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Acknowledgements This project was sponsored by the United States Department of Justice through a COPS grant awarded to the Colorado Springs Police Department. We'd like to thank Sgt. Terry Curry of the Colorado Springs Police Department for coordinating this exercise and allowing us to participate in this study. In addition, the Colorado Springs Police Department provided site security and logistical support. The Colorado Springs Fire Department provided the house to perform the cook in and also graciously provided emergency response, decontamination, and logistical support. We'd like to thank David Love and associates from the United States Drug Enforcement Agency in San Diego for providing technical expertise for this study and vioxx.
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Standardization of Criteria for AIS Brace Studies - SRS Committee on Bracing and Non-operative Management Robert Bernstein, MD, Charles d'Amato, MD, Ronney Ferguson, MD, George Thompson, MD, B. Stephens Richards, MD Texas Scottish Rite Hospital, Dallas, TX ; PURPOSE: To establish consistent parameters for future AIS bracing studies so that valid and reliable comparisons can be made. As prior literature lacks consistency for both inclusion criteria and brace effectiveness, clinicians are currently unable to draw valid conclusions from existing data. METHODS: A thorough review of published natural history studies was performed to determine the AIS patient population most at-risk for curve progression and the subsequent possible need for surgery ; . Then, 31 bracing articles including the current BrAIST proposal were analyzed to determine 1 ; inclusion criteria that will best identify those patients most at-risk for progression 2 ; the most appropriate definitions for bracing effectiveness, and 3 ; identification of additional variables which would provide valuable information. RESULT RESULTS: Early studies either lacked inclusion criteria or were quite varied in age at brace prescription 418.9 years ; , skeletal maturity Risser 0-4 ; , and curve magnitude 120-680 ; . In more recent studies, inclusion criteria narrowed considerably; specifically, Risser 0-2, age e" 10 years at brace prescription, and primary curves between 250-450 250-390 in the current BrAIST proposal ; . Curves 200-250 were included in some studies if progression had been documented. Brace effectiveness was usually defined as the prevention of curve progression d"50 at maturity. However, maturity was variably defined as the end of growth, Risser 4, or two years post-menarchal. Most commonly, bracing was described as ineffective when curve progression was e"60 or if surgical intervention was recommended. Less frequently, bracing was described as ineffective when progression was e"100, if the curve progressed to 450, or if there was change to another brace. In those studies with follow-up e"2 years beyond maturity, additional curve progression ultimately leading to surgical intervention ; was not unusual. Potentially useful additional variables included: curve patterns, curve grouping 250-350, 300-400, 350-450 ; , brace type, in-brace correction, and amount of daily time in brace. CONCLUSIONS: I. Inconsistent selection criteria in many older bracing studies prevent clinicians from drawing valid conclusions about the effectiveness of bracing in AIS. II. Optimal inclusion criteria for future AIS brace studies consist of age e"10 years old when brace is prescribed, Risser 0-2, primary curve angles between 250 and 390, and no prior treatment. III. Assessment of brace effectiveness should include: 1 ; the percentage of patients who have d"50 curve progression and the percentage who have e"60 progression at maturity 2 ; the percentage of patients who have had surgery recommended undertaken at maturity surgical indications must be documented ; , and 3 ; two-year follow-up beyond maturity to determine the percentage of patients who subsequently undergo surgery again, surgical indications must be documented ; . IV. All patients, regardless of subjective reports on compliance, should be included in results intent to treat ; . Whenever possible, compliance should be measured objectively. V. All studies should provide results stratified by curve type and size grouping.
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Nonlinear-dynamical control techniques, also known as chaos control, have been used with great success to control a wide range of physical systems. Such techniques have been used to control the behavior of in vitro excitable biological tissue, suggesting their potential for clinical utility. However, the feasibility of using such techniques to control physiological processes has not been demonstrated in humans. Here we show that nonlinear-dynamical control can modulate human cardiac electrophysiological dynamics by rapidly stabilizing an unstable target rhythm. Specifically, in 52 54 control attempts in five patients, we successfully terminated pacing-induced period-2 atrioventricular-nodal conduction alternans by stabilizing the underlying unstable steady-state conduction. This proof-of-concept demonstration shows that nonlinear-dynamical control techniques are clinically feasible and provides a foundation for developing such techniques for more complex forms of clinical arrhythmia.
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Canada Foundation for Innovation Name: Willan, Andrew RESERCH CONTRIBUTION IN THE LAST FIVE YEARS SAMPLE PUBLICATIONS 2002-2007 ; 1. Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Economics 2002; 11: 415-430. O'Brien BJ, Gertsen K, Willan AR, Faulkner L, Is there a kink in consumers' threshold value for cost-effectiveness in health care. Health Economics 2002; 11: 175180. Willan AR, Lin DY, Cook RJ, Chen E. Using inverse-weighing in cost-effectiveness analysis with censored data. Statistical Methods in Medical Research 2002; 11: 539551. Willan AR, Chen E, Cook RJ, Lin DY. Incremental net benefit in randomized clinical trials with qualify-adjusted survival. Statistics in Medicine 2003; 22: 353-362. Sears MR, Greene JM, Willan AR, Wiecek, EM, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Silva PA, Poulton R. Persistence, remission and relapse of childhood asthma followed to adulthood: a longitudinal population-based cohort study. NEJM 2003; 349 15 ; : 1414-1422. 6. Willan AR. Incremental net benefit in the analysis of economic data from clinical trials with application to the CADET-Hp Trial. European Journal of Gastroenterology and Hepatology 2004; 16: 543-549. Willan AR, Briggs AH, Hoch JS. Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Economics 2004; 13: 461-475. Briggs AH, Buxton M, Drummond M, Goeree R, Sculpher MJ, Willan AR. Unfinished Symphony: A Tribute to the Life and Career of Bernie O'Brien 19592004 ; . Medical Decision Making 2004; 24: 538-544. Willan AR, Lin DY, Manca A. Regression methods for cost-effectiveness analysis with censored data. Statistics in Medicine 2005; 24: 131-145. Willan AR, Pinto EM, O'Brien BJ, Kaul P, Goeree R, Lynd L, Armstrong PW. Country specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation: the Canadian ASSENT-3 economic analysis. Health Economics 2005; 14: 327-328. Willan AR, Pinto EM. The expected value of information and optimal clinical trial design. Statistics in Medicine 2005; 24: 1791-1806. Pinto EM, Willan AR, O'Brien BJ. Cost-effectiveness analysis for multinational clinical trials. Statistics in Medicine 2005; 24: 1965-1982. O'Hagan A, McCabe C, Akehurst R, Brennan A, BriggsA, Claxton K, Fenwick E, Fryback D, Sculpher M, Spiegelhalter M and Willan AR. Incorporation of uncertainty in health economic modelling studies. Pharmacoeconomics 2005; 23 6 ; : 529-36.
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