly and the sustained feeding of one fecund female and her progeny killed potted plants of C. imbricata and C. fulgida at week 18. This biotype has the potential to be an effective agent against C. fulgida, C. imbricata, C. kleiniae and C. tunicata and, as a consequence, an application seeking its release in Australia has been lodged.

The host range of four new biotypes of Dactylopius tomentosus (Hemiptera: Dactylopiidae) from southern USA and their potential as biological control agents of Cylindropuntiaspp.(Cactaceae) in Australia: Part II.

Eight Cylindropuntia species have naturalised in Australia and pose serious economic, environmental and social impacts. Two biotypes of Dactylopius tomentosus have been used as bio-control agents to control different Cylindropuntia species. The host range of four additional biotypes of Dactylopius tomentosus from southern USA was investigated. Feeding and development were restricted to the genus Cylindropuntia. However, they showed differences in specificity within this genus and some biotypes discriminated between the provenances of C. rosea and C. tunicata. Efficacy trials were conducted to determine whether populations of each biotype could be sustained on the naturalised Cylindropuntia species and if these populations could retard the growth or kill these plants. The acanthocarpa biotype offers potential control of C. rosea (Lorne Station), while the cylindropuntia sp. biotype shows great potential to control C. rosea (Grawin). The cylindropuntia sp. biotype also had a high impact on C. kleiniae and C. imbricata, and a moderate impact on C. leptocaulis and C. prolifera. The acanthocarpa X echinocarpa biotype had its greatest impact on C. tunicata (Grawin), killing this plant in 18 weeks. A fourth biotype, leptocaulis, was damaging to some species, but was less effective than the other biotypes. Cylindropuntia spinosior is the only naturalised species in Australia where no effective biocontrol agent has been found.

Scientometric analysis of some disciplines: Comparison of Indian institutions with other international institutions

We have carried out a three-part study comparing the research performance of Indian institutions with that of other international institutions. In the first part, the publication profiles of various Indian institutions were examined and ranked based on the h-index and p-index. We found that the institutions of national importance contributed the highest in terms of publications and citations per institution. In the second part of the study, we looked at the publication profiles of various Indian institutions in the high-impact journals and compared these profiles against that of the top Asian and US universities. We found that the number of papers in these journals from India was miniscule compared to the US universities. Recognizing that the publication profiles of various institutions depend on the field/departments, we studied the publication profiles of many science and engineering departments at the Indian Institute of Science (IISc), Bangalore, the Indian Institutes of Technology, as well as top Indian universities. Because the number of faculty in each department varies widely, we have computed the publications and citations per faculty per year for each department. We have also compared this with other departments in various Asian and US universities. We found that the top Indian institution based on various parameters in various disciplines was IISc, but overall even the top Indian institutions do not compare favourably with the top US or Asian universities.

Susceptibility of sperm chromatin to acid denaturation in situ: A study in endogenous FSH-deprived adult male bonnet monkeys (Macaca radiata)

Acid denaturation of calf thymus DNA in vitro followed by acridine orange (AO) binding induced a 112% increase in the emission of red, a 58% decrease in green, and a consequential decrease in the ratio of green:red fluorescences from 1.7 to 0.9. This metachromatic property of AO on binding to DNA following acid denaturation was utilized to study the susceptibility of normal and ovine follicle-stimulating hormone (oFSH) actively immunized bonnet monkey spermatozoa voided throughout the year. For analyses, the scattergram generated by the emission of red and green fluorescences by 10,000 AO-bound sperm from each semen sample was divided into 4 quadrant zones representing percentage cells fluorescing high green-low red (Q1), high green-high red (Q2), low green-low red (Q3) and low green-high red. (Q4). Normal monkey sperm obtained during the months of July-December exhibited 76, 13, and 11% cells in Q2, Q3, and Q4 quadrants, respectively. However, during January-June, when the females of the species are markedly subfertile, noncycling, and amenorrhoeic, the spermatozoa ejaculated by the male monkeys exhibited 38, 39, and 23% sperm in Q2, Q3, and Q4, respectively, the differences being highly significant (p < .01-.001). FSH deprivation induced significant shifts in fluorescence emissions, from respective controls, with 39, 33, and 28% cells in Q2, Q3, and Q4, respectively, during July-December, and 15, 48, and 37% sperm in Q2, Q3, and Q4 quadrants, respectively, during January-June. It is postulated that the altered kinetics of germ cell transformations and the deficient spermiogenesis observed earlier following FSH deprivation in these monkeys may have induced the enhanced susceptibility to acid denaturation in sperm.

Microstructure and mechanical properties at TiCp/Ni-alloy interfaces in laser-synthesized coatings

Titanium carbide particle (TiCp) reinforced Ni alloy composite coatings were synthesized by laser cladding using a cw 3 kW CO2 laser. Two kinds of coatings were present in terms of TiCp origins, i.e. undissolved and in situ reacted TiCp, respectively. The former came from the TiCp pre-coated on the sample, whereas the latter from in situ reaction between titanium and graphite in the molten pool during laser irradiation. Conventional and high-resolution transmission electron microscope observations showed the epitaxial growth of TiC, the precipitation of CrB, and the chemical reaction between Ti and B elements around phase interfaces of undissolved TiCp. The hardness, H, and elastic modulus, E, were measured by nanoindentation of the matrix near the TiCp interface. For undissolved TiCp, the loading curve revealed pop-in phenomena caused by the plastic deformation of the crack formation or debounding of TiCp from the matrix. As for in situ generated TiCp, no pop-in mark appears. On the other hand, in situ reacted TiCp led to much higher hardness and modulus than that in the case of undissolved TiCp. The coating reinforced by in situ generated TiCp displayed the highest impact wear resistance at both low and high impact conditions, as compared with coatings with undissolved TiCp and without TiCp. The impact wear resistance of the coating reinforced by undissolved TiCp increases at a low impact work but decreases at a high impact work, as compared with the single Ni alloy coating. The degree of wear for the composite coating depends primarily on the debonding removal of TiCp.

A systems approach to characterise the dissemination process of household water treatment systems in developing countries

Abstract: Starting in the 1980s, household-level water treatment and safe storage systems (HWTS) have been developed as simple, local, user-friendly, and low cost options to improve drinking water quality at the point of use. However, despite conclusive evidence of the health and economic benefits of HWTS, and promotion efforts in over 50 countries in the past 20 years, implementation outcomes have been slow, reaching only 5-10 million regular users. This study attempts to understand the barriers and drivers affecting HWTS implementation. Although existing literature related to HWTS and innovation diffusion theories proposed ample critical factors and recommendations, there is a lack of holistic and systemic approach to integrate these findings. It is proposed that system dynamics modelling can be a promising tool to map the inter-relationships of different critical factors and to understand the structure of HWTS dissemination process, which may lead to identifying high impact, leveraged mitigation strategies to scale-up HWTS adoption and sustained use.

Energy transfer between silicon-oxygen-related defects and Yb3+ in transparent glass ceramics containing Ba2TiSi2O 8 nanocrystals

We report on the conversion of near-ultraviolet radiation of 250-350 nm into near-infrared emission of 970-1100 nm in Yb3+-doped transparent glass ceramics containing Ba2TiSi2O8 nanocrystals due to the energy transfer from the silicon-oxygen-related defects to Yb3+ ions. Efficient Yb3+ emission (F-2(5/2)-> F-2(7/2)) was detected under the excitation of defects absorption at 314 nm. The occurrence of energy transfer is proven by both steady state and time-resolved emission spectra, respectively, at 15 K. The Yb2O3 concentration dependent energy transfer efficiency has also been evaluated, and the maximum value is 65% for 8 mol % Yb2O3 doped glass ceramic. These materials are promising for the enhancement of photovoltaic conversion efficiency of silicon solar cells via spectra modification.

Bi-doped BaF2 crystal for broadband near-infrared light source

Bi-doped BaF2 crystal was grown by the temperature gradient technique and its spectral properties were investigated. The absorption, emission and excitation spectra were measured at room temperature. Two broadband emissions centered at 1070 and 1500 nm were observed in Bi-doped BaF2 crystal. This extraordinary luminescence should be ascribed to Bi-related centers at distinct sites. We suggest Bi2+ or Bi+ centers adjacent to F vacancy defects are the origins of the observed NIR emissions. (C) 2009 Optical Society of America

Optical gain at 1550 nm from colloidal solution of Er3+-Yb3+ codoped NaYF4 nanocubes

We demonstrated optical amplification at 1550 nm with a carbon tetrachloride solution of Er3+-Yb3+ codoped NaYF4 nanocubes synthesized with solvo-thermal route. Upon excitation with a 980 nm laser diode, the nanocube solution exhibited strong near-infrared emission by the I-4(13/2) -> I-4(15/2) transition of Er3+ ions due to energy transfer from Yb3+ ions. We obtained the highest optical gain coefficient at 1550 nm of 0.58 cm(-1) for the solution with the pumping power of 200 mW. This colloidal solution might be a promising candidate as a liquid medium for optical amplifier and laser at the optical communication wavelength. (C) 2009 Optical Society of America

Photoluminescence of Ag nanoparticle embedded Tb3+/Ce3+ codoped NaYF4/PVP nanofibers prepared by electrospinning

Ag nanoparticle embedded NaYF4:0.05Tb center dot chi Ce/ PVP (PVP stands for poly(vinyl pyrrolidone)) composite nanofibers have been prepared by electrospinning. A field emission scanning electron microscope and x-ray diffraction have been utilized to characterize the size, morphology and structure of the as-prepared electrospun nanofibers. Obvious photoluminescence (PL) of NaYF4:0.05Tb center dot 0.05Ce/PVP electrospun nanofibers due to the efficient energy transfer from Ce3+ to Tb3+ ions is observed. The PL intensity of the electrospun nanofibers decreases gradually with the addition of Ag nanoparticles. No obvious surface plasmon resonance enhanced luminescence is observed. The reasons for the weakening of the emission intensity with the addition of Ag nanoparticles have also been discussed in this work.

Laser cooling of rubidium atoms from background vapor in diffuse light

In this paper we describe an experiment on laser cooling of Rb-87 atoms directly from a vapor background in diffuse light. Diffuse light is produced in a ceramic integrating sphere by multiple scattering of two laser beams injected through multimode fibers. A probe beam, whose propagation direction is either horizontal or vertical, is used to detect cold atoms. We measured the absorption spectra of the cold atoms by scanning the frequency of the probe beam, and observed both the absorption signal and the time of flight signal after we switched off the cooling light, from which we estimated the temperature and the number of cold atoms. This method is clearly attractive for building a compact cold atom clock.

Comportamento sexual e uso de álcool e drogas entre homens que fazem sexo com homens no Ceará: tendências e práticas de risco para DST/AIDS

No Brasil, o s casos de AIDS entre homens que fazem sexo com homens (HSH) predominaram durante um longo período. A partir da década de 90, observa-se um declínio nesta categoria com o aumento de casos entre heterossexuais. Na região Nordeste, entretanto, os casos de AIDS entre HSH representam, ainda, cerca de 50% do total dos casos registrados em anos recentes. Nosso objetivo foi estudar o comportamento sexual e o padrão de consumo de drogas e álcool entre HSH no Ceará, enfatizando as tendências recentes e suas relações com práticas sexuais de risco para DTS/AIDS. Foram realizados quatro estudos seccionais em 1995, 1998, 2002 e 2005 no Ceará, nordeste do Brasil. A população do estudo foi composta por homens que fazem sexo com homens (HSH), com 14 anos ou mais , que referiram prática sexual anal ou oral com homens nos últimos 12 meses. A seleção dos participantes utilizou técnicas do tipo Snow Ball (1995, 1998, 2002); Time Space Sampling (2002) e Respondent Driven Sampling (2005). O primeiro artigo enfoca as tendências do comportamento sexual em Fortaleza ao longo destes quatro períodos e o segundo os preditores do consumo de álcool e drogas nos municípios de Fortaleza (n=401), Sobral (n=100) e a região do Cariri (n=100) em 2002. Análise se basearam nas comparações entre proporções, utilizando o teste do de Pearson e intervalos de 95% de confiança (IC95%) e análise de regressão logística multivariada para avaliação dos fatores associados ao consumo de álcool e drogas, utilizando-se como medida de associação a razão de chances (odds ratio OR) e seus respectivos intervalos de 95% de confiança. Resultados Práticas sexuais: Elevado percentual da população estudada referiu práticas sexuais de risco em 1995 (49,9%), decrescendo significativamente em 1998 (32,6%), tornando a crescer em 2002 (54,6%) e apresentando os menores percentuais em 2005 (31,4%). Este padrão não apresentou grandes variações por idade, mas em relação à escolaridade observou-se que os indivíduos com escolaridade mais elevada aumentaram as práticas de risco entre 1998 (28,6%) e 2002 (46,5%) decrescendo no último período (21,0%) enquanto aqueles com baixa ou média escolaridade só mostraram uma queda significativa no comportamento de risco entre 2002 (82,1% - baixa; 67,7% - média) e 2005 (29,1% - baixa; 34,3 média). A prática sexual anal com preservativo cresceu no decorrer dos anos variando de 43,3% a 53,7% entre a primeira e a última onda ( de tendência p<0.001). A relação anal sem preservativo foi uma prática com alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de 57,7% para 26,3%) das relações fixas monogâmicas. Consumo de álcool e drogas: No estudo, 63% dos HSH participantes foram classificados como bebedores que se embriagam. Observou-se que o consumo crescente de álcool leva a um aumento do uso concomitante de outras drogas, sejam lícitas ou ilícitas. Foram variáveis preditoras de beber se embriagando: ter de 21 a 30 anos (OR: 1,5; IC 95%: 1,1-2,9); ter mais que 30 anos (OR: 1,6: IC95%: 1,2-2,3); ser solteiro/separado/divorciado (OR:3,0%; IC95%: 1,7-5,3); ser da raça negra (OR: 2,0 IC95%: 1,7-2,01); ser da raça parda (OR: 1,8 IC95%: 1,3-2,6); receber dinheiro por sexo (OR:2,0 IC95%: 1,8-2,9). As práticas sexuais dos SHS em Fortaleza apresentaram variações significativas ao longo doa anos estudados, semelhantemente a outros estudos internacionais. Vários fatores poderiam ser responsáveis por explicar o comportamento da curva observada em Fortaleza, seja no âmbito local, nacional ou internacional. Entre os fatores que podem explicar alterações observadas estariam: 1) redução nos recursos destinados à prevenção da AIDS no país devido a retirada de alguns organismos de cooperação internacional que se voltaram para outros países, como na África Leste Europeu, levando o Brasil a priorizar segmentos populacionais com maior vulnerabilidade; 2) grande impacto na prevenção das DST /AIDS na comunidade de homo/bissexuais masculinos, especialmente nos anos de 1998 a 2002; 3) o avanço no tratamento, surgimento de novas drogas, melhora da qualidade de vida e aumento da sobrevida, contribuindo para a construção da falsa ideia de segurança na população. Neste estudo a escolaridade mostrou-se um fator importante associado ao envolvimento em práticas sexuais não seguras. Os indivíduos com mais baixa escolaridade, no período de 1995 a 2002, se envolveram em maior risco, aparentando não terem sido atingidos pelas campanhas que possam ter ocorrido, principalmente no período de 1995 a 1998. A maior escolaridade apresenta-se como fator de proteção em todo o período estudado, provavelmente pelo maior acesso à informação. Finalmente, pode-se observar no ano de 2002 um elevado percentual de homens que consomem cinco ou mais doses em um dia típico e associam outras drogas ao consumo do álcool. Tal comportamento, dentro da população HSH, embora não seja caracterizado como dependência química, é alterado de maneira significativa pelo efeito etílico, levando à outras práticas de risco. Também se observou em nosso estudo que o consumo crescente de álcool leva a um aumento do uso de outras drogas, atuando para a adoção de comportamentos de risco. Existem evidências que suportam relação entre uso de outras drogas e a prática sexual de risco. Os indivíduos que referiram receber dinheiro em troca de sexo foram mais frequentemente classificados como bebedores que se embriagam. Os achados deste estudo mostram a importância da realização de uma vigilância comportamental contínua em relação ao HIV favorecendo o entendimento da dinâmica da epidemia junto das DST/AIDS nesta população vulnerável, assim como a importância que o álcool assume como problema de saúde pública neta população específica e a necessidade de se direcionar medidas voltadas para a sua prevenção.

Prevenção de riscos de tromboembolismo venoso: estratégias para redução da morbimortalidade

Estudo prospectivo com abordagem quantitativa envolvendo 3 grupos distintos de sujeitos. Grupo 1 constituído por 56 pacientes avaliados para o risco de tromboembolismo venoso (TEV) em um acompanhamento de 30 meses para verificar os desfechos morte, reinternação e profilaxia de TEV. Grupo 2 constituído por 50 enfermeiros assistenciais que responderam questionários sobre TEV, com o propósito de avaliar seus conhecimentos sobre os riscos e profilaxia dessa doença em pacientes clínicos internados. Grupo 3 constituído por 100 enfermeiros assistenciais que responderam questionários similares aos respondidos pelo grupo 2, antes e após treinamento sobre profilaxia de TEV. O objetivo geral foi verificar o grau de conhecimento de enfermeiros sobre tromboembolismo venoso considerando sua inserção no processo de prevenção de riscos; Os objetivos específicos foram: propor e implantar uma estratégia de treinamento para capacitação de enfermeiros no rastreamento de riscos de TEV em pacientes internados; verificar o impacto do treinamento sobre TEV no conhecimento dos enfermeiros para identificação de fatores de risco dessa doença; descrever os desfechos relacionados à TEV em pacientes internados por mais de 24 horas em um hospital quaternário num seguimento de 30 meses. No grupo 1 identificou-se que o evento TEV apresenta alta mortalidade 63,6% para pacientes que não receberam profilaxia. Identificou-se também que a maioria 89,2% desses sujeitos é acompanhada de seus médicos, 53,6% passaram por reinternações e 28,6% continuam usando alguma profilaxia para TEV. No grupo 2 verificou-se que os profissionais não sabem identificar corretamente os fatores de risco para TEV, havendo grande déficit de conhecimento em relação aos fatores de risco e profilaxia da doença, pois 90% da amostra não consegue apontar mais que 5 fatores de risco para TEV considerando-se 24 fatores contemplados por consensos internacionais, demonstrando um grau de conhecimento insuficiente pela utilização de uma escala intervalar proposta nesse estudo. No grupo 3, assim como identificado no grupo 2, houve similaridade no déficit de conhecimento, pois 100% não conseguiram apontar mais que 4 fatores de risco para a doença. Identificou-se que a realização de um treinamento sobre profilaxia de TEV para esses enfermeiros apresenta alto impacto em relação ao grau de retenção de informações sobre TEV, sendo uma ação facilmente replicável para profissionais de instituições hospitalares. Concluiu-se que o uso de um algoritmo/protocolo de avaliação voltado para rastreamento de riscos de TEV por enfermeiros representa uma ferramenta importante no processo de rastreamento e prevenção dessa doença em pacientes clínicos, como proposto nesse estudo, pois nos resultados demonstrou-se que 97% dos enfermeiros do grupo 3 não conhecem qualquer tipo de protocolo relacionado a prevenção de riscos de TEV. Os sujeitos apresentaram excelente nível de conhecimento sobre meios de profilaxia mecânica, mas identificou-se que a maioria 63% nunca deu orientações sobre a profilaxia enquanto cuidam, reforçando o entendimento de que não estão inseridos no processo de prevenção de riscos de TEV para pacientes internados. A inserção dos enfermeiros nesse processo de identificação de riscos deve ser capaz de reduzir a alta taxa de morbimortalidade e reduzir a incidência dessa doença em unidades hospitalares.