PubMed | University of Southern Denmark, DC and MChiro
Type: | Journal: Chiropractic & manual therapies | Year: 2015
Ultrasound is frequently used to measure activity in the lumbar multifidus muscle (LMM). However previous reliability studies on diagnostic ultrasound and LMM have included a limited number of subjects and few have used Bland-Altmans Limits of Agreement (LOA). Further one does not know if activity affects the subjects ability to contract the LMM.From January 2012 to December 2012 an inter- and intra-examiner reliability study was carried out in a clinical setting. It consisted of a total of four experiments with 30 subjects in each study. Two experienced examiners performed all measurements. Ultrasound measurements were made of: 1. the LMM in the resting state, 2. during a contracted state, 3. on subsequent days, and, before and after walking. Reliability and agreement was tested for 1. resting LMM, 2. contracted LMM, and 3. thickness change in the LMM. Mean values of three measurements were used for statistical analysis for each spinal level. The intra-class correlation coefficient (ICC) 3.1 and 3.2 was used to test for reliability, and Bland-Altmans LOA method to test for agreement.All of the studies indicate high levels of reliability, but as the LMM thickness increased (increasing contraction) the agreement between examiners was poorer than for low levels of contraction.The use of diagnostic ultrasound to measure the LMM seems to be reliable in subjects who have little or no change in thickness of the LMM with contraction.
Cudkowicz M.E.,Massachusetts General Hospital |
Titus S.,Massachusetts General Hospital |
Kearney M.,Massachusetts General Hospital |
Yu H.,Massachusetts General Hospital |
And 166 more authors.
The Lancet Neurology | Year: 2014
Background: Glutamate excitotoxicity might contribute to the pathophysiology of amyotrophic lateral sclerosis. In animal models, decreased excitatory aminoacid transporter 2 (EAAT2) overexpression delays disease onset and prolongs survival, and ceftriaxone increases EAAT2 activity. We aimed to assess the safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis in a combined phase 1, 2, and 3 clinical trial. Methods: This three-stage randomised, double-blind, placebo-controlled study was done at 59 clinical sites in the USA and Canada between Sept 4, 2006, and July 30, 2012. Eligible adult patients had amyotrophic lateral sclerosis, a vital capacity of more than 60% of that predicted for age and height, and symptom duration of less than 3 years. In stages 1 (pharmacokinetics) and 2 (safety), participants were randomly allocated (2:1) to ceftriaxone (2 g or 4 g per day) or placebo. In stage 3 (efficacy), participants assigned to ceftriaxone in stage 2 received 4 g ceftriaxone, participants assigned to placebo in stage 2 received placebo, and new participants were randomly assigned (2:1) to 4 g ceftriaxone or placebo. Participants, family members, and site staff were masked to treatment assignment. Randomisation was done by a computerised randomisation sequence with permuted blocks of 3. Participants received 2 g ceftriaxone or placebo twice daily through a central venous catheter administered at home by a trained caregiver. To minimise biliary side-effects, participants assigned to ceftriaxone also received 300 mg ursodeoxycholic acid twice daily and those assigned to placebo received matched placebo capsules. The coprimary efficacy outcomes were survival and functional decline, measured as the slope of Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) scores. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00349622. Findings: Stage 3 included 66 participants from stages 1 and 2 and 448 new participants. In total, 340 participants were randomly allocated to ceftriaxone and 173 to placebo. During stages 1 and 2, mean ALSFRS-R declined more slowly in participants who received 4 g ceftriaxone than in those on placebo (difference 0·51 units per month, 95% CI 0·02 to 1·00; p=0·0416), but in stage 3 functional decline between the treatment groups did not differ (0·09, -0·06 to 0·24; p=0·2370). No significant differences in survival between the groups were recorded in stage 3 (HR 0·90, 95% CI 0·71 to 1·15; p=0·4146). Gastrointestinal adverse events and hepatobiliary adverse events were more common in the ceftriaxone group than in the placebo group (gastrointestinal, 245 of 340 [72%] ceftriaxone vs 97 of 173 [56%] placebo, p=0·0004; hepatobiliary, 211 [62%] vs 19 [11%], p<0·0001). Significantly more participants who received ceftriaxone had serious hepatobiliary serious adverse events (41 participants [12%]) than did those who received placebo (0 participants). Interpretation: Despite promising stage 2 data, stage 3 of this trial of ceftriaxone in amyotrophic lateral sclerosis did not show clinical efficacy. The adaptive design allowed for seamless transition from one phase to another, and central venous catheter use in the home setting was shown to be feasible. Funding: National Institute of Neurological Disorders and Stroke. © 2014 Elsevier Ltd.
Nonrandomized comparison of neurofibromatosis type 1 and non-neurofibromatosis type 1 children who received carboplatin and vincristine for progressive low-grade glioma: A report from the Children's Oncology Group
Ater J.L.,University of Texas M. D. Anderson Cancer Center |
Xia C.,University of Southern California |
Mazewski C.M.,Emory University |
Booth T.N.,University of Texas Southwestern Medical Center |
And 5 more authors.
Cancer | Year: 2016
BACKGROUND: To evaluate tumor responses, event-free survival (EFS), overall survival (OS), and toxicity of chemotherapy, children with neurofibromatosis type 1 (NF1) and progressive low-grade glioma were enrolled into the Children's Oncology Group (COG) A9952 protocol and treated with carboplatin and vincristine (CV). METHODS: Non-NF1 patients were randomized to CV or thioguanine, procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea, and vincristine in COG A9952. NF1 patients were assigned to CV only. NF1 patients and non-NF1 patients who were treated with CV were compared with respect to baseline characteristics, toxicity, tumor responses, EFS, and OS. RESULTS: A total of 127 eligible patients with NF1 were nonrandomly assigned to CV: 42 NF1 patients (33%) had events, and 6 (4.7%) died. The 5-year EFS rate was 69%±4% for the CV-NF1 group and 39%±4% for the CV-non-NF1 group (P<.001). In a univariate analysis, NF1 children had a significantly higher tumor response rate and superior EFS and OS in comparison with CV-treated children without NF1. NF1 patients and non-NF1 patients differed significantly in amount of residual tumor, extent of resection, tumor location, and pathology. According to a multivariate analysis, NF1 was independently associated with better EFS (P<.001) but not with OS. NF1 patients also had a decreased risk of grade 3 or 4 toxicities in comparison with non-NF1 patients. Three second malignant neoplasms occurred in NF1 patients receiving CV (CV-NF1 group) at a median of 7.8 years (range, 7.3-9.4 years) after enrollment, but there were none in the non-NF1 group. CONCLUSIONS: Children with NF1 tolerated CV well and had tumor response rates and EFS that were superior to those for children without NF1. © 2016 American Cancer Society. © 2016 American Cancer Society.
Kashner T.M.,Loma Linda University |
Hettler D.L.,Pennsylvania State University |
Zeiss R.A.,DC |
Aron D.C.,Case Western Reserve University |
And 11 more authors.
Health Services Research | Year: 2016
Objective: To assess how changes in curriculum, accreditation standards, and certification and licensure competencies impacted how medical students and physician residents value interprofessional team and patient-centered care. Primary Data Source: The Department of Veterans Affairs Learners' Perceptions Survey (2003-2013). The nationally administered survey asked a representative sample of 56,569 U.S. medical students and physician residents, with a comparison group of 78,038 nonphysician trainees, to rate satisfaction with 28 elements, in two overall domains, describing their clinical learning experiences at VA medical centers. Study Design: Value preferences were scored as independent adjusted associations between an element (interprofessional team, patient-centered preceptor) and the respective overall domain (clinical learning environment, faculty, and preceptors) relative to a referent element (quality of clinical care, quality of preceptor). Principal Findings: Physician trainees valued interprofessional (14 percent vs. 37 percent, p < .001) and patient-centered learning (21 percent vs. 36 percent, p < .001) less than their nonphysician counterparts. Physician preferences for interprofessional learning showed modest increases over time (2.5 percent/year, p < .001), driven mostly by internal medicine and surgery residents. Preferences did not increase with trainees' academic progress. Conclusions: Despite changes in medical education, physician trainees continue to lag behind their nonphysician counterparts in valuing experience with interprofessional team and patient-centered care. © Health Research and Educational Trust.
News Article | November 2, 2016
HUNTINGTON BEACH, CA--(Marketwired - November 02, 2016) - Today, DC announces its partnership with Cartoon Network to introduce the DC x Adventure Time footwear collection for winter 2016-2017. The collection captures the adventures of Finn and his magical shape-shifting dog, Jake, in the post-apocalyptic land of Ooo, featuring original artwork on a variety of DC footwear styles for men, women and kids. Join the adventure and get a closer look at the entire collection, here: http://www.dcshoes.com/adventure-time-collection/. The DC x Adventure Time collection captures the land of Ooo with playful, colorful prints on key DC footwear styles, like the Men's Trase, Women's Heathrow and Trase Slip-On. Spot the series' most popular tag lines and characters like Finn, Jake and Princess Bubblegum throughout the entire footwear collection. DC x Adventure Time is now available in four different footwear styles for youth, including DC Kid's Rebound, Trase Slip-On, Heathrow and Pure. For more information on DC x Adventure Time collaboration and to shop the collection, please visit finer retailers around the world or dcshoes.com and for the latest on DC Shoes, follow the brand at @dcshoes and search #DCSHOES. Founded in 1994, DC quickly grew to a leader in performance skateboarding shoes and renowned action sports brand. Today DC Shoes stands as a global brand whose product line has expanded to include men's, women's and kids' skateboarding and lifestyle shoes, apparel, snowboards, snowboard boots, outerwear, and accessories. Adventure Time, Cartoon Network's Emmy and Peabody Award-winning original animated series introduces viewers to unlikely heroes Finn and Jake, buddies who traverse the mystical Land of Ooo and encounter its colorful inhabitants. The best of friends, our heroes always find themselves in the middle of heart-pounding escapades. Finn, a silly kid with an awesome hat and Jake, a brassy dog with a big kind heart, depend on each other through thick and thin. Adventure Time is created by Pendleton Ward and is produced at Cartoon Network Studios.
PubMed | MSc Chiropractic, DC and MSc Health science
Type: | Journal: Chiropractic & manual therapies | Year: 2017
The reliability of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology.Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain (NP) between the ages of 20-70 were recruited from October 2014 to April 2015. The muscles that were evaluated were the longus colli (Lcol), the rectus capitis posterior major (Rcpm), the deep cervical extensors (Dce) and the semispinalis capitis (Sscap). Each of the examiners captured ultrasound images of their allocated muscle and measured the thickness of that muscle twice, on separate occasions, for the first part of the intra-rater reliability study. For the second part, a second image of the same muscle was taken on the same subject and measured by the same examiner. The four examiners then met to measure on each others images, to test inter-rater reliability. Their results were compared pair-wise using Interclass Correlation Coefficients (ICC) and Bland-Altman plots. Linear regression analysis was performed to evaluate for possible bias.Inter-rater reliability was found to be good for Lcol and Sscap muscles and moderate towards poor for the deeper Rcpm and Dce muscles. Intra-rater reliability was good for all the muscles, with the exception of the Dce, which was found to be moderate in the second part of the study. The B&A plots showed good agreement, few outliers, and no bias. However, the agreement intervals indicated a measurement error within the variance of the method that may not have been acceptable for these small muscles if the aim is to evaluate change in thickness.This study found that MSK-DUSI had variable reliability in assessing the thickness of the Lcol, Rcpm, Dce, and Sscap muscles. No bias was demonstrated, but agreement intervals were wide.