Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis.

BACKGROUND: Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. METHODOLOGY: Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). RESULTS: Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. CONCLUSIONS: Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.

A decade of domiciliary non-invasive ventilation in the west of Ireland.

BACKGROUND: While domiciliary non-invasive ventilation (NIV) was initially used in the treatment of respiratory failure resulting from chest wall deformity, the main indication is now chronic obstructive pulmonary disease (COPD) with recurrent exacerbations associated with type 2 respiratory failure. A longitudinal study of domiciliary NIV provides insights into the evolution of this treatment in the west of Ireland. METHODS: The cohort of patients receiving new prescriptions for domiciliary NIV from Galway University Hospital from 2000 to 2012 was reviewed using study coordinator chart reviews and telephone follow-ups. RESULTS: In total, 161 patients were identified. Prescriptions for domiciliary NIV increased from 2 in 2000 to 35 in 2012. The most common indication between 2000 and 2006 was obesity hypoventilation syndrome (OHS), changing to COPD between 2007 and 2012. There were significantly higher mortality rates in COPD and neuromuscular disease at 1- and 3-year follow-up compared to OHS and chest wall disease. Patients with chest wall disease had most survival years (7.33 ± 5.51) following initiation of domiciliary NIV when compared to patients with OHS (5.50 ± 3.70) and COPD (3.03 ± 1.89) and patients with neuromuscular disease (2.50 ± 2.01). CONCLUSIONS: Domiciliary NIV use increased significantly in the West of Ireland from 2000 to 2012. There has been a shift in prescribing toward COPD. Survival rates for COPD on NIV are relatively short in contrast to patients with OHS and chest wall disease. Improved understanding of the benefits of NIV will allow physicians to better determine appropriate and cost-effective use in the future.

Cluster validation for unsupervised stochastic model-based image segmentation.

Image segmentation is an important and early processing stage in many image analysis problems. Often, this must be done in an unsupervised fashion in that training data is not available and the class-conditioned feature vectors must be estimated directly from the data. A major problem in such applications is the determination of the number of classes actually present in an image. This problem, called the cluster validation problem, remains essentially unsolved. We investigate the cluster validation problem associated with the use of a previously developed unsupervised segmentation algorithm based upon the expectation-maximization (EM) algorithm. More specifically, we consider several well-known information-theoretic criteria (ICs) as candidate solutions to the validation problem when used in conjunction with this EM-based segmentation scheme. We show that these criteria generally provide inappropriate solutions due to the domination of the penalty term by the associated log-likelihood function. As an alternative we propose a model-fitting technique in which the complete data log-likelihood functional is modeled as an exponential function in the number of classes acting. The estimated number of classes are then determined in a manner similar to finding the rise time of the exponential function. This new validation technique is shown to be robust and outperform the ICs in our experiments. Experimental results for both synthetic and real world imagery are detailed.

Maximum-likelihood parameter estimation for unsupervised stochastic model-based image segmentation.

An unsupervised stochastic model-based approach to image segmentation is described, and some of its properties investigated. In this approach, the problem of model parameter estimation is formulated as a problem of parameter estimation from incomplete data, and the expectation-maximization (EM) algorithm is used to determine a maximum-likelihood (ML) estimate. Previously, the use of the EM algorithm in this application has encountered difficulties since an analytical expression for the conditional expectations required in the EM procedure is generally unavailable, except for the simplest models. In this paper, two solutions are proposed to solve this problem: a Monte Carlo scheme and a scheme related to Besag's (1986) iterated conditional mode (ICM) method. Both schemes make use of Markov random-field modeling assumptions. Examples are provided to illustrate the implementation of the EM algorithm for several general classes of image models. Experimental results on both synthetic and real images are provided.

Nursing students attitudes toward AIDS: implications for education.

Increasingly, nursing students will be caring for patients with Acquired Immune Deficiency Syndrome (AIDS), as the disease reaches epidemic proportions. This study examined the attitudes of 87 senior baccalaureate nursing students toward caring for these patients. A 37-item researcher developed Likert scale instrument was administered and addressed five themes: (1) direct care of the AIDS patient, (2) students' rights, (3) educational preparation, (4) patients' rights and (5) general beliefs about AIDS. Overall responses were generally positive although 70% of subjects expressed a discomfort in working with patients with AIDS. A large number felt they should have the right to refuse to care for AIDS patients although most indicated they would not refuse such an assignment. Most were very supportive of patients' rights. Feelings of inadequate preparation to deal with these patient situations were indicated. Significantly more positive responses occurred in all areas among students who had actually cared for patients with AIDS. Findings have implications for development of teaching strategies and curricular approaches to address this health care issue. Data also provide a basis for educational and organisational policy formation.

A voice-activated integrated development environment for manually disabled programmers.

PURPOSE: The paper presents the design and implementation of voice-based interface to support two types of application development activities (coding, and visual GUI design) by manually disabled programmers. METHOD: Prototype programs were implemented, and tests were performed for both proposed voice-based interface models. RESULTS: The interface design concepts, and the results and lessons learned of the usability studies are discussed. CONCLUSIONS: The usability studies indicated that the interface models were sound, although the voice recognition aspects left something to be desired.

Knowledge retention and clinical application after continuing education.

The authors investigate the knowledge retention and clinical application of physical assessment skills by nurses who participated in a required continuing education workshop. Tools were developed to measure the specific application of workshop concepts. Results support the underlying objectives of nursing staff development, which are to increase knowledge and improve skills.