A users' guide to understanding therapeutic substitutions.

Therapeutic substitutions are common at the level of ministries of health, clinicians, and pharmacy dispensaries. Guidance in determining whether drugs offer similar risk-benefit profiles is limited. Those making decisions on therapeutic substitutions should be aware of potential biases that make differentiating therapeutic agents difficult.

Photophysics and luminescence spectroelectrochemistry of [Tc(dmpe)3](+/2+) (dmpe = 1,2-bis(dimethylphosphino)ethane).

The ligand-to-metal charge transfer (LMCT) excited state luminescence of [Tc(dmpe)3](2+) (dmpe is 1,2-bis-(dimethylphosphino)ethane) has been measured in solution at room temperature and is compared to its Re analogue. Surprisingly, both [M(dmpe)3](2+)* (M = Re, Tc) species have extremely large excited-state potentials (ESPs) as oxidants, the highest for any simple coordination complex of a transition metal. Furthermore, this potential is available using a photon of visible light (calculated for M = Tc; E°'* = +2.

Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.

Background: Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention.

Robust and censored modeling and prediction of progression in glaucomatous visual fields.

Purpose: Classic regression is based on certain assumptions that conflict with visual field (VF) data. We investigate and evaluate different regression models and their assumptions in order to determine point-wise VF progression in glaucoma and to better predict future field loss for personalised clinical glaucoma management.

Methods: Standard automated visual fields of 130 patients with primary glaucoma with a minimum of 6 years of follow-up were included.

Electrochemistry and Spectroelectrochemistry of europium(III) chloride in 3LiCl-2KCl from 643 to 1123 K.

The electrochemical and spectroelectrochemical behavior of europium(III) chloride in a molten salt eutectic, 3LiCl-2KCl, over a temperature range of 643-1123 K using differential pulse voltammetry, cyclic voltammetry, potential step chronoabsorptometry, and thin-layer spectroelectrochemistry is reported. The electrochemical reaction was determined to be the one-electron reduction of Eu(3+) to Eu(2+) at all temperatures. The redox potential of Eu(3+/2+) shifts to more positive potentials, and the diffusion coefficient for Eu(3+) increases as temperature increases.

Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis.

Aims: Self-monitoring and self-titration of antihypertensives (self-management) is a novel intervention which improves blood pressure control. However, little evidence exists regarding the cost-effectiveness of self-monitoring of blood pressure in general and self-management in particular. This study aimed to evaluate whether self-management of hypertension was cost-effective.

Does the process of deliberation change individuals' health state valuations? An exploratory study using the person trade-off technique.

Background: This article explores two gaps in the health state valuation literature: the effect of processes and the stability of health state valuations, and the existence of preexisting valuations. Stability in health state valuations over time depends on whether preferences are considered to be preexisting (axiom of completeness) and therefore can be gathered reliably, or are constructed during consideration and debate. Under the former, changes in revealed preferences are evidence of poor reliability; under the latter, it is a function of the deliberative process.

2-epi-5-epi-Valiolone synthase activity is essential for maintaining phycobilisome composition in the cyanobacterium Anabaena variabilis ATCC 29413 when grown in the presence of a carbon source.

The cyclase 2-epi-5-epi-valiolone synthase (EVS) is reported to be a key enzyme for biosynthesis of the mycosporine-like amino acid shinorine in the cyanobacterium Anabaena variabilis ATCC 29413. Subsequently, we demonstrated that an in-frame complete deletion of the EVS gene had little effect on in vivo production of shinorine. Complete segregation of the EVS gene deletion mutant proved difficult and was achieved only when the mutant was grown in the dark and in a medium supplemented with fructose.

Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey.

Background: Resource allocation is a key challenge for healthcare decision makers. While several case studies of organizational practice exist, there have been few large-scale cross-organization comparisons.

Methods: Between January and April 2011, we conducted an on-line survey of senior decision makers within regional health authorities (and closely equivalent organizations) across all Canadian provinces and territories.

Pleomorphic adenoma occurring outside the submandibular gland: a case report of an accessory submandibular gland.

The accessory submandibular gland is a rare anatomic variant and the incidence of pathology reported within an accessory submandibular gland is even rarer. This report describes the case of a 22-year-old woman who presented with a slowly enlarging mass in the submandibular triangle, which on ultrasound examination suggested that it was close to, but not arising from, the submandibular gland. Fine-needle aspiration cytology was consistent with a pleomorphic adenoma.

An economic evaluation of resistance training and aerobic training versus balance and toning exercises in older adults with mild cognitive impairment.

Background: Mild cognitive impairment (MCI) represents a critical window to intervene against dementia. Exercise training is a promising intervention strategy, but the efficiency (i.e.

Targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR): protocol for a randomised controlled trial.

Background: Self-monitoring of hypertension with self-titration of antihypertensives (self-management) results in lower systolic blood pressure for at least one year. However, few people in high risk groups have been evaluated to date and previous work suggests a smaller effect size in these groups. This trial therefore aims to assess the added value of self-management in high risk groups over and above usual care.

Water O-H stretching Raman signature for strong acid monitoring via multivariate analysis.

A distinct need exists for real time information on an acid concentration of industrial aqueous streams. Acid strength affects efficiency and selectivity of many separation processes, including nuclear fuel reprocessing. Despite the seeming simplicity of the problem, no practical solution has been offered yet, particularly for the large-scale schemes involving toxic streams such as highly radioactive nuclear wastes.

Redox-inflammatory synergy in the metabolic syndrome.

Metabolic syndrome (MetS) comprises interrelated disease states including obesity, insulin resistance and type 2 diabetes (T2DM), dyslipidemia, and hypertension. Essential to normal physiological function, and yet massively damaging in excess, oxidative stress and inflammation are pivotal common threads among the pathologies of MetS. Increasing evidence indicates that redox and inflammatory dysregulation parallels the syndrome's physiological, biochemical, and anthropometric features, leading many to consider the pro-oxidative, pro-inflammatory milieu an unofficial criterion in itself.

Urinary conjugated α-tocopheronolactone--a biomarker of oxidative stress in children with type 1 diabetes.

Increased oxidative stress has been implicated in both the onset and the progression of diabetes mellitus and its complications. The development of easy to measure biomarkers of oxidative stress would, therefore, help in determining in a prospective manner the impact of glycemic control on oxidative stress and macrovascular disease in patients with diabetes. We report the development and validation of a novel method to directly measure the urinary concentrations of the conjugated metabolites of vitamin E (α-tocopherol) and investigate whether the oxidized metabolite α-tocopheronolactone (α-TL) could be used as a biomarker of oxidative stress in children with type 1 diabetes.

Exploration of the association between quality of life, assessed by the EQ-5D and ICECAP-O, and falls risk, cognitive function and daily function, in older adults with mobility impairments.

Background: Our research sought to understand how falls risk, cognitive function, and daily function are associated with health related quality of life (using the EuroQol-5D) and quality of life (using the ICECAP-O) among older adults with mobility impairments.

Methods: The EQ-5D and ICECAP-O were administered at 12 months post first clinic attendance at the Vancouver Falls Prevention Clinic. We report descriptive statistics for all baseline characteristics collected at first clinic visit and primary outcomes of interest.

An investigation of the construct validity of the ICECAP-A capability measure.

Purpose: To investigate the construct validity of the ICECAP-A capability wellbeing measure.

Methods: A face-to-face interview-administered survey was conducted with 418 members of the UK general population, randomly sampled from the Postcode Address File. Pre-specified hypotheses were developed about the expected associations between individuals' ICECAP-A responses and their socio-economic circumstances, health and freedom.

Comparison of waist circumference using the World Health Organization and National Institutes of Health protocols.

Background: This study compares waist circumference (WC) measured using the World Health Organization (WHO) and National Institutes of Health (NIH) protocols to determine if the results differ significantly, and whether equations can be developed to allow comparison between WC taken at the two different measurement sites.

Data And Methods: Valid WC measurements using the WHO and NIH protocols were obtained for 6,306 respondents aged 3 to 79 from Cycle 2 of the Canadian Health Measures Survey. Linear regression was used to identify factors associated with the difference between the NIH and WHO values.

'Innovation' in health care coverage decisions: all talk and no substance?

There has been much discussion recently about 'innovation', or more precisely the lack of it, in pharmaceuticals and devices in health care. The concern has been expressed by national guideline bodies, such as the Common Drugs Review in Canada and the National Institute for Health & Clinical Excellence in the UK, applying strict cost-effectiveness criteria in their decision-making and, therefore, failing adequately to recognize the full benefits that come from innovation. In order to explore the legitimacy of such claims, we first define innovation, and second, explore the basis for assuming an independent and separable social value associated with innovation.

Focussing both eyes on health outcomes: revisiting cataract surgery.

Background: The appropriateness of cataract surgery procedures has been questioned, the suggestion being that the surgery is sometimes undertaken too early in the disease progression. Our three study questions were: What is the level of visual impairment in patients scheduled for cataract surgery? What is the improvement following surgery? Given the thresholds for a minimal detectable change (MDC) and a minimal clinically important difference (MCID), do gains in visual function reach the MDC and MCID thresholds?

Methods: The sample included a prospective cohort of cataract surgery patients from four Fraser Health Authority ophthalmologists. Visual function (VF-14) was assessed pre-operatively and at seven weeks post-operatively.

What happens to clinical training fellows? A retrospective study of the 20 years outcome of a Medical Research Council UK cohort.

Objectives: The Clinical Research Training Fellowship (CRTF) allows up to 3 years support for clinically qualified candidates to undertake specialised or further research training in biomedical sciences. CRTFs are perceived as a crucial step in the career development and progression of Clinical Academics but there are no published data to support this notion. We conducted an electronic survey of a large cohort of Medical Research Council (MRC) CRTFs followed for up to 20 years.

Two-level resampling as a novel method for the calculation of the expected value of sample information in economic trials.

It has already been pointed out that the bootstrap can be used to calculate the expected value of perfect information (EVPI) when individual-level data from a randomized controlled trial (RCT) is at hand. However, as mentioned by others, it is not clear if and how such a method can be extended to calculate the expected value of sample information (EVSI). In this article, we provide a nonparametric definition for EVPI and EVSI, which is based on considering the entire population distribution as the uncertain entity for which the current RCT provides partial information.

The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study.

Background: Physical inactivity is a serious issue for the American public. Because of conditions that result from inactivity, individuals incur close to $1 trillion USD in health-care costs, and approximately 250 000 premature deaths occur per year. Researchers have linked engaging in yoga to improved overall fitness, including improved muscular strength, muscular endurance, flexibility, and balance.

Rapid, long-distance dispersal by pumice rafting.

Pumice is an extremely effective rafting agent that can dramatically increase the dispersal range of a variety of marine organisms and connect isolated shallow marine and coastal ecosystems. Here we report on a significant recent pumice rafting and long-distance dispersal event that occurred across the southwest Pacific following the 2006 explosive eruption of Home Reef Volcano in Tonga. We have constrained the trajectory, and rate, biomass and biodiversity of transfer, discovering more than 80 species and a substantial biomass underwent a >5000 km journey in 7-8 months.

Do the methods used to analyse missing data really matter? An examination of data from an observational study of Intermediate Care patients.

Background: Missing data is a common statistical problem in healthcare datasets from populations of older people. Some argue that arbitrarily assuming the mechanism responsible for the missingness and therefore the method for dealing with this missingness is not the best option-but is this always true? This paper explores what happens when extra information that suggests that a particular mechanism is responsible for missing data is disregarded and methods for dealing with the missing data are chosen arbitrarily. Regression models based on 2,533 intermediate care (IC) patients from the largest evaluation of IC done and published in the UK to date were used to explain variation in costs, EQ-5D and Barthel index.