BACKGROUND & AIMS: :Neuroimmunological diseases often have a chronic course and a high socio-economic impact, as most of them occur in younger patients and result in progressing disability and loss of work force. Although for many conditions different treatment strategies are available no sufficient data exist to give a reasonable account on the cost effectiveness of individual therapies. Treatment decision should primarily be guided by evidence from high quality clinical studies and-if available-from direct head-to-head trials and cost-effectiveness analysis.

背景与目标： 神经免疫疾病通常具有慢性病程，并且对社会经济影响很大，因为它们大多发生在年轻的患者中，并导致残疾的发展和劳动力的丧失。尽管对于许多情况，可以使用不同的治疗策略，但没有足够的数据来合理说明各个疗法的成本效益。治疗决策应首先以高质量临床研究的证据为指导，如果可以的话，也应以直接的直接面对面试验和成本效益分析为依据。

BACKGROUND & AIMS: OBJECTIVES:To examine associations between sleep duration and health outcomes among distinct groups of sexual minority adults. METHODS:Using data from the 2014 Behavioral Risk Factor Surveillance System, we compared sleep duration (very short: ≤ 5 hr; short: 6 hr; normal: 7-8 hr; and long: ≥ 9 hr per day) between cisgender straight adults and distinct groups of sexual minorities. We further examined associations between sleep duration and 10 chronic health conditions among sexual minorities. RESULTS:Of 146,893 respondents, 142,507 (96.2%) were cisgender straight, and 4,386 (3.8%) were lesbian, gay, bisexual, transgender (LGBT). Overall, 17.3% of LGBT respondents reported very short sleep per day, compared with 12.2% for cisgender straight respondents (p < 0.0001). Among LGBT populations, the prevalence of very short sleep varied significantly among distinct groups, ranging from 13.2% among transgender female to male adults to 35.5% among transgender gender nonconforming adults. Very short sleep was further associated with increased odds of having stroke (aOR = 4.1, 95% CI [2.2-7.6]), heart attack (aOR = 3.0, CI [1.6-5.8]), coronary heart disease (aOR = 3.1, 95% CI [1.5-6.2]), asthma (aOR = 1.7, 95% CI [1.1-2.4]), chronic obstructive pulmonary disease (aOR = 2.5, CI [1.5-4.0]), arthritis (aOR = 2.1, CI [1.4-3.0]), and cancer (aOR = 1.8, 95% CI [1.0-3.2]) among sexual minorities. Disparities in the prevalence of stroke, heart attack, coronary health disease, COPD, diabetes, obesity, arthritis, and cancer were found among LGBT populations. CONCLUSIONS:Sexual minorities have a higher prevalence of sleep deprivation as compared with their straight counterparts. Sleep deprivation varies by sexual identity and gender. Very short sleep duration is associated with some chronic health conditions among LGBT populations. Promotion of sleep health education and routine medical assessment of sleep disorders are critically needed for sexual minority adults.

背景与目标： 目的：研究不同性别的成年少数群体的睡眠时间与健康结局之间的关联。
方法：使用2014年行为危险因素监测系统的数据，我们比较了直食成年成年直觉成年成年人的睡眠时间（非常短：≤5小时;短：6小时;正常：7-8小时;每天：≥9小时）以及不同性别的少数群体。我们进一步研究了性少数群体的睡眠时间与10种慢性健康状况之间的关联。
结果：在146,893名受访者中，有142,507名（96.2％）为顺性别，而有4,386名（3.8％）为女同性恋，男同性恋，双性恋和变性者（LGBT）。总体而言，LGBT受访者中有17.3％的人每天睡眠时间很短，而顺性别的受访者中有12.2％的人每天睡眠时间短（p <0.0001）。在LGBT人群中，不同组别的极短睡眠发生率差异显着，从跨性别女性到男性的13.2％，到跨性别性别不合格的成年人的35.5％。睡眠时间短还与中风（aOR = 4.1，95％CI [2.2-7.6]），心脏病发作（aOR = 3.0，CI [1.6-5.8]），冠心病（aOR = 3.1， 95％CI [1.5-6.2]），哮喘（aOR = 1.7、95％CI [1.1-2.4]），慢性阻塞性肺疾病（aOR = 2.5，CI [1.5-4.0]），关节炎（aOR = 2.1，CI [1.4-3.0]）和性少数人群中的癌症（aOR = 1.8，95％CI [1.0-3.2]）。在LGBT人群中发现中风，心脏病发作，冠心病，COPD，糖尿病，肥胖症，关节炎和癌症的患病率存在​​差异。
结论：与异性恋人群相比，性少数人群的睡眠剥夺患病率更高。睡眠剥夺因性别和性别而异。极短的睡眠时间与LGBT人群中的某些慢性健康状况有关。性少数成年人迫切需要促进睡眠健康教育和睡眠障碍的常规医学评估。

BACKGROUND & AIMS: INTRODUCTION:The role of botulinum toxin as a therapeutic agent for several conditions is expanding. We sought to determine if botulinum toxin is safe and effective in treating patients with cervical dystonia and maxillofacial conditions. Our purpose was to establish a safety and efficacy profile to determine whether or not this treatment may be used prophylactically in patients undergoing dental implant therapy. METHODS:We performed a systematic search of the literature to identify randomized clinical trials evaluating patients treated with botulinum toxin as an adjunct to dental implant therapy, maxillofacial conditions including temporomandibular disorders (TMD), and cervical dystonia. RESULTS:Four randomized controlled trials (RCTs) met our search criteria in the area of cervical dystonia and chronic facial pain. No RCTs were identified evaluating dental implant therapy. Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo. Adverse events were mild and transient with numbers needed to harm (NNH) ranging from 12 to 17. Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo. Rates of adverse events were less than 1%. CONCLUSION:Botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity. No literature exists evaluating its use in dental implantology. Randomized clinical trials are warranted to determine its safety and efficacy in dental implantology and other maxillofacial conditions such as bruxism.

背景与目标： 简介：肉毒杆菌毒素在多种情况下作为治疗剂的作用正在扩大。我们试图确定肉毒杆菌毒素在治疗患有颈肌张力障碍和颌面部疾病的患者中是否安全有效。我们的目的是建立安全性和有效性概况，以确定在接受牙种植体治疗的患者中是否可以预防性使用该治疗方法。
方法：我们进行了系统的文献检索，以鉴定评估用肉毒杆菌毒素作为牙科植入物治疗，颌面部疾病（包括颞下颌疾病（TMD）和颈肌张力障碍）的辅助治疗的患者的随机临床试验。
结果：四项随机对照试验（RCT）在宫颈肌张力障碍和慢性面部疼痛方面符合我们的搜索标准。未鉴定出评估牙种植体治疗的RCT。与安慰剂相比，宫颈肌张力障碍患者在基线功能，疼痛和整体评估方面表现出显着改善。不良事件是轻度和短暂的，需要伤害的数字（NNH）在12到17之间。与安慰剂相比，慢性面部疼痛患者在疼痛方面较基线有了显着改善。不良事件的发生率小于1％。
结论：肉毒杆菌毒素在治疗颈肌张力障碍和咀嚼亢进引起的慢性面部疼痛方面似乎相对安全有效。没有文献评估其在牙种植学中的用途。必须进行随机临床试验来确定其在牙种植术和其他颌面疾病（例如磨牙症）中的安全性和有效性。

BACKGROUND & AIMS: BACKGROUND:Palliative care is rarely being offered to patients with Parkinson's disease. AIM:To assess symptom prevalence, severity and palliative care needs in advanced stages of Parkinsonism. DESIGN:A cross-sectional survey using a palliative care assessment tool, the Palliative Outcome Scale was administered to patients. SETTING/PARTICIPANTS:Eight-two patients with a diagnosis of idiopathic Parkinson's disease, multiple systems atrophy or progressive supranuclear palsy were included in the study. RESULTS:Their mean age and disease stages 3-5 Hoehn and Yahr were 67 years and 4.1, respectively. Patients reported a mean of 10.7 (standard deviation = 3.9) physical symptoms. Over 80% had pain, fatigue, day time somnolence and problems with mobility. Other symptoms in 50%-80% included constipation, loss of bladder control, swallowing difficulties, drooling, breathlessness and sleep problems. Symptoms rated as causing severe problems were pain, fatigue, constipation and drooling. Assessment of mood revealed 70% of the patients felt anxiety and 60% had felt depressed. Eight-five per cent felt their families were anxious or worried about them. Thirty-eight per cent would have liked more information and 42% had practical problems that still needed to be addressed. There was a positive correlation between number of symptoms and disease severity (r = 0.39, p = 0.01). The total mean Palliative Outcome Scale score was 13.6 (standard deviation = 6.1), suggesting moderate palliative care needs. CONCLUSION:This is the first study to describe the care needs of people with Parkinson's disease using the Palliative Outcome Scale tool. The burden of symptoms and concerns was high in advanced stages of disease. It might be appropriate that people severely affected by these conditions should be considered for referral to specialist palliative care services.

背景与目标： 背景：帕金森氏病患者很少接受姑息治疗。
目的：评估帕金森病晚期患者的症状患病率，严重程度和姑息治疗需求。
设计：使用姑息治疗评估工具进行横断面调查，对患者进行“姑息治疗结果量表”。
设置/对象：本研究包括八十二名诊断为特发性帕金森氏病，多系统萎缩或进行性核上性麻痹的患者。
结果：他们的平均年龄和疾病阶段3-5 Hoehn和Yahr分别为67岁和4.1。患者报告的平均身体症状为10.7（标准差= 3.9）。超过80％的人有疼痛，疲劳，白天嗜睡和行动不便的问题。 50％-80％的其他症状包括便秘，失去膀胱控制，吞咽困难，流口水，呼吸困难和睡眠问题。被认为造成严重问题的症状是疼痛，疲劳，便秘和流口水。情绪评估显示70％的患者感到焦虑，60％的患者感到沮丧。百分之八十五的人认为他们的家人感到焦虑或担心。 38％的人希望获得更多信息，而42％的人有实际问题需要解决。症状数量与疾病严重程度之间呈正相关（r = 0.39，p = 0.01）。总体平均姑息治疗量表评分为13.6（标准差= 6.1），表明需要中等程度的姑息治疗。
结论：这是第一项使用姑息结果量表工具描述帕金森氏病患者护理需求的研究。在疾病的晚期阶段，症状和忧虑的负担很高。应当考虑将受这些疾病严重影响的人转介到专门的姑息治疗服务。

BACKGROUND & AIMS: :HSP90 is a molecular chaperone that participates in folding, stabilization, activation, and assembly of several proteins, all of which are key regulators in cell signaling. In dimorphic pathogenic fungi such as Paracoccidioides brasiliensis, the adaptation to a higher temperature, acid pH and oxidative stress, is an essential event for fungal survival and also for the establishing of the infectious process. To further understand the role of this protein, we used antisense RNA technology to generate a P. brasiliensis isolate with reduced PbHSP90 gene expression (PbHSP90-aRNA). Reduced expression of HSP90 decreased yeast cell viability during batch culture growth and increased susceptibility to acid pH environments and imposed oxidative stress. Also, PbHSP90-aRNA yeast cells presented reduced viability upon interaction with macrophages. The findings presented here suggest a protective role for HSP90 during adaptation to hostile environments, one that promotes survival of the fungus during host-pathogen interactions.

背景与目标： ：HSP90是一种分子伴侣，参与多种蛋白质的折叠，稳定，激活和组装，所有这些都是细胞信号传导中的关键调控因子。在双态致病性真菌（如巴西副球菌）中，适应更高的温度，酸性pH和氧化应激，是真菌存活和建立感染过程的重要事件。为了进一步了解该蛋白的作用，我们使用了反义RNA技术来生成具有降低的PbHSP90基因表达的巴西假单胞菌分离物（PbHSP90-aRNA）。 HSP90的表达降低会降低分批培养物生长过程中酵母细胞的活力，并增加对酸性pH环境的敏感性和施加的氧化应激。同样，PbHSP90-aRNA酵母细胞与巨噬细胞相互作用后，活力降低。此处提出的发现表明，HSP90在适应敌对环境期间具有保护作用，可在宿主与病原体相互作用期间促进真菌的存活。

BACKGROUND & AIMS: :In Chlamydomonas reinhardtii, the entire process of pattern formation was described, and the relation of pattern formation to external conditions was investigated. The typical pattern was a dot-like structure that formed during a series of changes in cellular behavior, and reappeared immediately and repeatedly after perturbation by mild agitation. Of the external conditions, cell density, depth of the cell suspension, and the vessel's wall are discussed mainly. Especially the vessel's wall may decide the position and whole shape of the pattern formation.

背景与目标： ：在莱茵衣藻中，描述了图案形成的整个过程，并研究了图案形成与外部条件的关系。典型的模式是在一系列细胞行为变化期间形成的点状结构，并在受到轻微搅动扰动后立即并反复出现。在外部条件中，主要讨论细胞密度，细胞悬浮液深度和血管壁。特别是容器壁可以决定图案形成的位置和整体形状。

BACKGROUND & AIMS: PURPOSE:The Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) developed an outpatient low-vision programme for patients with macular diseases providing low-vision rehabilitation comparable to VA inpatient blind rehabilitation centres (BRCs). This programme targets veterans who do not need or chose not to participate in a comprehensive inpatient blind rehabilitation programme. We examined costs and consequences using veterans in LOVIT and comparable veterans in an inpatient BRC. METHODS:We compared costs and consequences between treatment patients who participated in LOVIT, a two-site randomized clinical trial, and a sample of comparable patients who received treatment at a VA inpatient BRC. We measured consequences as the change in functional visual ability from baseline to follow-up (LOVIT: 4 months after randomization; BRC: 3 months after discharge) using the VA Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). RESULTS:There were 55 LOVIT and 121 BRC patients for our analyses. Average costs were $38,627.3 higher for BRC patients ($5,054.4 +/- $404.7 SD for LOVIT vs. $43,681.7 +/- $8,853.6 SD for BRC, p < 0.0001). Thus, the BRC cost $38,627.3 per patient more than the LOVIT programme (95% CI: $17,414 to $273,482). There was a greater improvement in overall visual ability, mobility, and visual motor skill scores for BRC patients; however, there was no significant difference in improvement in reading ability or visual information processing scores. CONCLUSIONS:As VA increases outpatient blind rehabilitation services, LOVIT provides a model for expanding outpatient low-vision rehabilitation services for veterans at substantially lower costs than current inpatient BRC services.

背景与目标： 目的：退伍军人事务部（VA）低视力干预试验（LOVIT）为黄斑疾病患者制定了门诊低视力计划，该计划可提供与VA住院盲人康复中心（BRC）相当的低视力康复服务。该计划针对不需要或选择不参加全面的住院盲人康复计划的退伍军人。我们使用LOVIT中的退伍军人和住院BRC中可比的退伍军人检查了成本和后果。
方法：我们比较了参加LOVIT的治疗患者，一项两点随机临床试验和在VA住院BRC接受治疗的可比较患者的样本之间的成本和后果。我们使用VA低视力视觉功能问卷（VA LV VFQ-48），测量了从基线到随访（LOVIT：随机分组后4个月； BRC：出院后3个月）的功能性视觉能力变化的后果。
结果：本研究共纳入55例LOVIT患者和121例BRC患者。 BRC患者的平均费用高出38,627.3美元（LOVIT为$ 5,054.4 /-$ 404.7 SD，而BRC为$ 43,681.7 /-$ 8,853.6 SD，p <0.0001）。因此，每位患者的BRC费用比LOVIT计划高出38,627.3美元（95％CI：17,414美元至273,482美元）。 BRC患者的整体视觉能力，活动能力和视觉运动技能得分有了更大的提高；但是，阅读能力或视觉信息处理得分的提高没有显着差异。
结论：随着VA增加门诊盲人康复服务，LOVIT提供了一种模式，可为退伍军人扩展门诊低视力康复服务，其成本远低于目前的住院BRC服务。

BACKGROUND & AIMS: INTRODUCTION:The objective of the present study was to evaluate, from an economic perspective, dabigatran etexilate in comparison to existing pharmaceutical therapeutic options available for the protection of moderate-to-high risk patients with non-valvular atrial fibrillation from cardioembolic risk. METHODS:An existing Markov model was adapted to the Greek setting to reflect the natural course of the disease and the management of patients with different therapies. The model predicts health and economic outcomes and the implications for the social security system during the course of a patient's lifetime. The data for the population of the model were derived from the international literature and local economic databases. RESULTS:The incremental cost per quality-adjusted life year (QALY) of dabigatran 150 mg twice daily relative to the other therapies varied from €5547 to €11,762 and that of dabigatran 110 mg twice daily from €7398 to €16,437. The incremental cost per QALY of dabigatran 150 mg relative to aspirin, the least costly option, was €11,762 and relative to warfarin and acenocoumarol, the local standards of care, it was €11,400 and €11,224 respectively, well below the local thresholds of acceptance. CONCLUSION:Dabigatran etexilate may represent a cost-effective option for the prevention of thromboembolic events in AF patients at moderate-to-high risk of stroke or systemic embolism.

背景与目标： 简介：本研究的目的是从经济角度评估达比加群酯与现有药物治疗方案的比较，以保护中至高危非瓣膜性心房颤动患者免受心脏栓塞风险。
方法：现有的马尔可夫模型适应希腊环境，以反映疾病的自然病程和采用不同疗法的患者的治疗。该模型可预测患者一生中的健康和经济状况以及对社会保障系统的影响。该模型的人口数据来自国际文献和当地经济数据库。
结果：相对于其他疗法，达比加群150 mg每天两次的每质量调整生命年（QALY）的增量成本从5547欧元到11762欧元不等，达比加群110 mg每天两次的费用从7398欧元到16437欧元。相对于阿司匹林（成本最低的选择），达比加群150 mg的每QALY增量成本为11,762欧元，而相对于华法林和醋香豆酚（当地护理标准），分别为11,400欧元和11,224欧元，远低于当地的接受阈值。
结论：达比加群酯可能是预防中风或全身性栓塞风险的中高风险房颤患者血栓栓塞事件的一种经济有效的选择。

BACKGROUND & AIMS: :We have assessed ectomycorrhizal fungi colonizing Norway spruce (Picea abies L.) seedlings in nine forest nurseries using restriction fragment length polymorphism (RFLP) and sequencing analyses of the internal transcribed spacers (ITS1-5.8S-ITS2) amplicons. Restriction analysis of the amplified DNA fragments with HinfI, MboI, and TaqI enzymes allowed the definition of 17 RFLP genotypes; five of them could be unambiguously assigned to Thelephora terrestris, Hebeloma longicaudum, H. crustuliniforme, Tricharina ochroleuca, and Cenococcum geophilum species by comparison with the sporocarp RFLP-pattern database. The remaining genotypes have been sequenced and compared with sequences deposited in the GenBank database. The phylogenetic analysis of resulting sequences and their identified matches indicated that isolated genotypes have formed seven clades. The ascomycetes were predominant: we have determined eight species--Wilcoxina mikolae, Phialophora finlandia, Tuber sp., Cenococcum geophilum, Tricharina ochroleuca, Pulvinula constellatio, and two unidentified ascomycetes--whereas the basidiomycetes were less common (four species denoted: Amphinema byssoides, Hebeloma crustuliniforme, H. longicaudum, and Thelephora terrestris). Wilcoxina mikolae and Phialophora finlandia were the most frequent fungi. Analysis of variance revealed that ascomycetes abundance was higher in nurseries that used organic fertilizer.

背景与目标： ：我们使用限制性片段长度多态性（RFLP）和内部转录间隔区（ITS1-5.8S-ITS2）扩增子的测序分析，评估了9个森林苗圃中挪威云杉（Picea abies L.）幼苗定植的外生菌根真菌。用HinfI，MboI和TaqI酶对扩增的DNA片段进行限制性分析，可以确定17种RFLP基因型。通过与子果皮RFLP模式数据库进行比较，可以明确地将它们中的5个明确地分配给Thelephora terrestris，Hebeloma longicaudum，H。crustuliniforme，Tricharina ochroleuca和Cenococcum geophilum物种。其余的基因型已经测序，并与GenBank数据库中保存的序列进行了比较。对所得序列及其鉴定的匹配进行系统发育分析表明，分离的基因型已形成七个进化枝。子囊菌占主导地位：我们已经确定了8种-麦考克单胞菌（Wilcoxina mikolae），费氏毛虫（Phialophora finlandia），块茎菌（Tuber sp。），地塞诺古球菌（Cenococcum geophilum），Tricharina ochroleuca，Pulvinula星座和两种未鉴定的子囊菌-其中，担子菌是少见的（以4种种表示为鳞茎鞘虫） ，铁锈菌，长假丝酵母和地雷希氏菌）。喜树Wilcoxina mikolae和芬兰Phialophora finlandia是最常见的真菌。方差分析表明，在使用有机肥料的苗圃中，子囊菌的丰度更高。

BACKGROUND & AIMS: :Research has shown that mothers often differentiate among their adult children in terms of closeness and support; however, studies have not addressed why some mothers report preferences among children and others do not. To distinguish between mothers who do and do not report favouring some of their adult children, we used data from a within-family study in which 553 older mothers were interviewed about each of their children. Almost all of the mothers reported differentiating among their children regarding emotional closeness, confiding, or preference among caregivers. Multivariate analyses revealed that mothers' values and mother-child value similarity predicted which mothers differentiated among their children regarding closeness and confiding, whereas mothers' and children's demographic characteristics predicted which mothers differentiated regarding preferred caregivers. Black mothers were less likely than white mothers to differentiate when seeking a confidant; however, race played no role in mothers' likelihood of differentiating regarding emotional closeness or help during illness. Taken together, these findings indicate that differentiating among adult children is common; further, family-level predictors of mothers' differentiating mirror the patterns shown in dyad-level analyses of mothers' favouritism.

背景与目标： 研究表明，母亲经常在成年子女之间在亲密和支持方面有所区别；但是，研究还没有解决为什么有些母亲报告说孩子中有孩子的偏爱，而另一些母亲却没有。为了区分哪些母亲不报告自己的成年子女，哪些不报告他们的偏爱，我们使用了一项家庭内部研究的数据，在该研究中，对553名年龄较大的母亲进行了访谈，询问了每个孩子的情况。几乎所有的母亲都报告说，他们的孩子在照顾者之间的情感亲密，自信或偏爱方面有所区别。多变量分析显示，母亲的价值观和母子价值观的相似性可以预测哪些母亲在孩子之间的亲密和交往方面有所区别，而母亲和儿童的人口统计学特征则可以预测哪些母亲在偏爱的照顾者方面有所区别。与白人母亲相比，黑人母亲寻求知己的可能性较小。然而，种族对母亲在生病期间在情感上的亲密或帮助方面的差异化没有任何作用。综上所述，这些发现表明在成年子女之间进行区分是很普遍的。此外，母亲差异化的家庭层面预测因素反映了母亲偏爱的二元分析中显示的模式。

BACKGROUND & AIMS: OBJECTIVES:To assess the clinical effectiveness and cost-effectiveness of central venous catheters (CVCs) treated with anti-infective agents in preventing catheter-related bloodstream infection (CRBSI). DATA SOURCES:Major electronic databases were searched from 1985 to August 2005. REVIEW METHODS:The systematic clinical and economic reviews were conducted according to accepted procedures. Only full economic evaluations (synthesis of costs and benefits) comparing the use of anti-infective central venous catheters (AI-CVCs) with untreated CVCs or other treated catheters were selected for inclusion in the economic review. RESULTS:A total of 32 trials met the clinical inclusion criteria. Seven different types of AI-CVC were identified, with the most frequently tested being chlorhexidine and silver sulfadiazine (CHSS) (externally treated), CHSS (externally and internally treated) and minocycline rifampicin (internally and externally treated). In general, the trials were of a poor quality in terms of reported methodology, microbiological relevance and control of confounding variables. The pooled result suggests a statistically significant advantage for AI-CVCs in comparison to standard catheters in reducing CRBSI [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.34 to 0.60, 24 studies, I-squared = 0%, fixed effects]. Analysis by subgroups of catheters demonstrates that antibiotic-treated catheters and catheters treated internally and externally decrease CRBSI rates significantly (OR 0.26, 95% CI 0.15 to 0.46, six studies, I-squared = 0%, fixed effects, and OR 0.43, 95% CI 0.26 to 0.70, nine studies, I-squared = 0%, fixed effects, respectively). Catheters treated only externally demonstrate a wider CI and non-significant effect (OR 0.67, 95% CI 0.43 to 1.06, nine studies, I-squared = 0%, fixed effects). A treatment effect was also found for trials with an average duration of between 5 and 12 days, and for the one study with a mean duration of over 20 days. There was a statistically significant treatment effect for both femoral and jugular insertion sites and for those studies reporting a mix of insertion sites. The treatment effect was not observed in trials using exclusively subclavian insertion sites. Of the four trials that compared treated catheters, one reported a benefit of antibiotic-treated catheters over catheters treated externally with CHSS. All three sensitivity analyses testing for study design differences reported a statistically significant treatment effect. The review was limited owing to the quality of the trials included, marked differences in the definitions and methods of diagnosis of CRBSI, and inconsistent reporting of risk factors and patient population factors. Furthermore, two-thirds of trials were commercially funded. The economic performance (cost-effectiveness and potential cost-savings) of using AI-CVCs to reduce the number of CRBSIs in patients requiring a CVC was also reviewed. Results show that the use of AI-CVCs instead of standard CVCs can lead to a reduction in CRBSIs and decreased medical costs. To complement the reviews, a basic decision-analytic model was constructed to explore a range of possible scenarios for the NHS in England and Wales. Results show that for every patient who receives an AI-CVC there is an estimated cost-saving of 138.20 pounds. The multivariate sensitivity analyses estimate potentially large cost-savings, depending on the size of the population, under a wide range of cost and clinical assumptions. However, those considering the purchase of AI-CVCs should ensure that their patient populations and the important characteristics of local clinical practice are indeed similar to those described in this economic evaluation. CONCLUSIONS:Overall, AI-CVCs are clinically effective and relatively inexpensive and therefore their integration into clinical practice can be justified. However, the use of these anti-infective catheters without the appropriate use of other practical care initiatives will have only a limited success on the prevention of CRBSIs. Comparative trials are required to determine which, if any, of the treated catheters is the most effective. Pragmatic research related to the effectiveness of bundles of care that may reduce rates of CRBSI is also warranted.

背景与目标： 目的：评估用抗感染剂治疗的中心静脉导管（CVC）在预防导管相关的血流感染（CRBSI）方面的临床效果和成本效益。
数据来源：从1985年到2005年8月，检索了主要的电子数据库。
审查方法：根据公认的程序进行系统的临床和经济审查。只有将将抗感染中心静脉导管（AI-CVC）与未经治疗的CVC或其他经过治疗的导管进行比较的全面经济评估（成本和收益的综合）才被选入经济评估。
结果：总共32项试验符合临床纳入标准。鉴定出七种不同类型的AI-CVC，最常测试的是洗必太和磺胺嘧啶银（CHSS）（外部治疗），CHSS（外部和内部治疗）和米诺环素利福平（内部和外部治疗）。总体而言，就报告的方法学，微生物学相关性和混杂变量的控制而言，这些试验的质量较差。汇总结果表明，与标准导管相比，AI-CVC在降低CRBSI方面具有统计学上的显着优势[比值比（OR）0.45，95％置信区间（CI）0.34至0.60，24个研究，I平方= 0％，固定效果]。导管亚组的分析表明，抗生素治疗过的导管和内外治疗过的导管显着降低了CRBSI率（OR 0.26，95％CI 0.15至0.46，六项研究，I平方= 0％，固定效应，OR 0.43，95 ％CI 0.26至0.70，九项研究，I平方= 0％，分别为固定效应）。仅在外部进行治疗的导管显示出较宽的置信区间，且无显着影响（OR为0.67，95％置信区间为0.43至1.06，九项研究，I平方= 0％，固定效应）。对于平均持续时间为5至12天的试验以及平均持续时间超过20天的一项研究，也发现了治疗效果。股骨和颈静脉插入部位以及报告混合插入部位的研究在统计学上均具有显着的治疗效果。在仅使用锁骨下插入位点的试验中未观察到治疗效果。在比较经治疗的导管的四项试验中，有一项报告指出，与经CHSS外部治疗的导管相比，经抗生素治疗的导管有益处。针对研究设计差异的所有三个敏感性分析测试均报告了统计学上显着的治疗效果。由于包括的试验质量，CRBSI的诊断定义和诊断方法存在明显差异以及危险因素和患者人群因素的报告不一致，因此该审查受到了限制。此外，三分之二的试验是由商业资助的。还回顾了使用AI-CVC减少需要CVC的患者的CRBSI数量的经济表现（成本效益和潜在的成本节省）。结果表明，使用AI-CVC代替标准CVC可以减少CRBSI并降低医疗成本。为了补充评论，构建了基本的决策分析模型，以探索英格兰和威尔士的NHS的各种可能方案。结果表明，每位接受AI-CVC的患者估计可节省138.20磅。多元敏感性分析估计，在广泛的成本和临床假设下，取决于人群的规模，可能会节省大量成本。但是，考虑购买AI-CVC的人员应确保其患者人数和当地临床实践的重要特征确实与本经济评估中所述的相似。
结论：总体而言，AI-CVC具有临床效果且相对便宜，因此可以证明将其整合到临床实践中是合理的。但是，在没有适当使用其他实践护理措施的情况下使用这些抗感染导管在预防CRBSI方面仅会取得有限的成功。需要进行比较试验，以确定哪一种治疗过的导管最有效。还必须进行与可能降低CRBSI发生率的护理捆绑的有效性相关的务实研究。

BACKGROUND & AIMS: BACKGROUND:Annually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling. METHODS/DESIGN:The study is designed as a randomised controlled trial (RCT) with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100) or usual care (n = 100) group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary approach entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed. DISCUSSION:Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and the evaluation of adherence. If proven effective, implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls. TRIAL REGISTRATION:Current Controlled Trials ISRCTN11546541.

背景与目标： 背景：每年，年龄在65岁以上的人中至少有30％跌倒一次，而15％的人跌倒至少两次。跌倒通常会导致严重的伤害，例如骨折。因此，防止意外跌倒是必要的。目的是描述一项研究的设计，该研究评估多学科评估和多种跌倒危险因素的治疗的多学科评估和治疗的有效性和成本效益，这些老人独立生活在有跌倒高风险的老年人中。
方法/设计：本研究设计为具有经济评估的随机对照试验（RCT）。最近经历过跌倒的65岁及65岁以上的独立生活者在他们的家中接受采访，并使用经过验证的跌倒风险图来筛查反复跌倒的风险。反复跌倒风险低的人不包括在RCT中。反复跌倒风险高的人被盲目随机分为干预组（n = 100）或常规护理组（n = 100）。干预措施包括多学科评估和多因素跌倒危险因素的治疗。跨壁的多学科方法需要老年医生，初级保健医师，物理治疗师和职业治疗师之间的密切合作，并且可以在相关专家的陪同下进行扩展。秋季日历用于记录随访一年中的秋季。主要结果是第一次和第二次跌倒的时间。进行家访后的三个，六个和十二个月，完成了经济评估问卷。一年后，在第二次家庭访视期间，将重新评估次要结局指标，并评估对干预措施的依从性。将根据意向性治疗原则对数据进行分析，并进行治疗中分析。
讨论：本研究的优势在于选择高风险反复跌倒的人，然后进行多学科干预，其透壁性和依从性评估。如果证明有效，实施我们的多学科评估再治疗跌倒危险因素，将减少跌倒的发生率。
试用注册：电流控制试验ISRCTN11546541。

BACKGROUND & AIMS: PURPOSE:Barriers to the treatment of anemia in patients with chronic kidney disease (CKD), the role of pharmacists in screening patients for anemia and developing guidelines for the use of anemia therapies in patients with CKD, the goals of and considerations in developing pharmacist-managed anemia management clinics, and the potential benefits of these clinics are described. SUMMARY:The complexity of patients with CKD, patient nonadherence to the treatment regimen, a shortage of nephrologists, and a lack of familiarity with clinical practice guidelines and recommendations for treating anemia in these patients are possible barriers to the treatment of anemia. Pharmacists can play a role in improving the treatment of anemia in patients with CKD by screening for anemia, developing guidelines for the use of anemia therapies, and providing patient education to promote adherence to the treatment regimen. The optimal upper limit for hemoglobin concentration during treatment with erythropoietin-stimulating agents (ESA) in patients with CKD remains to be determined, but it should not routinely exceed 13.0 g/dL. Extended dosing of darbepoetin alfa and the new agent continuous erythropoiesis receptor activator appears effective. Iron status often is not assessed in patients with CKD because of difficulty interpreting iron laboratory values and identifying iron deficiency. The usefulness of iron supplementation is not limited to patients with iron deficiency. The intravenous (i.v.) or oral route of administration may be used for iron supplementation in predialysis patients and peritoneal dialysis patients, but the i.v. route is recommended for hemodialysis patients. Adverse effects and drug interactions limit the use of oral iron supplements. Administration of parenteral iron is time consuming and accompanied by concerns about iron accumulation and uncertainty about the optimal maximum serum ferritin concentration. Improved access to care and clinical outcomes and reduced costs have been documented in pharmacist-managed anemia management clinics. CONCLUSION:Pharmacists can help overcome barriers to treating anemia in patients with CKD. Clinical and economic benefits are associated with pharmacist-managed anemia management clinics.

背景与目标： 目的：慢性肾脏病（CKD）患者的贫血治疗障碍，药剂师在筛查贫血患者中的作用以及制定在CKD患者中使用贫血疗法的指南，开发药剂师的目的和考虑因素-管理的贫血管理诊所，并介绍了这些诊所的潜在好处。
摘要：CKD患者的复杂性，患者对治疗方案的不依从，肾病专家的缺乏以及对这些患者治疗贫血的临床实践指南和建议的不熟悉，可能是治疗贫血的障碍。药剂师可以通过筛查贫血，制定使用贫血疗法的指南以及提供患者教育以促进对治疗方案的依从性，在改善CKD贫血的治疗中发挥作用。 CKD患者使用促红细胞生成素刺激剂（ESA）治疗期间血红蛋白浓度的最佳上限尚待确定，但通常不应超过13.0 g / dL。延长剂量的darbepoetin alfa和新药持续性红细胞生成素受体激活剂似乎是有效的。 CKD患者通常无法评估铁的状况，因为难以解释铁的实验室值和识别铁的缺乏。补充铁的用途不仅限于缺铁的患者。静脉内（i.v.）或口服给药途径可用于透析前患者和腹膜透析患者的铁补充，但是i.v.建议血液透析患者使用此途径。不良反应和药物相互作用限制了口服铁补充剂的使用。肠胃外铁剂的给药非常耗时，并伴随着对铁累积和最佳血清铁蛋白最高浓度不确定性的担忧。在药剂师管理的贫血管理诊所中，已有记录显示，改善了获得医疗服务和临床结果的途径，并降低了成本。
结论：药剂师可以帮助克服CKD患者贫血的治疗障碍。临床和经济利益与药剂师管理的贫血管理诊所有关。

BACKGROUND & AIMS: :Individuals with autism spectrum conditions have difficulties in understanding and responding appropriately to others. Additionally, they demonstrate impaired perception of biological motion and problems with motor control. Here we investigated whether individuals with autism move with an atypical kinematic profile, which might help to explain perceptual and motor impairments, and in principle may contribute to some of their higher level social problems. We recorded trajectory, velocity, acceleration and jerk while adult participants with autism and a matched control group conducted horizontal sinusoidal arm movements. Additionally, participants with autism took part in a biological motion perception task in which they classified observed movements as 'natural' or 'unnatural'. Results show that individuals with autism moved with atypical kinematics; they did not minimize jerk to the same extent as the matched typical control group, and moved with greater acceleration and velocity. The degree to which kinematics were atypical was correlated with a bias towards perceiving biological motion as 'unnatural' and with the severity of autism symptoms as measured by the Autism Diagnostic Observation Schedule. We suggest that fundamental differences in movement kinematics in autism might help to explain their problems with motor control. Additionally, developmental experience of their own atypical kinematic profiles may lead to disrupted perception of others' actions.

背景与目标： ：患有自闭症的人很难理解和适当地回应他人。此外，他们还表现出对生物运动的感知受损和运动控制问题。在这里，我们调查了自闭症患者是否以非典型的运动学特征运动，这可能有助于解释知觉和运动障碍，并且原则上可能会导致他们的一些较高层次的社会问题。我们记录了自闭症成年参与者和相匹配的对照组进行水平正弦手臂运动时的轨迹，速度，加速度和加速度。此外，自闭症参与者参加了生物运动感知任务，他们将观察到的动作归类为“自然”或“非自然”。结果表明，自闭症患者的运动学非典型。他们没有将跳动的程度降低到与典型对照组相同的程度，而是以更大的加速度和速度运动。运动学的非典型程度与将生物学运动感知为“非自然”的偏见以及自闭症诊断观察时间表所测得的自闭症症状的严重程度相关。我们建议自闭症运动运动学的根本差异可能有助于解释他们在运动控制方面的问题。另外，他们自己的非典型运动学特征的发展经验可能会导致他人行为的感知被打乱。

BACKGROUND & AIMS: :Different methods of extracting speech features from an auditory model were systematically investigated in terms of their robustness to different noises. The methods either computed the average firing rate within frequency channels (spectral features) or inter-spike-intervals (timing features) from the simulated auditory nerve response. When used as the front-end for an automatic speech recognizer, timing features outperformed spectral features in Gaussian noise. However, this advantage was lost in babble, because timing features extracted the spectro-temporal structure of babble noise, which is similar to the target speaker. This suggests that different feature extraction methods are optimal depending on the background noise.

背景与目标： ：系统地研究了从听觉模型中提取语音特征的不同方法，它们对不同噪声的鲁棒性强。这些方法或者从模拟听觉神经反应中计算出频道（频谱特征）或尖峰间隔（定时特征）内的平均发声率。当用作自动语音识别器的前端时，时序特征在高斯噪声中的表现优于频谱特征。但是，由于时序特征提取了与目标说话者相似的胡言乱语的频谱时态结构，因此在胡言乱语中失去了这一优势。这表明根据背景噪声，不同的特征提取方法是最佳的。