The 2005 Lancet review proved superior quality of homeopathy trials: what's next?

Several former reviews showed positive effects of homeopathy, but in 2005 The Lancet published a review which claimed that homeopathy is a placebo effect. This review was criticised for not revealing essential information. A reconstruction of post-publication data challenges the negative conclusion. The only conclusion that was rectified by the methodology of the 2005 review was that the quality of homeopathy trials, and especially of smaller trials, is better than quality of conventional trials. The comparison of the effect of 110 homeopathy trials with 110 matched conventional trials was flawed by selection bias, different publication bias, different quality, and different safety. Nevertheless, there is no significant difference of effects between both methods. Discussions about proof for homeopathy are in fact discussions about science. The prior assumption that homeopathy cannot work pervades all aspects of this discussion and is not properly evaluated in the introduction of most analyses.

The Representation of Syrian Refugees in Canadian Online Media: A Focus on the Topos of Burdening

Background: This study focuses on the representation of Syrian refugees in Canadian online news media. It examines 375 articles selected from three of the most visited Canadian news sites, namely the Toronto Star, which favours the Liberal Party, and the Toronto Sun and National Post, which favour the Conservative Party. Analysis: The basis of this research is a topoi analysis, whereby instances of the topos of burdening are identified, examined, and categorized as either positive or negative. Conclusion and implications: A distinction is drawn between the depiction of Syrian refugees in conservative- and liberal-leaning news sources. The findings aim to provide some insight into the possible impact of media representation on both the Syrian refugees and the Canadian public. Contexte: Cette étude porte sur la représentation des réfugiés syriens dans les médias d’information canadiens en ligne. Elle examine 375 articles choisis à partir de trois des sites de nouvelles canadiens les plus visités, à savoir le Toronto Star, partisan du Parti libéral, le Toronto Sun et le National Post, partisans du Parti conservateur. Analyse: Cette recherche se fonde sur l’analyse de topoï pour identifier, examiner et catégoriser des topos sur les fardeaux comme étant positif ou négatifs. Conclusion et implications: Cette étude établit une distinction entre la manière dont les sources de nouvelles à tendance conservatrice dépeignent les réfugiés syriens et la manière dont les sources à tendance libérale le font. L’objectif est de mieux comprendre l’impact possible des représentations médiatiques sur les réfugiés syriens ainsi que sur le public canadien.

How we handled COVID crisis? Experience of an Indian tertiary level NICU

Background: Coronavirus disease (COVID-19) has imposed several challenges in clinical care. With rapid increase in the disease, there has been lot of incidences of COVID-19 positive exposure among the healthcare workers resulting in major crisis. Aim: The aim of the study was to emphasize various methods that can be used to manage COVID-19 crisis due to accidental exposure. Methods: An unprecedented exposure occurred to a COVID-19 positive healthcare worker in the Neonatal Intensive Care Unit (NICU), which led to quarantine of almost 90% of the primary staff. The methods undertaken included communication and continuation of clinical care through teleconsultation (video calling, zoom meetings for clinical decision, telecharting of daily prescription, and facilitating manpower from allied departments [only one pediatric resident each day], and restoration of services with come back). Results: There were total 11 babies at the time of exposure. Two babies were on respiratory support. The parents were counseled through teleconsultation. Nine babies could be discharged during quarantine period and there was no significant deterioration in the clinical condition of the two babies on respiratory support. All the babies were tested for COVID-19 as per post-exposure protocol and remained negative. Conclusion: With the help of teleconsultation and support from allied specialties and other health facilities, the crisis of COVID-19 exposure can be handled well.

Role of Creatine Kinase in the Troponin Era: A Systematic Review

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.

Antibody Testing of Infants Born to Asymptomatic COVID-19 Positive Mothers

Awareness of SARS-COV-2 IgG may contribute to the management of asymptomatic RT PCR COVID-19 positive pregnant women, their newborns, and future vaccination practices. Objective: Characterize COVID testing results of asymptomatic COVID-19 positive pregnant women and their infants. Our assumption/hypothesis maintained that all infants born to asymptomatic COVID-19 positive mothers would have detectable SARS-CoV-2 specific IgG. Study Design: Retrospective chart review. Clinical demographics/COVID-19 testing of maternal/infant dyads were reviewed/collected for reporting purposes. Setting: Center for Women and Infants (CWI), University of Louisville Hospital, Louisville, KY Participants: Asymptomatic COVID-19 positive pregnant women/infant dyads admitted to the CWI between June 2020 to February 2021. Results: 36 COVID-19 positive asymptomatic mother/37 infant dyads (one set of twins) reviewed. 38% of the mother/infant dyads were positive for SARS-CoV-2 IgG, while 27% of mother/infant dyads were negative for IgG. A COVID-19 positive mother of twins was IgG negative, but both twins were positive. Two mothers in this study group had developed significant COVID-19 disease at 28w4d gestation and 34w0d gestation. Both required intensive care but recovered, and their pregnancies were maintained until 37w4d and 39w3d gestation, respectively. By the time of delivery, both mothers had negative COVID-19 RT PCR testing, but both infants were positive for SARS-CoV-2 IgG antibodies. COVID-19 RT PCR testing on both of these infants at 24 and 48 hours of age was negative. Conclusion: SARS-CoV-2 IgG is passively transferred to the infant during pregnancy of asymptomatic positive COVID-19 mothers however appears variable and/or possibly based on the ability of IgG detection with current testing. Further investigation of the immune system’s response to the SARS-CoV-2 virus during pregnancy can direct future management/treatment during pregnancy, especially in the wake of vaccination for the virus during pregnancy and emerging variants.

Prevalence of asymptomatic SARS-CoV-2 Infection in couples seeking in vitro fertilization treatment in Riyadh, July–November, 2020

Background: After the start of the coronavirus disease (COVID-19) pandemic, assisted reproductive services were suspended and restarted in in vitro fertilization (IVF) clinics worldwide. In our center we implemented screening of all couples for COVID-19 the day before starting the ovulation cycle and before the ovum pick-up (OPU) procedure. Objectives: Assess the prevalence of asymptomatic COVID-19 among couples undergoing in vitro fertilization (IVF). Design: Cross-sectional and retrospective cohort study. Setting: An IVF unit in Riyadh from July to November 2020. Patients and methods: Patients and their partners were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 24-48 hours before their initial visit to initiate the fertility cycle and again prior to the ovum pick-up visit. Main outcome measures: Prevalence of asymptomatic SARS-CoV-2 infection. Sample size: 508 couples. Results: A total of 508 couples were tested. Of the 508 cycles of therapy, 24 (4.7%) were cancelled, 16 (3.14%) before the start of the cycle, and 8 (1.66%) before ovum pick-up, because one or both partners in the couple tested SARS-CoV-2 positive. Before the start of the cycle, 3 patients and their partners both tested positive; 7 patients tested positive and their partners tested negative; and 6 partners tested positive and the patient testing negative. In addition, on retesting 481 couples before OPU 3 patients and their partners both tested positive; 3 patients tested positive, and their partners tested negative; and 2 partners tested positive and the patients tested negative. Conclusion: The prevalence of asymptomatic SARS-CoV-2 infection in couples seeking IVF was higher than that in the general population. Implementing a policy of screening couples for SARS-CoV-2 prior to IVF treatment, minimized the possibility of transmission of SARS-CoV-2 from patients to healthcare workers.

Understanding Women Who Try to Kill Their Abusers: Print Media Coverage of R. v. Ryan

Background: The news coverage of domestic violence survivors who lethally defend themselves is often negative and promotes misconceptions. The trials of Nicole Doucet, who tried to hire a hitman to kill her abusive husband, provides an opportunity to assess if tone of the coverage changed over time. Analysis: News coverage of the Ryan case started neutral or favourable to Doucet and included feminist legal analysis. Interjections by Michael Ryan and the RCMP shifted the coverage to use more men’s rights arguments and negatively portray Doucet. Conclusion and implications: Canadian newspapers demonstrated, in equal measure, a better grasp of women’s defensive violence and a susceptibility to be swayed by men’s rights arguments.Contexte : La couverture médiatique des survivantes de la violence domestique qui se défendent mortellement est souvent négative et fait avancer des idees fausses. Les procès de Nicole Doucet, qui a tenté d’embaucher un tueur à gages pour tuer son mari violent, offre l’occasion d’évaluer si le ton de la couverture changé au fil du temps. Analyse : La couverture des journaux a débuté neutre ou positive et comprenait des analyses juridiques féministes. Les interjections de Michael Ryan et de la GRC ont modifié la couverture pour incluier plus d’arguments en faveur relatifs aux des droits des hommes et pour dépeindre Doucet de manière négative. Conclusion et implications : Les journaux canadiens ont démontré une meilleure compréhensionde la violence défensive des femmes et leur susceptibilité à être influencés par les arguments des droits des hommes

Qualitative approximations to causality: Non-randomizable factors in clinical psychology

Background Causal quests in non-randomized studies are unavoidable just because research questions are beyond doubt causal (e.g., aetiology). Large progress during the last decades has enriched the methodical toolbox. Aims Summary papers mainly focus on quantitative and highly formal methods. With examples from clinical psychology, we show how qualitative approaches can inform on the necessity and feasibility of quantitative analysis and may yet sometimes approximate causal answers. Results Qualitative use is hidden in some quantitative methods. For instance, it may yet suffice to know the direction of bias for a tentative causal conclusion. Counterfactuals clarify what causal effects of changeable factors are, unravel what is required for a causal answer, but do not cover immutable causes like gender. Directed acyclic graphs (DAGs) address causal effects in a broader sense, may give rise to quantitative estimation or indicate that this is premature. Conclusion No method is generally sufficient or necessary. Any causal analysis must ground on qualification and should balance the harms of a false positive and a false negative conclusion in a specific context.

Changes of matrix metalloproteinases in the stroma after corneal cross-linking in rabbits

AIM: To observe changes in the content of matrix metalloproteinases (MMPs) in the corneal stroma after corneal cross-linking (CXL) in rabbits, and further explore the corneal pathophysiological process after CXL. METHODS: Forty-two rabbits (42 eyes) were randomly divided into seven groups. One group served as the control group, while the other six groups were treated with CXL. The concentrations of MMPs in corneal stroma were evaluated through parallel reaction monitoring at baseline and 3, 7, 15, 30, 90, and 180d after treatment. RESULTS: The levels of MMP-2 in the corneal stroma of rabbits were 0.76±0.07, 2.78±1.39, 4.12±0.69, 2.00±0.29, 2.00±0.30, 1.22±0.18, and 1.35±0.18 (10-9 mol/g) at baseline and 3, 7, 15, 30, 90, and 180d after treatment, respectively. The contents of tissue inhibitor of metalloproteinase-1 (TIMP-1) were 1.83±0.26, 7.94±0.58, 6.95±2.64, 3.81±0.48, 3.07±0.92, 1.72±0.19, and 1.69±0.74 (10-9 mol/g), respectively. The ratios of MMP-2/TIMP-1 were 0.42±0.33, 0.36±0.20, 0.62±0.10, 0.54±0.15, 0.68±0.13, 0.71±0.10, and 0.68±0.09, respectively. After CXL, the expression of MMP-2 and TIMP-1 in the rabbit corneal stroma was initially increased and subsequently decreased. The levels of MMP-2 remained higher than those recorded at baseline 180d after treatment, but it was not statistically significant. The levels of TIMP-1 returned to baseline levels at 90d after treatment. The ratio of MMP-2/TIMP-1 started to rise from 7d after CXL. It was significantly higher than that calculated at baseline 30-180d after CXL. The results for MMP-1, -3, -7, -9, -13, and TIMP-2 were negative. CONCLUSION: CXL can lead to changes in the content of MMP-2 and TIMP-1 in the rabbit corneal stroma. The ratio of MMP-2/TIMP-1 remains higher versus baseline, indicating that MMP-2 is involved in the corneal pathophysiological process after CXL.

Possible impact of the green economy requirements on the furniture industry development in Kaliningrad region

The article discusses the possible impact of the requirements of the “green economy” on the furniture industry development in Kaliningrad region. The main question posed in the article – whether furniture manufacturers from Kaliningrad region can withstand future changes related to the “green economy”. The authors collected and examined data on the main factors affecting the Kaliningrad furniture industry earlier (changes in customs regulations) and now (impact of the COVID-19 pandemic). Along with the general analysis, the authors considered the manufacture of individual products. No sharper drop in the furniture manufacture for home use compared with the furniture manufacture for offices was found as a result. As vendors, component suppliers, and furniture manufacturers have formed a regional cluster, its role in overcoming current challenges was also examined. Taking into account the current situation, the authors come to a rather negative conclusion about the contribution of the Kaliningrad Association of Furniture Manufacturers to the general anti-crisis actions. The requirements of the “green economy” are expected to lead to a significant increase in capital expenditures for Kaliningrad furniture manufacturers. Taking into account the current problems caused by changes in customs regulations and the COVID-19 epidemic, Kaliningrad furniture manufacturers will not put these costs at the top of their priorities in the next 3-5 years.