The Benefit of Thrombectomy in Patients With Low ASPECTS Is a Matter of Shades of Gray—What Current Trials May Have Missed

Randomized trials supporting the benefit of endovascular treatment in acute ischemic stroke patients with a large early infarction are not yet available. Few retrospective studies exist that suggest a potential positive treatment effect on functional outcome, as well as procedural safety. However, potential benefit or harm of MT in patients with low initial ASPECTS is still a subject of current debate, and in particular, how to select these patients for treatment. The purpose of this pilot study was to evaluate how early tissue water uptake in acute ischemic brain might determine lesion fate and functional outcome in low ASPECTS patients undergoing MT. We observed that the degree of early water uptake measured by quantitative NWU was significantly associated with functional outcome in low ASPECTS patients, yielding a higher diagnostic power compared to other parameters such as ASPECTS, age, or NIHSS. No conclusive evidence of a beneficial effect of successful reperfusion was observed in patients with low ASPECTS and high NWU, which highlights the potential of NWU as a tool to specify patient selection.

The Effectiveness of FFC-AL-EIT on Psychosocial Outcomes and Care Interactions

This study included a subset of 59 communities and 550 residents from the full FFC-AL-EIT study. Participants were mostly white (98%), female (69%) and had a mean age of 89.30 (SD=7.63). Sites were randomized to the four step FFC-AL-EIT intervention implemented by a function focused care nurse facilitator working with a facility champion over 12 months versus education only. Resident measures included depression, agitation, resistiveness to care and the quality of care interactions and were obtained at baseline, 4 and 12 months. There was a significant positive treatment effect related to depression, agitation, resistiveness to care and quality of care interactions with either less decline or some improvement in these behaviors and symptoms and improvement in the quality of care provided between the treatment versus control group. The study suggests there is some benefit to implementing FFC-AL-EIT for psychosocial outcomes and care interactions among residents in assisted living communities.

The Effectiveness of Monetary and Promotion Rewards in the Public Sector and the Moderating Effect of PSM (PSM-Reward Fit or PSM Crowding Out): A Survey Experiment

To what extent does public service motivation (PSM) affect how monetary rewards and promotion opportunities motivate government officials? This study offers an answer to this question through a survey experiment conducted with a sample of city government officials in Florida. The experimental results demonstrate that both monetary and promotion reward treatments positively motivate officials with low PSM. However, as the level of PSM increases, the positive treatment effect of the monetary reward decreases and converges on 0. Conversely, the positive effect of the promotion opportunity treatment not only decreases but becomes negative, indicating that PSM crowding out is taking place.

Impact of biofertilizers on resistance to diseases of spring barley

The article is devoted to the effect of biofertilizers (Bioklad and Vermix) on the severity of common diseases of spring barley in field trials conducted in the Orel region. The authors estimate risks of spring barley diseases and analyse the results of the three-year experiment, carried out under certain weather and climate conditions. The subject of the research is the spring barley crop Suzdalets under intensive farming (zoned for 2, 3, 5 regions of Russia). For a more comprehensive assessment, the experimental process includes separate and combined application of biofertilizers at two different doses. The results of the experiment shows that spring barley crops have responded to all tested combinations of treatment and, at the same time, biofertilizers Bioklad and Vermix, regardless of the doses of application used, had a positive treatment effect and reduced development of severe plant diseases such as root rot by 8.4%, Helminthosporium spot by 29.2%, powdery mildew by 28.9%, Rhynchosporium by 26.3%, stem rust by 65.9%, Septoria spot by 24.4%, and Fusarium head blight by 12%. The most productive agrocenosis of spring barley was formed with the use of Bioklad: barley yield was 0.59 t/ha at a dose of 1 L/ ha and 0.61 t/ha at a dose of 2 L/ha.

Optimized multiple testing procedures for nested sub-populations based on a continuous biomarker

An important step in the development of targeted therapies is the identification and confirmation of sub-populations where the treatment has a positive treatment effect compared to a control. These sub-populations are often based on continuous biomarkers, measured at baseline. For example, patients can be classified into biomarker low and biomarker high subgroups, which are defined via a threshold on the continuous biomarker. However, if insufficient information on the biomarker is available, the a priori choice of the threshold can be challenging and it has been proposed to consider several thresholds and to apply appropriate multiple testing procedures to test for a treatment effect in the corresponding subgroups controlling the family-wise type 1 error rate. In this manuscript we propose a framework to select optimal thresholds and corresponding optimized multiple testing procedures that maximize the expected power to identify at least one subgroup with a positive treatment effect. Optimization is performed over a prior on a family of models, modelling the relation of the biomarker with the expected outcome under treatment and under control. We find that for the considered scenarios 3 to 4 thresholds give the optimal power. If there is a prior belief on a small subgroup where the treatment has a positive effect, additional optimization of the spacing of thresholds may result in a large benefit. The procedure is illustrated with a clinical trial example in depression.

Appetite-Suppressing and Satiety-Increasing Bioactive Phytochemicals: A Systematic Review

The prevalence of obesity is increasing worldwide. Bioactive phytochemicals in food supplements are a trending approach to facilitate dieting and to improve patients’ adherence to reducing food and caloric intake. The aim of this systematic review was to assess efficacy and safety of the most commonly used bioactive phytochemicals with appetite/hunger-suppressing and/or satiety/fullness-increasing properties. To be eligible, studies needed to have included at least 10 patients per group aged 18 years or older with no serious health problems except for overweight or obesity. Of those studies, 32 met the inclusion criteria, in which 27 different plants were tested alone or as a combination, regarding their efficacy in suppressing appetite/hunger and/or increasing satiety/fullness. The plant extracts most tested were derived from Camellia sinensis (green tea), Capsicum annuum, and Coffea species. None of the plant extracts tested in several trials showed a consistent positive treatment effect. Furthermore, only a few adverse events were reported, but none serious. The findings revealed mostly inconclusive evidence that the tested bioactive phytochemicals are effective in suppressing appetite/hunger and/or increasing satiety/fullness. More systematic and high quality clinical studies are necessary to determine the benefits and safety of phytochemical complementary remedies for dampening the feeling of hunger during dieting.

Low Participation Rates

This chapter focuses on low participation rates. Low participation rates squeeze the effective sample size for a test, making it more difficult, statistically, to identify a positive treatment effect. There are two moments in which low participation rates can materialize: during the intake process to a study or intervention, or after random assignment to treatment or control. Low participation during the intake process often occurs when marketing a program to the general public. Researchers working in the field with partner organizations often face inflexible constraints in trying to cope with low participation during intake. The second type of low participation—that which occurs after subjects have been randomly assigned to treatment or control—is a more daunting problem and is less likely solvable than low participation at the intake phase.

Sample size re-estimation in a superiority clinical trial using a hybrid classical and Bayesian procedure

When designing studies involving a continuous endpoint, the hypothesized difference in means ([Formula: see text]) and the assumed variability of the endpoint ([Formula: see text]) play an important role in sample size and power calculations. Traditional methods of sample size re-estimation often update one or both of these parameters using statistics observed from an internal pilot study. However, the uncertainty in these estimates is rarely addressed. We propose a hybrid classical and Bayesian method to formally integrate prior beliefs about the study parameters and the results observed from an internal pilot study into the sample size re-estimation of a two-stage study design. The proposed method is based on a measure of power called conditional expected power (CEP), which averages the traditional power curve using the prior distributions of θ and [Formula: see text] as the averaging weight, conditional on the presence of a positive treatment effect. The proposed sample size re-estimation procedure finds the second stage per-group sample size necessary to achieve the desired level of conditional expected interim power, an updated CEP calculation that conditions on the observed first-stage results. The CEP re-estimation method retains the assumption that the parameters are not known with certainty at an interim point in the trial. Notional scenarios are evaluated to compare the behavior of the proposed method of sample size re-estimation to three traditional methods.

Treatment of sex offenders

This essay discusses various treatments for sexual offenders and their success in reducing reoffending. Overall, research reveals a positive treatment effect that indicates up to 25 per cent less recidivism in treatment versus control groups. Cognitive-behavioral therapy, relapse prevention, and programs based on the Risk–Need–Responsivity model have the strongest evidence base, although the studies and findings are heterogeneous and outcomes vary depending on many factors. Most promising are programs that involve treatment in the community and in forensic hospitals, delivered in a partly individualized mode, implemented with sound integrity, targeting medium- to high-risk offenders, addressing young individuals, and being evaluated in well-documented small studies. In contrast, programs in prisons, delivered merely in a group format, including low-risk offenders, and evaluations in large samples show smaller or no effects. Recent developments aim to modernize and widen standard programs toward more differentiated interventions, but more sound evaluation research is needed.

ANTIOXIDANT SUPPLEMENTS IN ALZHEIMER’S DEMENTIA AND MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW

Objective: Current treatments have only a modest effect on impairment in Alzheimer’s Dementia (AD) and there is no treatment currently licensed for Mild Cognitive Impairment (MCI). Oxidative stress is postulated to play a role in the pathogenesis of AD and MCI and this provides a rationale for treatment with antioxidant supplements. The aim of this review is to evaluate the effect of antioxidant supplements in people with AD and MCI. Methods: A systematic review of published randomised controlled trials was carried out. 4 electronic databases were searched. Studies were included if they compared the use of a placebo with the following antioxidant supplements in people with AD or MCI: Vitamin e, vitamin c, selenium, alpha lipoic acid, phenols, zinc, curcumin, beta carotene, coenzyme Q10, melatonin. The primary outcome measure was cognitive impairment. Secondary outcome measures included functional impairment, behavioural disturbance and safety. Results: 10 trials were identified which met the inclusion criteria. Outcome data was not suitable for meta-analysis. 5 studies reported a small positive treatment effect on cognition and 1 reported a negative effect. 2 reported a positive treatment effect on functional ability and 1 on behaviour. There were no consistent adverse effects found overall however two studies raised concern of possible worsening of cognition in certain circumstances. Conclusions: The findings of this systematic review do not support the use of antioxidant supplements to slow cognitive, functional or behavioural deterioration in people with AD or MCI. However the majority of included studies had a high or unknown risk of bias. In the one study which had a low overall risk of bias, there was evidence that antioxidant supplements may have a positive effect on functional decline in AD. The overall risk of harm associated with short term antioxidant supplementation appears to be low however caution is warranted. Further studies evaluating the role of oxidative stress in the pathogenesis of AD are suggested.