253 research outputs found
Home interventions and light therapy for the treatment of vitiligo (HI-Light Vitiligo Trial): Study protocol for a randomised controlled trial
No full textINTRODUCTION: Vitiligo is a condition resulting in white patches on the skin. People with vitiligo can suffer from low self-esteem, psychological disturbance and diminished quality of life. Vitiligo is often poorly managed, partly due to lack of high-quality evidence to inform clinical care. We describe here a large, independent, randomised controlled trial (RCT) assessing the comparative effectiveness of potent topical corticosteroid, home-based hand-held narrowband ultraviolet B-light (NB-UVB) or combination of the two, for the management of vitiligo., METHODS AND ANALYSIS: The HI-Light Vitiligo Trial is a multicentre, three-arm, parallel group, pragmatic, placebo-controlled RCT. 516 adults and children with actively spreading, but limited, vitiligo are randomised (1:1:1) to one of three groups: mometasone furoate 0.1% ointment plus dummy NB-UVB light, vehicle ointment plus NB-UVB light or mometasone furoate 0.1% ointment plus NB-UVB light. Treatment of up to three patches of vitiligo is continued for up to 9 months with clinic visits at baseline, 3, 6 and 9 months and four post-treatment questionnaires. The HI-Light Vitiligo Trial assesses outcomes included in the vitiligo core outcome set and places emphasis on participants' views of treatment success. The primary outcome is proportion of participants achieving treatment success (patient-rated Vitiligo Noticeability Scale) for a target patch of vitiligo at 9 months with further independent blinded assessment using digital images of the target lesion before and after treatment. Secondary outcomes include time to onset of treatment response, treatment success by body region, percentage repigmentation, quality of life, time-burden of treatment, maintenance of response, safety and within-trial cost-effectiveness., ETHICS AND DISSEMINATION: Approvals were granted by East Midlands-Derby Research Ethics Committee (14/EM/1173) and the MHRA (EudraCT 2014-003473-42). The trial was registered 8 January 2015 ISRCTN (17160087). Results will be published in full as open access in the NIHR Journal library and elsewhere., TRIAL REGISTRATION NUMBER: ISRCTN17160087. Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.https://dx.doi.org/10.1136/bmjopen-2017-01864
Prescribing and using vitiligo treatments: Lessons from a nested process evaluation within the HI-Light vitiligo randomised controlled trial
No full textBackground: The HI-Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim: We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision?. Methods: This was a mixed-methods process evaluation, including semi-structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results: Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion: Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients
The Reflection of Islamic Culture and Beliefs in the Stories of Dr. Akram Osman
No full textThe sacred religion of Islam encompasses its own distinct principles, laws, and worldview, as presented through the Holy Quran, a divine guide for humanity. This guidance shapes the beliefs, actions, and morals of Muslims according to an Islamic perspective. Islam is a comprehensive and complete religion that addresses all aspects of individual, familial, social, economic, political, and cultural life. It provides everything necessary for human guidance and prosperity, as conveyed to humanity by Prophet Muhammad (PBUH), the savior of mankind, who is the final prophet, and Islam is the ultimate and final religion. In Islamic societies, the responsibility of promoting and conveying Islamic teachings was not limited to religious scholars alone. Muslim poets and writers also undertake this significant mission, using their literary talents in both poetry and prose to inspire individuals and societies with the values and teachings of this sacred religion. The late Dr. Mohammad Akram Osman, a distinguished author from Afghanistan, made remarkable contributions to storytelling that not only enriched the world of literature but also served as a guide for humanity in learning and understanding Islamic culture and beliefs. This article aims to explore the reflection of Islamic culture and beliefs in the stories of Dr. Mohammad Akram Osman, highlighting his ability to intertwine Islamic teachings with literary expression
Neutralisation state driven single-agent search strategy for solving constraint satisfaction problem / Saajid Akram Ahmed Abuluaih
No full textIn the past seven decades, Constraint Satisfaction (CS) has been extensively studied and remarkably evolved to where the scientific community perceives it as the centre of the intelligent behaviour. Therefore, most of the recent research in the field is devoted to improving the problem solvers that utilize search strategies and techniques. Since Constraint Satisfaction Problem (CSP) is an NP-complete problem, brute-force search algorithms such as Backtracking algorithm (BT) are required as the guarantee to find a solution, when there is one. Moreover, since the establishment of the field, AI pioneers and specialists have setup instructions and guidelines on how to solve this type of problems back in the seventies of the last century and have not been changed or improved. For example, the framework of solving CSP imposes a complete permutation of assignments to all remaining variables in order to derive a valid model. The author argues in this study that the problem can be neutralised and it is not necessary to perform brute-force searching all the time if a search strategy could have guided the process to the level where the values of the remaining variables can be determined implicitly, creating what the author calls Solo-Path of assignments in the problem search tree
Clinical characteristics of critically ill patients infected with COVID-19 in rasoul akram hospital in Iran: A single center study
No full textBackground: Knowledge about clinical features of critically ill patients with COVID-19 still lacks adequate information up to now. Objectives: We aimed to describe and compare the epidemiological and clinical characteristics of critically ill patients with COVID-19 in Rasoul Akram Hospital. Methods: In this case series, 70 critically ill patients with COVID-19 admitted in ICU wards of Rasoul Akram Hospital, Tehran, Iran, from 29 February to 25 April 2020 were enrolled. Demographic and clinical characteristics, laboratory data, and outcomes of the patients were all collected and compared between deceased and recovered patients. Results: Fifty-six cases had died of COVID-19, and 14 patients had fully recovered and discharged. The median age of the patients was 68 years old, ranging from 22 to 91 years, 66 were men, 80 had one or more comorbidities, and hypertension was the most common comorbidities (45 of deceased cases). The most common signs and symptoms at the onset of illness were SPO2 depression (92) and dyspnea (90). Dyspnea was significantly more common in deceased patients (95) than recovered patients (70) (P = 0.048). Most patients had lymphopenia (80). The number of patients who needed mechanical ventilation in the deceased patients was 53 (95), which was significantly more than the recovered patients (10 70%) (P = 0.048). Conclusions: The mortality rate of critically ill patients with COVID-19 is very high, and the patients with dyspnea and required mechanical ventilation are at higher risk for death. © 2020, Author(s)
Akram Khan, Lloyd Newson, and the Challenges of British Multiculturalism
No full textIn a climate riven by national insecurities, anti-immigration movements and competing visions of a post-Brexit future, this paper examines the contentious space multiculturalism has inhabited in 21st-century British choreography. It analyses acclaimed works by Akram Khan and Lloyd Newson to explore starkly differing perspectives on cultural diversity in the UK. Khan’s contribution to the London 2012 Olympics Opening Ceremony (Abide with Me) emphasised the nation’s post-imperialist and cosmopolitan profile. By contrast, Newson’s contemporaneous work Can We Talk about this? (2011/12) was highly critical of current models of multiculturalism and in particular attitudes towards Islam. This paper compares the two choreographies using a theoretical framework that draws on both political thought and dance analysis, to evaluate their contributions to debates around culture, tolerance and diasporic identities and illustrate the broader entanglement between British dance and contemporary politics.@ 2018, Edinburgh University Press. The attached document is an author produced version of a paper accepted for publication in Dance Research, uploaded in accordance with the publisher’s self-archiving policy. Some minor differences between this version and the final published version may remain. Once published, we suggest you refer to the final published version (Version of Record) should you wish to cite from it
Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial
No full textBACKGROUND: The HI-Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings., AIM: We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision?, METHODS: This was a mixed-methods process evaluation, including semi-structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers., RESULTS: Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A 'mixed economy' model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical., CONCLUSION: Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients. Copyright © 2022 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.https://dx.doi.org/10.1111/ced.1519
Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT
No full textBACKGROUND: Systematic reviews suggest that narrowband ultraviolet B light combined with treatments such as topical corticosteroids may be more effective than monotherapy for vitiligo., OBJECTIVE: To explore the clinical effectiveness and cost-effectiveness of topical corticosteroid monotherapy compared with (1) hand-held narrowband ultraviolet B light monotherapy and (2) hand-held narrowband ultraviolet B light/topical corticosteroid combination treatment for localised vitiligo., DESIGN: Pragmatic, three-arm, randomised controlled trial with 9 months of treatment and a 12-month follow-up., SETTING: Sixteen UK hospitals - participants were recruited from primary and secondary care and the community., PARTICIPANTS: Adults and children (aged >= 5 years) with active non-segmental vitiligo affecting 75% of the expected treatment protocol were more likely to achieve treatment success. Over 40% of participants had lost treatment response after 1 year with no treatment. Grade 3 or 4 erythema was experienced by 62 participants (12%) (three of whom were using the dummy) and transient skin thinning by 13 participants (2.5%) (two of whom were using the placebo). We observed no serious adverse treatment effects. For combination treatment compared with topical corticosteroids, the unadjusted incremental cost-effectiveness ratio was 2328.56 (adjusted 1932) per additional successful treatment (from an NHS perspective)., LIMITATIONS: Relatively high loss to follow-up limits the interpretation of the trial findings, especially during the post-intervention follow-up phase., CONCLUSION: Hand-held narrowband ultraviolet B light plus topical corticosteroid combination treatment is superior to topical corticosteroids alone for treatment of localised vitiligo. Combination treatment was relatively safe and well tolerated, but was effective in around one-quarter of participants only. Whether or not combination treatment is cost-effective depends on how much decision-makers are willing to pay for the benefits observed., FUTURE WORK: Development and testing of new vitiligo treatments with a greater treatment response and longer-lasting effects are needed., TRIAL REGISTRATION: Current Controlled Trials ISRCTN17160087., FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 64. See the NIHR Journals Library website for further project information.https://dx.doi.org/10.3310/hta2464
A comparison of global surgery tariffs and the actual cost of bills at Hazrate Rasoole Akram educational and medical center
No full textBackground: The health service tariff is an appropriate policymaking tool and the financial leverage of the health system control which affects quality, availability, cost, efficiency, equity and accountability of health services. Global surgeries include 91 common cases of general and specialized surgeries in hospitals; fixed tariffs are annually defined for these surgeries, and insurance companies must pay medical centers based on these tariffs. The aim of this study was to examine and compare hospital bills with global surgery tariffs at Hazrate Rasoole Akram Educational and Medical Center in 2017. Methods: This descriptive-Analytic study was conducted retrospectively and compared the global and actual costs of global surgeries performed in the third quarter of the year 2017 at Hazrate Rasoole Akram Educational and Medical Center. Required data on the actual costs of surgeries was collected through the Hospital Information System (HIS) and patients' records. Information on the global costs was obtained from the Annual Circulars of Insurance Council for the studied period about the cost of global surgeries. Linear regression (STATA13 software) was used to investigate the effect of items on tariff and invoice differences; concerning other calculations, EXCEL software was used. Results: The highest frequency of global surgeries was related to ophthalmic surgery which accounted for approximately half of total surgeries performed at Hazrate Rasoole Akram Hospital. The most significant difference between global tariff and invoice was also related to ophthalmic surgery (188709.3 Dollar a year).Overall, the actual hospital bills were much higher than the tariffs approved for global surgeries, and the total difference was 461805.5 Dollar. The results revealed that there was a significant relationship between some of the items such as the cost of operating rooms, anesthesia and other services. Conclusions: Referral hospitals which are at the level three of referral networks usually treat more complex patients; this should be taken into account when defining surgery tariffs of these centers. On the other hand, hospitals need to control the costs and reduce the end cost of these surgeries by improving clinical management and cost management. In addition, prospective and case-based payment methods can control health costs. © 2020 The Author(s)
Transformation function tests
No full textEconometric models usually relate a known function of a dependent variable, Y , with some observable covariates X. A misspeci ed transformation function, however, can cause inconsistency. The estimated parameters will be biased and inconsistent. The marginal e ects and the elasticities calculated using these estimated parameters can be far from the truth and any inference based on them will be misleading. The problem of misspeci cation can be resolved simply by estimating the transformation function. There are di erent methods of estimating the model based on the parametric assumptions on the transformation function, or the distribution of the error term, or both. In a completely parametric setup, both the transformation function and the distribution of the error term are known up to a vector of parameters. The Box-Cox transformation is a good example of using parametric transformation functions. It is also possible, however, to estimate the transformation function without parametric assumptions. In this dissertation two Hausman tests for transformation functions are proposed where validity does not depend on distributional assumptions. These tests compare estimators that remain consistent regardless of the transformation function to an estimator whose consistency depends on the transformation function. The properties of these test statistics are studied in nite sample and under di erent designs. The behavior of these test statistics is studied both when the adopted transformation function is correct and when the true transformation function deviates from the hypothesized one. This dissertation applies the semiparametric transformation function test to study reported crimes in the U.S. metropolitan areas. Most studies in this literature adopt a logarithmic transformation of reported crimes. There is no theoretical justi cation for this speci c function. In addition, it is likely that city level crime is misreported (underreported). Therefore, testing is particularly relevant. I show that, although for particular types of crimes the log function is appropriate, the same log function cannot be used for broadly de ned categories of crimes.Ph. D.Includes bibliographical referencesIncludes vitaby Kaveh Akra
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