Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

BACKGROUND: Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases. OBJECTIVES: This review addresses the effect of antiviral therapy on Bell's palsy. SEARCH STRATEGY: We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008). SELECTION CRITERIA: Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. DATA COLLECTION AND ANALYSIS: Twenty-three papers were selected for consideration. MAIN RESULTS: Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66). AUTHORS' CONCLUSIONS: High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.</p

The challenges of implementing packaged hospital electronic prescribing and medicine administration systems in UK hospitals: premature purchase of immature solutions?

The UK National Health Service is making major efforts to implement Hospital Electronic Prescribing and Medicine Administration (HEPMA) to improve patient safety and quality of care. Substantial public investments have attracted a wide range of UK and overseas suppliers offering Commercial-Off –The-Shelf (COTS) solutions. A lack of (UK) implementation experience and weak supplier-user relationships are reflected in systems with limited configurability, poorly matched to the needs and practices of English hospitals. This situation echoes the history of comparable corporate information infrastructures - Enterprise Resource Planning systems - in the 1980s/1990s. UK government intervention prompted a similar swarming of immature, often unfinished, products into the market. This resulted, in both cases, in protracted and difficult implementation processes as vendors and adopters struggled to get the systems to work and match the circumstances of the adopting organisations. An analysis of the influence of the Installed Base on Information Infrastructures should explore how the evolution of COTS solutions is conditioned by the structure of adopter and vendor ‘communities’

Specific Cognitive Deficits in ADHD: A Diagnostic Concern in Differential Diagnosis

We present a critical account of existing tools used to diagnose children with Attention Deficit Hyperactivity Disorder and to make a case for the assessment of cognitive impairments as a part of diagnostic system. Surveys have shown that clinicians rely almost entirely upon subjective reports or their own clinical judgment when arriving at diagnostic decisions relating to this prevalent disorder. While information from parents and teachers should always be carefully considered, they are often influenced by a host of emotional and perceptual factors. It increases the possibility for misdiagnosis of a condition like ADHD. Recent experimental literature on ADHD has identified unique underlying cognitive dysfunction, specific to ADHD. Therefore, we propose that there is a need to incorporate information on cognitive mechanisms underlying ADHD and inculcate such information in the diagnostic system, which will provide a more sensitive as well as specific tool in differential diagnosis of ADHD

Core or Cusps: The Central Dark Matter Profile of a Strong Lensing Cluster with a Bright Central Image at Redshift 1

We report on SPT-CLJ2011-5228, a giant system of arcs created by a cluster at z = 1.06. The arc system is notable for the presence of a bright central image. The source is a Lyman break galaxy at z s = 2.39 and the mass enclosed within the Einstein ring of radius 14 arcsec is $\sim {10}^{14.2}\ {M}_{\odot }$. We perform a full reconstruction of the light profile of the lensed images to precisely infer the parameters of the mass distribution. The brightness of the central image demands that the central total density profile of the lens be shallow. By fitting the dark matter as a generalized Navarro–Frenk–White profile—with a free parameter for the inner density slope—we find that the break radius is ${270}_{-76}^{+48}$ kpc, and that the inner density falls with radius to the power −0.38 ± 0.04 at 68% confidence. Such a shallow profile is in strong tension with our understanding of relaxed cold dark matter halos; dark matter-only simulations predict that the inner density should fall as ${r}^{-1}$. The tension can be alleviated if this cluster is in fact a merger; a two-halo model can also reconstruct the data, with both clumps (density varying as ${r}^{-0.8}$ and ${r}^{-1.0}$) much more consistent with predictions from dark matter-only simulations. At the resolution of our Dark Energy Survey imaging, we are unable to choose between these two models, but we make predictions for forthcoming Hubble Space Telescope imaging that will decisively distinguish between them

Metabotropic glutamate receptor 5 as a potential target for smoking cessation

Rationale Most habitual smokers find it difficult to quit smoking because they are dependent upon the nicotine present in tobacco smoke. Tobacco dependence is commonly treated pharmacologically using nicotine replacement therapy or drugs, such as varenicline, that target the nicotinic receptor. Relapse rates, however, remain high and there remains a need to develop novel non-nicotinic pharmacotherapies for the dependence that are more effective than existing treatments. Objective The purpose of this paper is to review the evidence from preclinical and clinical studies that drugs that antagonise the metabotropic glutamate receptor 5 (mGluR5) in the brain are likely to be efficacious as treatments for tobacco dependence. Results Imaging studies reveal that chronic exposure to tobacco smoke reduces the density of mGluR5s in human brain. Preclinical results demonstrate that negative allosteric modulators (NAMs) at mGluR5 attenuate both nicotine self-administration and the reinstatement of responding evoked by exposure to conditioned cues paired with nicotine delivery. They also attenuate the effects of nicotine on brain dopamine pathways implicated in addiction. Conclusions Although mGluR5 NAMs attenuate most of the key facets of nicotine dependence they potentiate the symptoms of nicotine withdrawal. This may limit their value as smoking cessation aids. The NAMs that have been employed most widely in preclinical studies of nicotine dependence have too many \u201coff target\u201d effects to be used clinically. However newer mGluR5 NAMs have been developed for clinical use in other indications. Future studies will determine if these agents can also be used effectively and safely to treat tobacco dependence

Core or Cusps: The Central Dark Matter Profile of a Strong Lensing Cluster with a Bright Central Image at Redshift 1

We report on SPT-CLJ2011-5228, a giant system of arcs created by a cluster at z = 1.06. The arc system is notable for the presence of a bright central image. The source is a Lyman break galaxy at z s = 2.39 and the mass enclosed within the Einstein ring of radius 14 arcsec is $\sim {10}^{14.2}\ {M}_{\odot }$. We perform a full reconstruction of the light profile of the lensed images to precisely infer the parameters of the mass distribution. The brightness of the central image demands that the central total density profile of the lens be shallow. By fitting the dark matter as a generalized Navarro–Frenk–White profile—with a free parameter for the inner density slope—we find that the break radius is ${270}_{-76}^{+48}$ kpc, and that the inner density falls with radius to the power −0.38 ± 0.04 at 68% confidence. Such a shallow profile is in strong tension with our understanding of relaxed cold dark matter halos; dark matter-only simulations predict that the inner density should fall as ${r}^{-1}$. The tension can be alleviated if this cluster is in fact a merger; a two-halo model can also reconstruct the data, with both clumps (density varying as ${r}^{-0.8}$ and ${r}^{-1.0}$) much more consistent with predictions from dark matter-only simulations. At the resolution of our Dark Energy Survey imaging, we are unable to choose between these two models, but we make predictions for forthcoming Hubble Space Telescope imaging that will decisively distinguish between them

Combinatorial depletion analysis to assemble the network architecture of the SAGA and ADA chromatin remodeling complexes

A combinatorial depletion strategy is combined with biochemistry, quantitative proteomics and computational approaches to elucidate the structure of the SAGA/ADA complexes. The analysis reveals five connected functional modules capable of independent assembly

Staging of laser-plasma accelerators

We present results of an experiment where two laser-plasma-accelerator stages are coupled at a short distance by a plasma mirror. Stable electron beams from the first stage were used to longitudinally probe the dark-current-free, quasi-linear wakefield excited by the laser of the second stage. Changing the arrival time of the electron beam with respect to the second stage laser pulse allowed reconstruction of the temporal wakefield structure, determination of the plasma density, and inference of the length of the electron beam. The first stage electron beam could be focused by an active plasma lens to a spot size smaller than the transverse wake size at the entrance of the second stage. This permitted electron beam trapping, verified by a 100 MeV energy gain

‘What Do I Get?’ Punk Objects as Meaningful and Valuable Souvenirs

Despite social scientists’ increasing interest on souvenirs in tourism, little has been written on the role and meanings of souvenirs within specific subcultures, such as punk subcultures. This chapter focuses on the exploration of punk objects as potential souvenirs in relation to “punk tourism” by investigating the meanings attached to subcultural artefacts as opposed to mass produced products. As part of an ethnographic fieldwork on punk tourism that the two authors have been conducting in Malaysia since 2016, in this chapter we focus on the role and meanings of punk souvenirs within the Malaysian punk scene. As the empirical material presented in this chapter shows, a DIY produced punk product has the advantage of channelling more than one value. While the value of souvenirs lies in their propensity to act as “mnemonic devices” related to a place visited, subcultural products like those produced by punks have the potential to fulfil additional values. In an age where authenticity and claims of appropriation of culture are placed under scrutiny, a punk object holds the potential of being a meaningful and valuable souvenir

Comparison of deferral rates using a computerized versus written blood donor questionnaire: a randomized, cross-over study [ISRCTN84429599]

BACKGROUND: Self-administered computer-assisted blood donor screening strategies may elicit more accurate responses and improve the screening process. METHODS: Randomized crossover trial comparing responses to questions on a computerized hand-held tool (HealthQuiz, or HQ), to responses on the standard written instrument (Donor Health Assessment Questionnaire, or DHAQ). Randomly selected donors at 133 blood donation clinics in the area of Hamilton, Canada participated from 1995 to 1996. Donors were randomized to complete either the HQ or the DHAQ first, followed by the other instrument. In addition to responses of 'yes' and 'no' on both questionnaires, the HQ provided a response option of 'not sure'. The primary outcome was the number of additional donors deferred by the HQ. RESULTS: A total of 1239 donors participated. Seventy-one potential donors were deferred as a result of responses to the questionnaires; 56.3% (40/71) were deferred by the DHAQ, and an additional 43.7% (31/71) were deferred due to risks identified by the HQ but not by the DHAQ. Fourteen donors self-deferred; 11 indicated on the HQ that they should not donate blood on that day but did not use the confidential self-exclusion option on the DHAQ, and three used the self-exclusion option on the DHAQ but did not indicate that they should not donate blood on the HQ. The HQ identified a blood contact or risk factor for HIV/AIDS or sexually transmitted infection that was not identified by the DHAQ in 0.1% to 2.7% of donors. CONCLUSION: A self-administered computerized questionnaire may increase risk reporting by blood donors