D. Blöch

Abstract The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non‐RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non‐RA rheumatic disease control subjects.

Abstract For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

To standardize outcome measures in systemic lupus erythematosus (SLE). Three indices were identified which could adequately describe outcome (disease activity, damage from disease, and health status); we describe here the development of the Disease Activity Index.Twenty-four variables were identified as important factors in a disease activity index. These were used to generate 574 patient profiles, which were rated on a disease activity scale of 0-10 by 14 rheumatologists. A second rating of 10 of the profiles yielded scores that were not significantly different from the first, indicating that experienced clinicians can reliably make global estimates of disease activity. Multiple regression models were used to estimate the relative importance of the 24 clinical variables in the physicians' global rating of disease activity. These were estimated on a "training set" of 75% of physicians' ratings, and then validated on a "testing set," consisting of the remaining 25% of physicians' ratings.The explanatory power of the models in the training set was high (R2 = 0.93). The models' regression coefficients for the organ systems were simplified for easier use in clinical practice. This generated a "weighted" index of 9 organ systems for disease activity in SLE, the SLEDAI, as follows: 8 for central nervous system and vascular, 4 for renal and musculoskeletal, 2 for serosal, dermal, immunologic, and 1 for constitutional and hematologic. The maximum theoretical score is 105, but in practice, few patients have scores greater than 45. The SLEDAI predicted well the physicians' ratings in the testing set (Pearson's correlation coefficients = 0.64-0.79).The SLEDAI is a validated model of experienced clinicians' global assessments of disease activity in lupus. It represents the consensus of a group of experts in the field of lupus research.

Criteria for the classification of giant cell (temporal) arteritis were developed by comparing 214 patients who had this disease with 593 patients with other forms of vasculitis. For the traditional format classification, 5 criteria were selected: age greater than or equal to 50 years at disease onset, new onset of localized headache, temporal artery tenderness or decreased temporal artery pulse, elevated erythrocyte sedimentation rate (Westergren) greater than or equal to 50 mm/hour, and biopsy sample including an artery, showing necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 93.5% and a specificity of 91.2%. A classification tree was also constructed using 6 criteria. These criteria were the same as for the traditional format, except that elevated erythrocyte sedimentation rate was excluded, and 2 other variables were included: scalp tenderness and claudication of the jaw or tongue or on deglutition. The classification tree was associated with a sensitivity of 95.3% and specificity of 90.7%.

Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.

Abstract Criteria for the classification of Churg‐Strauss syndrome (CSS) were developed by comparing 20 patients who had this diagnosis with 787 control patients with other forms of vasculitis. For the traditional format classification , 6 criteria were selected: asthma, eosinophilia >10% on differential white blood cell count, mononeuropathy (including multiplex) or polyneuropathy, non‐fixed pulmonary infiltrates on roentgenography, paranasal sinus abnormality, and biopsy containing a blood vessel with extravascular eosinophils. The presence of 4 or more of these 6 criteria yielded a sensitivity of 85% and a specificity of 99.7%. A classification tree was also constructed with 3 selected criteria: asthma, eosinophilia >10% on differential white blood cell count, and history of documented allergy other than asthma or drug sensitivity. If a subject has eosinophilia and a documented history of either asthma or allergy, then that subject is classified as having CSS. For the tree classification, the sensitivity was 95% and the specificity was 99.2%. Advantages of the traditional format compared with the classification tree format, when applied to patients with systemic vasculitis, and their comparison with earlier work on CSS are discussed.

Criteria for the classification of Takayasu arteritis were developed by comparing 63 patients who had this disease with 744 control patients with other forms of vasculitis. Six criteria were selected for the traditional format classification: onset at age less than or equal to 40 years, claudication of an extremity, decreased brachial artery pulse, greater than 10 mm Hg difference in systolic blood pressure between arms, a bruit over the subclavian arteries or the aorta, and arteriographic evidence of narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities. The presence of 3 or more of these 6 criteria demonstrated a sensitivity of 90.5% and a specificity of 97.8%. A classification tree also was constructed with 5 of these 6 criteria, omitting claudication of an extremity. The classification tree demonstrated a sensitivity of 92.1% and a specificity of 97.0%.

Abstract Criteria for the classification of Wegener's granulomatosis (WG) were developed by comparing 85 patients who had this disease with 722 control patients with other forms of vasculitis. For the traditional format classification , 4 criteria were selected: abnormal urinary sediment (red cell casts or >5 red blood cells per high power field), abnormal findings on chest radiograph (nodules, cavities, or fixed infiltrates), oral ulcers or nasal discharge, and granulomatous inflammation on biopsy. The presence of 2 or more of these 4 criteria was associated with a sensitivity of 88.2% and a specificity of 92.0%. A classification tree was also constructed with 5 criteria being selected. These criteria were the same as for the traditional format, but included hemoptysis. The classification tree was associated with a sensitivity of 87.1% and a specificity of 93.6%. We describe criteria which distinguish patients with WG from patients with other forms of vasculitis with a high level of sensitivity and specificity. This distinction is important because WG requires cyclophosphamide therapy, whereas many other forms of vasculitis can be treated with corticosteroids alone.

To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA).RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died.The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.

Criteria for the classification of polyarteritis nodosa were developed by comparing 118 patients who had this disease with 689 control patients who had other forms of vasculitis. For the traditional format classification, 10 criteria were selected: weight loss greater than or equal to 4 kg, livedo reticularis, testicular pain or tenderness, myalgias, mononeuropathy or polyneuropathy, diastolic blood pressure greater than 90 mm Hg, elevated blood urea nitrogen or serum creatinine levels, presence of hepatitis B reactants in serum, arteriographic abnormality, and presence of granulocyte or mixed leukocyte infiltrate in an arterial wall on biopsy. The presence of 3 or more of these 10 criteria was associated with a sensitivity of 82.2% and specificity of 86.6%. A classification tree was also constructed, with 6 criteria being selected. Three of these, angiographic abnormality, biopsy-proven granulocyte or mixed leukocyte infiltrate in arterial wall, and neuropathy, were criteria used in the traditional format. The other 3 criteria used in the tree format included the patient's sex, weight loss greater than 6.5 kg, and elevated serum aspartate aminotransferase or alanine aminotransferase levels above the range of normal. The classification tree yielded a sensitivity of 87.3% and a specificity of 89.3%.

A sample size calculation for logistic regression involves complicated formulae. This paper suggests use of sample size formulae for comparing means or for comparing proportions in order to calculate the required sample size for a simple logistic regression model. One can then adjust the required sample size for a multiple logistic regression model by a variance inflation factor. This method requires no assumption of low response probability in the logistic model as in a previous publication. One can similarly calculate the sample size for linear regression models. This paper also compares the accuracy of some existing sample-size software for logistic regression with computer power simulations. An example illustrates the methods.

Abstract Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multi‐center study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylar‐thropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the “classification tree” method were 92% sensitive and 98% specific. The “traditional format” classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.

Abstract Criteria for identifying Henoch‐Schönlein Purpura (HSP) and distinguishing HSP from other forms of systemic arteritis were developed by comparing the manifestations in 85 patients who had HSP with those of 722 control patients with other forms of vasculitis. By the traditional format of choosing different combinations of candidate criteria and comparing the combinations for their ability to separate HSP cases from controls, 4 criteria were identified: age ≤20 years at disease onset, palpable purpura, acute abdominal pain, and biopsy showing granulocytes in the walls of small arterioles or venules. The presence of any 2 or more of these criteria distinguish HSP from other forms of vasculitis with a sensitivity of 87.1% and a specificity of 87.7%. The criteria selected by a classification tree method were similar: palpable purpura, age ≤20 years at disease onset, biopsy showing granulocytes around arterioles or venules, and gastrointestinal bleeding. These were able to distinguish HSP from other forms of vasculitis with a sensitivity of 89.4% and a specificity of 88.1%.

Arthritis & RheumatismVolume 33, Issue 8 p. 1065-1067 ArticleFree to Read The American College of Rheumatology 1990 criteria for the classification of vasculitis: Introduction Gene G. Hunder MD, Corresponding Author Gene G. Hunder MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorWilliam P. Arend MD, Corresponding Author William P. Arend MD University of Colorado Health Science Center, Denver, COAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDaniel A. Bloch PhD, Corresponding Author Daniel A. Bloch PhD Chair, Subcommittee on Classification of Vasculitis, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorLeonard H. Calabrese DO, Corresponding Author Leonard H. Calabrese DO Cleveland Clinic Foundation, Cleveland, OHAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAnthony S. Fauci MD, Corresponding Author Anthony S. Fauci MD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJames F. Fries MD, Corresponding Author James F. Fries MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRandi Y. Leavitt MD, Phd, Corresponding Author Randi Y. Leavitt MD, Phd NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJ. T. Lie MD, Corresponding Author J. T. Lie MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRobert W. Lightfoot Jr Md, Corresponding Author Robert W. Lightfoot Jr Md University of Kentucky, Lexington, KYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAlfonse T. Masi MD, DRPH, Corresponding Author Alfonse T. Masi MD, DRPH University of Illinois College of Medicine, Peoria, ILAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDennis J. McShane MD, Corresponding Author Dennis J. McShane MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorBeat A. Michel MD, Corresponding Author Beat A. Michel MD Rheumaklinik Universitätsspital, Zurich, SwitzerlandAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJohn A. Mills MD, Corresponding Author John A. Mills MD Massachusetts General Hospital, Boston, MAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorMary Betty Stevens MD, Corresponding Author Mary Betty Stevens MD Johns Hopkins University, Baltimore, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorStanley L. Wallace MD, Corresponding Author Stanley L. Wallace MD SUNY Downstate Medical Center, Brooklyn, NYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorNathan J. Zvaifler MD, Corresponding Author Nathan J. Zvaifler MD University of California, San Diego, San Diego, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this author Gene G. Hunder MD, Corresponding Author Gene G. Hunder MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorWilliam P. Arend MD, Corresponding Author William P. Arend MD University of Colorado Health Science Center, Denver, COAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDaniel A. Bloch PhD, Corresponding Author Daniel A. Bloch PhD Chair, Subcommittee on Classification of Vasculitis, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorLeonard H. Calabrese DO, Corresponding Author Leonard H. Calabrese DO Cleveland Clinic Foundation, Cleveland, OHAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAnthony S. Fauci MD, Corresponding Author Anthony S. Fauci MD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJames F. Fries MD, Corresponding Author James F. Fries MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRandi Y. Leavitt MD, Phd, Corresponding Author Randi Y. Leavitt MD, Phd NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJ. T. Lie MD, Corresponding Author J. T. Lie MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRobert W. Lightfoot Jr Md, Corresponding Author Robert W. Lightfoot Jr Md University of Kentucky, Lexington, KYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAlfonse T. Masi MD, DRPH, Corresponding Author Alfonse T. Masi MD, DRPH University of Illinois College of Medicine, Peoria, ILAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDennis J. McShane MD, Corresponding Author Dennis J. McShane MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorBeat A. Michel MD, Corresponding Author Beat A. Michel MD Rheumaklinik Universitätsspital, Zurich, SwitzerlandAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJohn A. Mills MD, Corresponding Author John A. Mills MD Massachusetts General Hospital, Boston, MAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorMary Betty Stevens MD, Corresponding Author Mary Betty Stevens MD Johns Hopkins University, Baltimore, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorStanley L. Wallace MD, Corresponding Author Stanley L. Wallace MD SUNY Downstate Medical Center, Brooklyn, NYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorNathan J. Zvaifler MD, Corresponding Author Nathan J. Zvaifler MD University of California, San Diego, San Diego, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this author First published: August 1990 https://doi.org/10.1002/art.1780330802Citations: 452AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue8August 1990Pages 1065-1067 RelatedInformation

The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system.The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation).These findings may serve as a guide to clinicians considering therapeutic options in patients who are candidates for ablation.

The D0 experiment enjoyed a very successful data-collection run at the Fermilab Tevatron collider between 1992 and 1996. Since then, the detector has been upgraded to take advantage of improvements to the Tevatron and to enhance its physics capabilities. We describe the new elements of the detector, including the silicon microstrip tracker, central fiber tracker, solenoidal magnet, preshower detectors, forward muon detector, and forward proton detector. The uranium/liquid-argon calorimeters and central muon detector, remaining from Run I, are discussed briefly. We also present the associated electronics, triggering, and data acquisition systems, along with the design and implementation of software specific to D0.

H. Summary H.1. symptom modifying drugs The primary outcome variable is a specific aspect of joint pain, although a ‘signal' symptom or some measure of function may also be studied. Trials of drugs with a rapid onset of effect can be as short as 1–4 weeks but may be as long as 12 weeks. Longer trials (up to 2 years) may be needed to evaluate longer-term toxicity, determine optimal long-term dosing regimens, or establish long-term benefit. Supplemental escape analgesia should be minimized, monitored and discontinued prior to evaluation of efficacy. Some agents that provide symptom relief may not provide benefit until weeks after initiation of therapy. Under these circumstances, trials will vary from 3–12 months in length. If the agent is administered in courses, episodic readministration of the drug may be needed in long-term trials. Longer trials (up to 2 years) may be required to exclude toxicity or establish long-term benefit. H.2. structure modifying drugs These drugs are intended to prevent, retard, stabilize or reverse development of the morphologic changes of OA. Although this has been called ‘chondroprotection', the term is misleading and should be avoided, because all structures of the joint are involved in OA, not articular cartilage alone. The benefits of disease modifying therapy may not be apparent until years after the onset of treatment. The selection of high-risk groups may shorten the time of investigation. Improvement in symptoms (i.e., joint pain) is not a requisite for the efficacy of a drug in this category. In these studies, it may be necessary to permit concomitant use of drugs for relief of symptoms (NSAIDs, analgesics). The confounding effects of glucocorticoids and NSAIDs in these trials is not yet understood and very restricted use of IA depocorticosteroids is recommended. Demonstration of structure modification will require the use of direct measures of joint anatomy, such as radiography, particularly measurement of the radiographic joint space. As stated above, the plain radiograph is presently the most reproducible and readily available method for assessment of disease modification. Studies are needed to validate surrogate markers of disease activity, since they may help shorten Phase 2 structure modifying drug trials. As an alternative to radiography, some trials may utilize arthroscopy. As we approach the beginning of the twenty-first century, concepts of clinical trials of OA drugs are changing. Methodology and techniques for the evaluation of new agents for OA have been refined dramatically over the last decade. We look forward to the future with excitement as we anticipate the development of new agents that may alter the symptoms and course of OA. The above recommendations are intended to help us ascertain which of these new agents are effective.

The relation between knee meniscal structural damage and cartilage degradation is plausible but not yet clearly proven.To quantitate the cartilage volume changes in knee osteoarthritis using magnetic resonance imaging (MRI), and determine whether meniscal alteration predicts cartilage volume loss over time.32 patients meeting ACR criteria for symptomatic knee osteoarthritis were studied. MRI knee acquisitions were done every six months for two years. The cartilage volumes of different knee regions were measured. Three indices of structural change in the medial and lateral menisci were evaluated--degeneration, tear, and extrusion--using a semiquantitative scale.24 patients (75%) had mild to moderate or severe meniscal damage (tear or extrusion) at baseline. A highly significant difference in global cartilage volume loss was observed between severe medial meniscal tear and absence of tear (mean (SD), -10.1 (2.1)% v -5.1 (2.4)%, p = 0.002). An even greater difference was found between the medial meniscal changes and medial compartment cartilage volume loss (-14.3 (3.0)% in the presence of severe tear v -6.3 (2.7)% in the absence of tear; p<0.0001). Similarly, a major difference was found between the presence of a medial meniscal extrusion and loss of medial compartment cartilage volume (-15.4 (4.1)% in the presence of extrusion v -4.5 (1.7)% with no extrusion; p<0.001).Meniscal tear and extrusion appear to be associated with progression of symptomatic knee osteoarthritis.

We report the observation of the X(3872) in the J/psipi(+)pi(-) channel, with J/psi decaying to mu(+)mu(-), in pp collisions at sqrt[s]=1.96 TeV. Using approximately 230 pb(-1) of data collected with the Run II D0 detector, we observe 522+/-100 X(3872) candidates. The mass difference between the X(3872) state and the J/psi is measured to be 774.9+/-3.1(stat)+/-3.0(syst) MeV/c(2). We have investigated the production and decay characteristics of the X(3872) and find them to be similar to those of the psi(2S) state.

Measurement of change in patients' health status is central to both clinical trials and clinical practice. Trials commonly use serial measurements by the patients at 2 points in time while clinicians use the patient's retrospective assessment of change made at 1 point in time. How well these measures correlate is not known.To compare the 2 methods in measurement of changes in pain and disability.Longitudinal survey of patients starting new therapy for chronic arthritis in 1994 and 1995. Surveys were completed at baseline (before intervention) and at 6 weeks and 4 months.Community health education program and university medical and orthopedic services.A total of 202 patients undertaking self-management education (n = 140), therapy with prednisone or methotrexate (n = 34), or arthroplasty of the knee or hip (n = 28).Concordance between serial (visual analog scale for pain and Health Assessment Questionnaire for disability) and retrospective (7-point Likert scale) measures, sensitivities of these measures, and their correlation with patients' satisfaction with the change (7-point Likert scale).When change was small (education group), serial measures correlated poorly with retrospective assessments (eg, r=0.13-0.21 at 6 weeks). With greater change, correlations improved (eg, r = 0.45-0.71 at 6 weeks). Average agreement between all pairs of assessments was 29%. Significant lack of concordance was confirmed in all 12 comparisons by McNemar tests (P = .02 to <.001) and by t tests (P = .03 to <.001). Retrospective measures were more sensitive to change than serial measures and correlated more strongly with patients' satisfaction with change.The 2 methods for measuring health status change did not give concordant results. Including patient retrospective assessments in clinical trials might increase the comprehensiveness of information gained and its accord with clinical practice.

The factors associated with mortality were examined in a prospective longitudinal study, over an average of 12 years, with 94% followup of patients diagnosed as having rheumatoid arthritis. Of 805 patients, 233 died during the period of the study. Survivorship of rheumatoid arthritis patients was approximately 50% less than that of population controls. Survivorship was decreased by the traditional demographic variables of greater age and male sex; however, a significant independent effect of variables reflecting disease severity (American Rheumatism Association functional class, rheumatoid factor titer, number of involved joints) was identified by multivariate analysis. Seventy-nine excess deaths (i.e., those that would not have been expected in a control population) were due in part to disease-related causes, to infections, and to gastrointestinal complications of therapy. Treatment with gold or prednisone did not seem to affect survivorship or cause of death, except for the clustering of deaths of patients with vasculitis within the prednisone group. Our findings indicate that rheumatoid arthritis, a chronic disabling disease, is also associated with a major decrease in survivorship.

The thesis of this paper is that gastropathy associated with nonsteroidal antiinflammatory drugs (NSAIDs) is the most frequent and, in aggregate, the most severe drug side effect in the United States.This work is based on a consecutive series of 2400 patients with rheumatoid arthritis followed prospectively for an average of 3.5 yr by ARAMIS, the American Rheumatism Association Medical Information System.We present a preliminary exploration of the magnitude of the problem, the population at risk, and the patients within that population who are at particularly high risk.Patients on NSAIDs had a hazard ratio for gastrointestinal (GI) hospitalization that was 6.45 times that of patients not on NSAIDs.Characteristically, high-risk patients for GI hospitalization and GI death are older, have had previous upper abdominal pain, have previously stopped NSAIDs for GI side effects, and have previously used antacids or Hz-receptor antagonists for GI side effects.They also are frequently on corticosteroids.In contrast, patients attributing relatively minor symptoms to the drug tend to be younger and more frequently female.Our preliminary analysis is univariate and, as these variables are interdependent, firm conclusions regarding the relative importance of these risk factors will require reevaluating our data base as it is expanded using multivariate analysis.The syndrome of NSAID-associated gastropathy can be estimated to account for at least 2600 deaths and 20,000 hospitalizations each year in patients with rheumatoid arthritis alone.

We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 12-60 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0-3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.

Arthritis & RheumatismVolume 33, Issue 8 p. 1135-1136 ArticleFree to Read The American College of Rheumatology 1990 criteria for the classification of vasculitis: Summary James F. Fries MD, Corresponding Author James F. Fries MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorGene G. Hunder MD, Corresponding Author Gene G. Hunder MD Chair Mayo Clinic, Rochester, MN Subcommittee on Classification of VasculitisAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDaniel A. Bloch PhD, Corresponding Author Daniel A. Bloch PhD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorBeat A. Michel MD, Corresponding Author Beat A. Michel MD Rheumaklinik Universitätsspital, Zurich, SwitzerlandAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorWilliam P. Arend MD, Corresponding Author William P. Arend MD University of Colorado Health Science Center, Denver, COAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorLeonard H. Calabrese DO, Corresponding Author Leonard H. Calabrese DO Cleveland Clinic Foundation, Cleveland, OHAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAnthony S. Fauci MD, Corresponding Author Anthony S. Fauci MD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRandi Y. Leavitt MD, PHD, Corresponding Author Randi Y. Leavitt MD, PHD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJ. T. Lie MD, Corresponding Author J. T. Lie MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRobert W. Lightfoot Jr Md, Corresponding Author Robert W. Lightfoot Jr Md University of Kentucky, Lexington, KYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAlfonse T. Masi MD, DRPH, Corresponding Author Alfonse T. Masi MD, DRPH University of Illinois College of Medicine, Peoria, ILAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDennis J. McShane MD, Corresponding Author Dennis J. McShane MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJohn A. Mills MD, Corresponding Author John A. Mills MD Massachusetts General Hospital, Boston, MAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorMary Betty Stevens MD, Corresponding Author Mary Betty Stevens MD Johns Hopkins University, Baltimore, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorStanley L. Wallace MD, Corresponding Author Stanley L. Wallace MD SUNY Downstate Medical Center, Brooklyn, NYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorNathan J. Zvaifler MD, Corresponding Author Nathan J. Zvaifler MD University of California, San Diego, San Diego, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this author James F. Fries MD, Corresponding Author James F. Fries MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorGene G. Hunder MD, Corresponding Author Gene G. Hunder MD Chair Mayo Clinic, Rochester, MN Subcommittee on Classification of VasculitisAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDaniel A. Bloch PhD, Corresponding Author Daniel A. Bloch PhD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorBeat A. Michel MD, Corresponding Author Beat A. Michel MD Rheumaklinik Universitätsspital, Zurich, SwitzerlandAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorWilliam P. Arend MD, Corresponding Author William P. Arend MD University of Colorado Health Science Center, Denver, COAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorLeonard H. Calabrese DO, Corresponding Author Leonard H. Calabrese DO Cleveland Clinic Foundation, Cleveland, OHAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAnthony S. Fauci MD, Corresponding Author Anthony S. Fauci MD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRandi Y. Leavitt MD, PHD, Corresponding Author Randi Y. Leavitt MD, PHD NIAID, NIH, Bethesda, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJ. T. Lie MD, Corresponding Author J. T. Lie MD Mayo Clinic, Rochester, MNAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorRobert W. Lightfoot Jr Md, Corresponding Author Robert W. Lightfoot Jr Md University of Kentucky, Lexington, KYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorAlfonse T. Masi MD, DRPH, Corresponding Author Alfonse T. Masi MD, DRPH University of Illinois College of Medicine, Peoria, ILAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorDennis J. McShane MD, Corresponding Author Dennis J. McShane MD Stanford University, Stanford, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorJohn A. Mills MD, Corresponding Author John A. Mills MD Massachusetts General Hospital, Boston, MAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorMary Betty Stevens MD, Corresponding Author Mary Betty Stevens MD Johns Hopkins University, Baltimore, MDAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorStanley L. Wallace MD, Corresponding Author Stanley L. Wallace MD SUNY Downstate Medical Center, Brooklyn, NYAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this authorNathan J. Zvaifler MD, Corresponding Author Nathan J. Zvaifler MD University of California, San Diego, San Diego, CAAmerican College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329Search for more papers by this author First published: August 1990 https://doi.org/10.1002/art.1780330812Citations: 230AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue8August 1990Pages 1135-1136 RelatedInformation

purpose: The most prevalent serious drug toxicity in the United States is increasingly recognized as gastrointestinal (GI) pathology associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The incidence of serious GI events (hospitalization or death) associated with NSAID use was therefore prospectively analyzed in patients with rheumatoid arthritis (RA) and patients with osteoarthritis. patients, methods, and results: The study consisted of 2,747 patients with RA and 1,091 patients with osteoarthritis. The yearly hospitalization incidence during NSAID treatment was 1.58% in RA patients and was similar in all five populations studied. The hazard ratio of patients taking NSAIDs to those not taking NSAIDs was 5.2. The incidence in osteoarthritis may be less. The risk of GI-related death in RA patients was 0.19% per year with NSAIDs. Multivariate analyses assessing risk factors for serious GI events were performed in the 1,694 (98 with an event) RA patients taking NSAIDs at the predictive visit. The main risk factors were higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, level of disability, and NSAID dose. A rule is presented that allows estimation of the risk for the individual patient with RA. conclusion: Knowledge of the risk factors for NSAID-associated gastropathy and their interrelationships provides a tool for identification of the patient at high risk and for initiation of appropriate therapeutic action.

To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures. Active or sham CPAP Three neurocognitive variables, each representing a neurocognitive domain: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F]) The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test. CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship. Registered at clinicaltrials.gov. Identifier: NCT00051363.

Conditioning with total lymphoid irradiation plus antithymocyte serum protects mice against acute graft-versus-host disease (GVHD) after hematopoietic-cell transplantation. We tested this strategy in humans.Thirty-seven patients with lymphoid malignant diseases or acute leukemia underwent an experimental conditioning regimen with 10 doses of total lymphoid irradiation (80 cGy each) plus antithymocyte globulin, followed by an infusion of HLA-matched peripheral-blood mononuclear cells from related or unrelated donors who received granulocyte colony-stimulating factor.Of the 37 transplant recipients, only 2 had acute GVHD after hematopoietic-cell transplantation. Potent antitumor effects in patients with lymphoid malignant diseases were shown by the change from partial to complete remission. In the transplant recipients who underwent conditioning with total lymphoid irradiation and antithymocyte globulin, the fraction of donor CD4+ T cells that produced interleukin-4 after in vitro stimulation increased by a factor of five, and the proliferative response to alloantigens in vitro was reduced, as compared with normal control subjects and control subjects who underwent conditioning with a single dose of total-body irradiation (200 cGy).A regimen of total lymphoid irradiation plus antithymocyte globulin decreases the incidence of acute GVHD and allows graft antitumor activity in patients with lymphoid malignant diseases or acute leukemia treated with hematopoietic-cell transplantation.

Abstract Six hundred eighty‐one consecutive patients with rheumatoid arthritis were followed for an average of 11.9 years to identify initial factors that predicted subsequent disability. of 39 potentially predictive variables obtained at study onset and studied by stepwise regression methods, age was found to be the most powerful single predictor of disability, followed by radiologic grade, sex, and initial functional class. The worst prognosis for disability was found in patients who were older women and who showed radiologic worsening and developed functional impairment early in the disease course. Both disability and radiologic progression of disease were found to develop most rapidly during the first years after disease onset and to assume a slow, nearly linear rate of increase after 10 years. Approximately 10% of patients did not develop significant disability. This study suggests that it is possible to identify, early in the disease course, those patients who are likely to develop severe disability, and that “disease‐modifying” therapy might well be initiated earlier in such patients and used consistently throughout the subsequent treatment.

DELPHI (DEtector with Lepton, Photon and Hadron Identication) is a detector for e + e physics, designed to provide high granularity o v er a 4 solid angle, allowing an eective particle identication.It has been operating at the LEP (Large Electron-Positron) collider at CERN since 1989.This article reviews its performance.

Abstract We conducted followup of 264 patients with definite systemic sclerosis (SSc) who were entered into the multicenter Scleroderma Criteria Cooperative Study (SCCS) during 1973–1977. At the end of the study (average 5.2 years of followup), 38% were known to be alive, 50% were dead (68% of these deaths definitely related to SSc), and 12% were lost to followup. Survival analyses of 484 demographic, clinical, and laboratory items recorded at entry into the SCCS (within 2 years of physician diagnosis of SSc) were performed. Survival declined linearly, and the cumulative survival rate was &lt;80% at 2 years, 50% at 8.5 years, and 30% at 12 years after entry. Analysis using combinations of entry variables identifying organ system involvement confirmed that renal, cardiac, pulmonary, and gastrointestinal involvement in SSc predicted reduced survival; however, data on organ system involvement at study entry could not be used to consistently predict which organ system would ultimately be involved as the primary cause of death. By survival tree analysis, the individual entry variables best predicting reduced survival included older age (&gt;64 years), reduced renal function (blood urea nitrogen &gt;16 mg/dl), anemia (hemoglobin ≤11 gm/dl), reduced pulmonary diffusing capacity for carbon monoxide (≤50% of predicted), reduced total serum protein level (≤6 gm/dl), and reduced pulmonary reserve (forced vital capacity &lt;80% with hemoglobin &gt;14 gm/dl or forced vital capacity &lt;65% with hemoglobin ≤14 gm/dl). Cox proportional hazards model analysis confirmed these results. Different combinations of variables led to markedly different survival rates. The poorest prospects for survival were in patients with SSc who were ≤64 years old with a hemoglobin level ≤11 gm/dl, and in those &gt;64 years old with a blood urea nitrogen level &gt;16 mg/dl. These results may be useful in predicting individual patients at risk for shortened survival.

Weak isosinglet Neutral Heavy Leptons (v m) have been searched for using data collected by the DELPHI detector corresponding to 3.3 × 106 hadronic Z0 decays at LEP1. Four separate searches have been performed, for short-lived v m production giving monojet or acollinear jet topologies, and for long-lived v m giving detectable secondary vertices or calorimeter clusters. No indication of the existence of these particles has been found, leading to an upper limit for the branching ratio BR(Z0 → v m?) of about 1.3 × 10−6 at 95% confidence level for v m masses between 3.5 and 50 GeV/c2. Outside this range the limit weakens rapidly with the v m mass. The results are also interpreted in terms of limits for the single production of excited neutrinos.

Two general but different contexts in which kappa might be used are defined: agreement and association. Two models, one for agreement and one for utility of association, are defined yielding different kappa coefficients and different sampling theory. Asymptotic results are derived for both models. Small-sample evaluations are presented for the model for agreement.

Abstract Objective To evaluate the change in osteoarthritic (OA) knee cartilage volume over a two‐year period with the use of magnetic resonance imaging (MRI) and to correlate the MRI changes with radiologic changes. Methods Thirty‐two patients with symptomatic knee OA underwent MRI of the knee at baseline and at 6, 12, 18, and 24 months. Loss of cartilage volumes were computed and contrasted with changes in clinical variables for OA and with standardized semiflexed knee radiographs at baseline at 1 and 2 years. Results Progression of cartilage loss at all followup points was statistically significant ( P &lt; 0.0001), with a mean ± SD of 3.8 ± 5.1% for global cartilage loss and 4.3 ± 6.5% for medial compartment cartilage loss at 6 months, 3.6 ± 5.1% and 4.2 ± 7.5% at 12 months, and 6.1 ± 7.2% and 7.6 ± 8.6% at 24 months. Discriminant function analysis identified 2 groups of patients, those who progressed slowly (&lt;2% of global cartilage loss; n = 21) and those who progressed rapidly (&gt;15% of global cartilage loss; n = 11) over the 2 years of study. At baseline, there was a greater proportion of women ( P = 0.001), a lower range of motion ( P = 0.01), a greater circumference and higher level of pain ( P = 0.05) and stiffness in the study knee, and a higher body mass index in the fast progressor group compared with the slow progressor group. No statistical correlation between loss of cartilage volume and radiographic changes was seen. Conclusion Quantitative MRI can measure the progression of knee OA precisely and can help to identify patients with rapidly progressing disease. These findings indicate that MRI could be helpful in assessing the effects of treatment with structure‐modifying agents in OA.

Abstract Criteria for the classification of hypersensitivity vasculitis were developed by comparing 93 patients who had this disease with 714 control patients with other forms of vasculitis. For the traditional format classification , 5 criteria were selected: age &gt;16 at disease onset, history of taking a medication at onset that may have been a precipitating factor, the presence of palpable purpura, the presence of maculopapular rash, and a biopsy demonstrating granulocytes around an arteriole or venule. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 71.0% and a specificity of 83.9%. A classification tree was also constructed. The criteria appearing in the tree structure were the same as for the traditional format, except there were 2 pathology criteria: one required the presence of granulocytes in the wall of an arteriole or venule, and the other required the presence of eosinophils in the inflammatory exudate. The classification tree was associated with a sensitivity of 78.5% and a specificity of 78.7%.

The objective was to review the current results of endovascular abdominal aortic aneurysm repair with the AneuRx stent graft and to determine the effectiveness of the device in achieving the primary objective of preventing aneurysm rupture.The outcome of all patients treated during the past 4 years in the U.S. AneuRx clinical trial was determined, and the worldwide clinical experience was reviewed.A total of 1192 patients were treated with the AneuRx stent graft during all phases of the U.S. Clinical Trial from June 1996 to November 1999, with follow-up extending to June 2000. Ten (0.8%) patients have had aneurysm rupture, with most ruptures (n = 6) occurring in 174 (3.4%) patients treated with an early stiff bifurcation stent graft design used in phase I and in the initial stages of phase II. Since the current, flexible, segmented bifurcation stent graft design was introduced, four (0.4%) ruptures have occurred among 1018 patients treated. Of these, one was during implantation, two were placed too far below the renal arteries, and one patient refused treatment of a type I endoleak. Kaplan-Meier analysis of all 1192 patients treated with the AneuRx stent graft including both stent graft designs revealed the patient survival rate to be 93% at 1 year, 88% at 2 years, and 86% at 3 years, freedom from conversion to open repair to be 98% at 1 year, 97% at 2 years, and 93% at 3 years, and freedom from secondary procedure to be 94% at 1 year, 92% at 2 years, and 88% at 3 years. Freedom from aneurysm rupture with the commercially available segmented bifurcation stent graft was 99.7% at 1 year, 99.5% at 2 years, and 99.5% at 3 years. The presence or absence of endoleak on contrast computed tomography scanning after stent graft placement was not found to be a significant predictor of long-term outcome measures. Worldwide experience with the AneuRx device now approaches 10,000 patients.Endovascular management of abdominal aortic aneurysms with the AneuRx stent graft has markedly reduced the risk of aneurysm rupture while eliminating the need for open aneurysm surgery in 98% of patients at 1 year and 93% of patients at 3 years. The device was effective in preventing aneurysm rupture in 99.5% of patients over a 3-year period. The overall patient survival rate was 93% at 1 year and 86% at 3 years.

We reviewed the incidence of stent-graft migration after endovascular aneurysm repair in a prospective multicenter trial and identified factors that may predispose to such migration.All patients who received treatment during the course of the multicenter AneuRx clinical trial were reviewed for evidence of stent-graft migration over 5 years, from 1996 to 2001. Post-deployment distance from the renal arteries to the proximal end of the stent graft and the proximal fixation length (length of the infrarenal neck covered by the stent graft) were determined in patients for whom pre-procedure and post-procedure computed tomography scans were measured in an independent core laboratory.Stent-graft migration was reported in 94 of 1119 patients, with mean time after device implantation of 30 +/- 11 months. Freedom from migration was 98.6% at 1 year, 93.4% at 2 years, and 81.2% at 3 years (Kaplan-Meier method). Subset (n = 387) analysis revealed that initial device deployment was lower in 47 patients with migration, as evidenced by a greater renal artery to stent-graft distance (1.1 +/- 0.7 cm), compared with 340 patients without migration (0.8 +/- 0.6 cm; P =.006) on post-implantation computed tomography scan. Proximal fixation length was shorter in patients with migration (1.6 +/- 1.4 cm) compared with patients without migration (2.3 +/- 1.4 cm; P =.005). There was significant variation in migration rate among clinical sites (P <.001), ranging from 0% to 30% (median, 8%), with a greater than twofold difference in migration rate between the lowest quartile (6%) and the highest quartile (15%) clinical sites. Univariate and multivariate analysis revealed that renal artery to stent-graft distance (P =.001) and proximal fixation length (P =.005) were significant predictors of migration, and that each millimeter increase in distance below the renal arteries increased risk for subsequent migration by 5.8% and each millimeter increase in proximal fixation length decreased risk for migration by 2.5%. Pre-implantation aortic neck length, neck diameter, degree of device oversizing, correct versus incorrect oversizing, device type (stiff vs flexible), placement of proximal extender cuffs at the original procedure, and post-procedure endoleak were not significant predictors of migration. Migration was treated with placement of extender modules in 23 patients and surgical conversion in 7 patients; 64 patients (68%) with migration have required no treatment.Stent-graft migration among patients treated in the AneuRx clinical trial appears to be largely related to low initial deployment of the device, below the renal arteries, and short proximal fixation length. Significant variation in migration rate among clinical sites highlights the importance of the technical aspects of stent-graft deployment. Advances in intraoperative imaging and deployment techniques that have been made since completion of the clinical trial facilitate precision of device placement below the renal arteries and should increase proximal fixation length. Whether this, together with increased iliac fixation length, will result in lower risk for migration remains to be determined in long-term follow-up studies.

The American College of Rheumatology Subcommittee on Classification of Vasculitis of the Diagnostic and Therapeutic Criteria Committee developed classification criteria for 7 forms of vasculitis: polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, hypersensitivity vasculitis, Henoch-Schönlein purpura, giant cell (temporal) arteritis, and Takayasu arteritis. The data collection methods, quality control, and analytic procedures used to derive the classification rules are discussed herein.

We report on a measurement of the inclusive jet cross section in pp[over ] collisions at a center-of-mass energy sqrt[s]=1.96 TeV using data collected by the D0 experiment at the Fermilab Tevatron Collider corresponding to an integrated luminosity of 0.70 fb;{-1}. The data cover jet transverse momenta from 50 to 600 GeV and jet rapidities in the range -2.4 to 2.4. Detailed studies of correlations between systematic uncertainties in transverse momentum and rapidity are presented, and the cross section measurements are found to be in good agreement with next-to-leading order QCD calculations.

Abstract Objective : This analysis proposes safety and performance goals for prospective single‐arm trials of bare nitinol stents to treat patients with debilitating claudication associated with femoropopliteal (FP) atherosclerotic lesions. Background : To date there have been no analyses of clinical trials data to set efficacy and safety benchmarks for new bare nitinol stents in the treatment of claudication from FP disease. Industry has been reluctant to sponsor studies of nitinol stents due to logistical barriers. Methods : VIVA Physician's, Inc. (VPI) analyzed subject‐level data from the PTA control arm of three randomized FDA device trials conducted by industry. Subjects with Rutherford category 2‐4 claudication and FP lesion lengths 4–15 cm with 12 month duplex ultrasound (DUS) assessment were identified. These data were combined with the results of a survey of the medical literature (1990–2006) for similar subjects. Results : Analysis of the industry derived control arm PTA data identified 116 patients (mean lesion length 8.7 cm) with a 12 month DUS defined FP patency of 28%. A similar cohort of 191 patients was identified from the medical literature in which the 12‐month vessel patency equaled 37%; from these combined patient cohorts, expected vessel patency for PTA was estimated to equal 33%. Conclusion : Based on the PTA performance efficacy rate of 33% derived from industry clinical trial data and the medical literature, and the requirement that the bare nitinol stent 12‐month efficacy performance goal be set to equal twice this rate, the patency efficacy goal equals 66%. Additional information is provided on safety and other reporting standards and stent integrity evaluation for bare metal stents. © 2007 Wiley‐Liss, Inc.

We present the first measurement of the integrated forward-backward charge asymmetry in top-quark–top-antiquark pair (t¯t) production in proton-antiproton (p¯p) collisions in the lepton+jets final state. Using a b-jet tagging algorithm and kinematic reconstruction assuming t¯t+X production and decay, a sample of 0.9 fb−1 of data, collected by the D0 experiment at the Fermilab Tevatron Collider, is used to measure the asymmetry for different jet multiplicities. The result is also used to set upper limits on t¯t+X production via a Z′ resonance.Received 7 December 2007DOI:https://doi.org/10.1103/PhysRevLett.100.142002©2008 American Physical Society

This paper considers an index to assess the success of blinding with application to a clinical trial of disulfiram. The index increases as the success of blinding increases, accounts for uncertain responses, and is scaled to an interval of 0.0 to 1.0, 0.0 being complete lack of blinding and 1.0 being complete blinding.

First measurements of the mass and width of the Z0 performed at the newly commissioned LEP Collider by the DELPHI Collaboration are presented. The measuements are derived from the study of multihadronic final states produced in e+e− annihilations at several energies around the Z0 mass. The values found for the mass and width are M(Z0)=91.06±0.09 (stat) ±0.045 (syst.) GeV and Γ(Z0)=2.42±0.21 (stat.) GeV respectively, froma three-parameter fit to the line shape. A two-parameter fit in the framework of the standard model yields for the number of light neutrino species Nν=2.4±0.4 (stat.) ±0.5 (syst.).

From an analysis of the flavor-tagged decay Bs0-->J/psiphi we obtain the width difference between the Bs0 light and heavy mass eigenstates, DeltaGammas = 0.19+/-0.07(stat)(-0.01)+0.02(syst) ps(-1), and the CP-violating phase, phi s= -0.57(-0.30)+0.24(stat)(-0.02)+0.08(syst). The allowed 90% CL intervals of DeltaGammas and phi s are 0.06 < DeltaGammas < 0.30 ps(-1) and -1.20 < phi s < 0.06, respectively. The data sample corresponds to an integrated luminosity of 2.8 fb(-1) accumulated with the D0 detector at the Fermilab Tevatron collider.

The sciatic functional index previously described in rats has proven to be a reliable index of functional recovery following sciatic nerve injury and repair. A similar functional assay of sciatic, peroneal, and posterior tibial nerve lesions was developed in a mouse model. Forty-eight C57/BL6 mice were randomly divided into 4 groups: sham surgery, sciatic nerve transection, peroneal nerve transection, and posterior tibial nerve transection. Preoperative and postoperative (48 hours) walking tracks were obtained. The pawprints were analyzed in a blinded fashion for measurements of print length (PL), toe spread (TS), intermediate toe spread (IT), and the orthogonal distance from the toe of one paw to the hind pad of the opposite paw (TOF). Multiple linear regression analysis was performed using these measurements to determine their significance and appropriate weighted contribution to the index formula for each nerve lesion. For the sciatic functional index, changes in the PL (P = 0.0092) and TS (P = 0.0008) were significant, resulting in an R2 value of 0.88. For the peroneal functional index, only TS (P < 0.0001) was significant with R2 = 0.83. For the posterior tibial index, only PL (P < 0.0001) was significant with R2 = 0.89. Formulas for a sciatic, peroneal, and posterior tibial functional index were created based on the coefficients derived from the multiple linear regression analysis. The indices that were developed will allow investigators to assess functional recovery following specific nerve lesions in mice. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:119-124 1998

We report results of a study of the B(s)(0) oscillation frequency using a large sample of B(s)(0) semileptonic decays corresponding to approximately 1 fb(-1) of integrated luminosity collected by the D0 experiment at the Fermilab Tevatron Collider in 2002-2006. The amplitude method gives a lower limit on the B(s)(0) oscillation frequency at 14.8 ps(-1) at the 95% C.L. At delta m(s) = 19 ps(-1), the amplitude deviates from the hypothesis A= 0(1) by 2.5 (1.6) standard deviations, corresponding to a two-sided C.L. of 1% (10%). A likelihood scan over the oscillation frequency, delta m(s), gives a most probable value of 19 ps(-1) and a range of 17 < delta m(s) < 21 ps(-1)at the 90% C.L., assuming Gaussian uncertainties. This is the first direct two-sided bound measured by a single experiment. If delta m(s) lies above 22 ps(-1), then the probability that it would produce a likelihood minimum similar to the one observed in the interval 16-22 ps(-1) is (5.0 +/- 0.3)%.

Abstract Erosions and cartilage destruction are nearly universal features in peripheral joints that have been chronically affected by rheumatoid arthritis. Scoring methods to measure the extent of these abnormalities in hands and wrists have been developed and have been thoroughly tested in several studies to establish their reproducibility. In this study, we utilized one of these scoring methods to examine the progression of radiologic damage as related to duration of disease. Two hundred ninety‐two patients from 3 different participating centers in the Arthritis, Rheumatism, and Aging Medical Information System were included. Six hundred fifty films of the hands and wrists, obtained from 210 patients, were scored for erosions and joint space narrowing. The average annual rate of progression of the total radiologic score, which sums erosion and joint space abnormalities and has a maximum possible score of 314, was approximately 4 units per year over the first 25 years after onset; this progression was more rapid in the earlier years of disease and slightly slower in the later years. Data were insufficient to accurately determine the progression rate in disease of more than 25 years duration.

Postural control deficits have been suggested to be a major component of gait disorders in cerebral palsy (CP). Standing balance was investigated in 23 ambulatory children and adolescents with spastic diplegic CP, ages 5 to 18 years, and compared with values of 92 children without disability, ages 5 to 18 years, while they stood on a force plate with eyes open or eyes closed. The measurements included center of pressure calculations of path length per second, average radial displacement, mean frequency of sway, and Brownian random motion measures of the short-term diffusion coefficient, and the long-term scaling exponent. In the majority of children with CP (14 of 23) all standing balance values were normal. However, approximately one-third of the children with CP (eight of 23) had abnormal values in at least two of the six center of pressure measures. Thus, mean values for path length, average radial displacement, and diffusion coefficient were higher for participants with CP compared with control individuals with eyes open and closed (p<0.05). Mean values for frequency of sway and the long-term scaling exponent were lower for participants with CP compared with control participants (p<0.05). Increased average radial displacement was the most common (nine of 23) postural control deficit. There was no increase in abnormal values with eyes closed compared with eyes open for participants with CP, indicating that most participants with CP had normal dependence on visual feedback to maintain balance. Identification of those children with impaired standing balance can delineate factors that contribute to the patient's gait disorder and help to guide treatment.

There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.The risk-factor-free group showed average disability scores near zero 10-12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.

OBJECTIVES More than 31 million persons living in the United States do not speak English, therefore language discordance between the clinician and patient may hinder delivery of cost-effective medical care. A new language service was developed in which interpreters are trained in the skills of simultaneous interpretation commonly used at international conferences. The interpreters are linked from a remote site to headsets worn by the clinician and patient through standard communication wires. The service is called “remote-simultaneous interpretation,” to contrast it with a traditional method of an interpreter being physically present at the interview and interpreting consecutively “Proximate-consecutive interpretation.” The aim of this study is to assess in a randomized protocol the quality of communication, interpretation, and level of patient, interpreter, and physician satisfaction with these two language services. METHODS The first postpartum visit with each of 49 mothers and their newborn babies was assigned randomly to proximate-consecutive interpretation (control) or to remote-simultaneous interpretation (experimental). Main outcome measures included (1) the number of physician and mother utterances in the visit, (2) the quality of the interpretation, and (3) physician, interpreter, and mother preferences between the two services. RESULTS The remote-simultaneous interpreter service averaged 8.3 (10%) more physician utterances (95% confidence interval [CI] 4.3, 12.4) and 9.1 (28%) more mother utterances (95% CI 6.1, 12.1). On average, there were 2.8 (12%) fewer inaccuracies of physician utterances in experimental visits compared with control visits (95% CI -5.9, 0.4) and 3.0 (13%) fewer inaccuracies of mother utterances in experimental visits compared with control visits (95% CI -5.4, -0.6). Mothers and physicians significantly preferred the remote-simultaneous service to proximate-consecutive interpretation service. Interpreters stated that they thought mothers and physicians better understood each other using the remote-simultaneous service, although the interpreters preferred to work with the proximate-consecutive service. CONCLUSIONS Using remote-simultaneous interpretation to improve the quality of communication in discordant-language encounters promises to enhance delivery of medical care for the millions of non-English-speaking patients in the United States.

To compare the toxicities of commonly employed disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA).Toxicity Index scores, computed from symptoms, laboratory abnormalities, and hospitalizations attributable to DMARD therapy, were assessed in 2,747 patients with RA receiving 3,053 courses of 6 DMARDs and 1,309 courses of prednisone over 7,278 patient-years. Results were adjusted for severity of illness and other covariates.Least toxic was hydroxychloroquine (mean +/- SEM score 1.38 +/- 0.15), followed by intramuscular gold (2.27 +/- 0.17) and the closely grouped D-penicillamine (3.38 +/- 0.36), methotrexate (3.82 +/- 0.35), and azathioprine (3.92 +/- 0.39). Auranofin (5.25 +/- 0.32) was most toxic, but this toxicity resulted from a high frequency of minor complications. Hospitalizations because of auranofin or hydroxychloroquine therapy were not noted. Prednisone (3.83 +/- 0.39) was of comparable toxicity, although it is likely that not all events of prednisone toxicity were captured. For reference, the toxicity of methotrexate and azathioprine was similar to that of the most toxic nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin 3.99, tolmetin sodium 3.96, and meclofenamate 3.86). Hydroxychloroquine showed less toxicity than the most commonly used prescription NSAIDs.There are substantial differences in toxicity among DMARDs and less important differences in toxicity between specific DMARDs and specific NSAIDs.

BACKGROUND This study was performed to identify a statistical combination of independent pathologic and clinical features that best predict 5-year disease free survival (DFS) in patients with early stage cervical carcinoma treated by radical hysterectomy. The main goal of the study was to identify subsets of patients based on risk factors with maximal differences in DFS. METHODS Three hundred and seventy patients were found for whom complete clinical and pathologic material, including cone and cervical biopsies, were available for analysis. Variables studied included age, weight, race, marital status, economic status, tumor size (TS), depth of invasion (DI), lymph-vascular space involvement (LVSI), cell type, tumor grade, lymph node metastasis (LNM), and number of lymph nodes removed. Patients with LNM, parametrial involvement, and positive or close surgical margins were offered postoperative radiation. After excluding patients with microinvasive and small cell carcinoma, data from the remaining 301 patients were submitted to univariate and multivariate analyses to define those variables that best predict DFS. RESULTS Univariate analysis showed that, ranked by degree of significance, DI, TS, LVSI, LNM, tumor volume (TV) and clinical stage were significant in predicting survival. Significant (P < 0.05) single parameters and other variables considered important were chosen for multivariate analysis, including the creation of a survival tree. With this method, DI (;cc6 mm and > 2 cm), LVSI, age (;ce40 yrs), and LNM were found to be the best combination of risk factors to define prognosis. CONCLUSIONS The multivariate survival tree analysis maximally separates patients with early stage invasive carcinoma of the cervix into 3 subgroups with 5-year DFS of 91%, 68%, and 43%, respectively. The authors excluded patients with microinvasive carcinoma (SGO, Society of Gynecologic Oncologists), who have an excellent DFS of 100%, and patients with small carcinoma, who have a poor DFS of 36.4% based on cell type alone, to define independent risk factors that maximally separate the remaining patients by DSF. The survival tree prognostic scoring system is easy to apply, and only requires DI (mm), LVSI (+, −), LNM, and age to assign an individual patient to one of three risk groups. Cancer 1996;78:1438-46.

Abstract Radiologic assessment of progressive joint destruction in rheumatoid arthritis is generally considered to be the ultimate standard for evaluation of treatment. We compared alternative radiologic techniques by performing a randomized, controlled trial in which hand films of rheumatoid arthritis patients were read by several skilled observers. The number of joints evaluated (34 versus 18) was found to make relatively little difference, but the number of readers and their experience level was critical. Films should be read in pairs. Joint space narrowing and erosion scores were shown to contribute independent information. Use of recommended techniques can reduce the number of patients required and, thus, can reduce the cost of a clinical trial by more than half and can substantially increase the sensitivity and efficiency of a trial. Therefore, critical selection of the method of assessing study endpoint is of great importance.

The production of single- and multi-photon events has been studied in the reaction e+e- -&gt; gamma (gamma) + invisible particles. The data collected with the DELPHI detector during the years 1999 and 2000 at centre-of-mass energies between 191 GeV and 209 GeV was combined with earlier data to search for phenomena beyond the Standard Model. The measured number of light neutrino families was consistent with three and the absence of an excess of events beyond that predicted by the Standard Model processes was used to set limits on new physics. Both model-independent searches and searches for new processes predicted by supersymmetric and extra-dimensional models have been made. Limits on new non-standard model interactions between neutrinos and electrons were also determined.

Several investigators have used the Brier index to measure the predictive accuracy of a set of medical judgments; the Brier scores of different raters who have evaluated the same patients provides a measure of relative accuracy. However, such comparisons may be difficult to interpret because of the lack of a statistical test for differentiating between two Brier scores. To demonstrate a method for addressing this issue we analyzed the judgments of five medical students, each of whom independently evaluated the same 25 patients with recurrent chest pain. Using the method we determined that two of the students gave judgments that were incompatible with the actual observed outcomes (p < 0.05); of the three remaining students we detected a significant difference between two (p < 0.05). These results differed from receiver operating characteristic curve area analysis, another technique used to evaluate predictive accuracy. We suggest that the proposed method can provide a useful tool for investigators using the Brier index to compare how well clinicians express uncertainty using probability judgments.

Let $x_1 < x_2 < \cdots < x_n$ be an ordered random sample of size $n$ from the absolutely continuous cdf $F(x)$ with positive density $f(x)$ having a continuous first derivative in a neighborhood of the $p$th population quantile $\nu_p(= F^{-1} (p))$. In order to convert the median or any other "quick estimator" [1] into a test we must estimate its variance, or for large samples its asymptotic variance which depends on $1/f(\nu_p)$. Siddiqui [4] proposed the estimator $S_{mn} = n(2m)^{-1}(x_{\lbrack np\rbrack+m} - x_{\lbrack np\rbrack-m+1})$ for $1/f(\nu_p)$, showed it is asymptotically normally distributed and suggested that $m$ be chosen to be of order $n^{\frac{1}{2}}$. In this note we show that the value of $m$ minimizing the asymptotic mean square error (AMSE) is of order $n^{\frac{1}{5}}$ (yielding an AMSE of order $n^{-\frac{4}{5}}$). Our analysis is similar to Rosenblatt's [2] study of a simple estimate of the density function.

In a retrospective investigation of 104 patients with multiple primary tumors of the upper alimentary and respiratory tracts, the data suggest that patients who smoke heavily before developing cancer are more likely to develop second, primary tumors. Continued smoking after initial diagnosis or radiation therapy for the first primary is associated with an increased frequency of second primary tumors. Discontinuance of smoking and drinking after the first primary provides no assurance against the development of a second primary cancer.

The radiobiology of prostate cancer may favor the extreme hypofractionation inherent in stereotactic body radiation therapy (SBRT); however, data from a large multicenter study are lacking. We therefore examined the hypothesis that dose-escalated SBRT can be safely administered across multiple institutions, with favorable 5-year disease-free survival (DFS) rates compared with historical controls.Twenty-one centers enrolled 309 patients with prostate adenocarcinoma: 172 with low-risk (LR) and 137 with intermediate-risk (IR) disease. All were treated with a non-coplanar robotic SBRT platform using real-time tracking of implanted fiducials. The prostate was prescribed 40 Gy in 5 fractions of 8 Gy. We assessed toxicities using Common Terminology Criteria for Adverse Events (CTCAE) version 3 and biochemical failure using the "nadir + 2" definition. The study population yielded 90% power to identify excessive (>10%) rates of grade ≥3 genitourinary (GU) or gastrointestinal toxicities and, in the LR group, 80% power to show superiority in DFS over a 93% historical comparison rate.At a median follow-up of 61 months, 2 LR patients (1.2%) and 2 IR patients (1.5%) experienced grade 3 GU toxicities, far below the 10% toxicity rate deemed excessive (upper limits of 95% confidence interval, 3.5% and 4.3%, respectively). No grade 4 or 5 toxicities occurred. All grade 3 toxicities were GU, occurring 11 to 51 months after treatment. For the entire group, the actuarial 5-year overall survival rate was 95.6% and the DFS rate was 97.1%. The 5-year DFS rate was 97.3% for LR patients (superior to the 93% DFS rate for historical controls; P = .0008; lower limit of 95% confidence interval, 94.6%) and 97.1% for IR patients.Dose-escalated prostate SBRT was administered with minimal toxicity in this multi-institutional study. Relapse rates compared favorably with historical controls. SBRT is a suitable option for LR and IR prostate cancer.

The COVID-19 outbreak has sent shockwaves throughout the aviation industry, sending a myriad of liquidity-strapped airlines into administration or part government ownership. In turn, this paper argues that the novel phenomenon of Ultra Long Haul (ULH) operations already maintains the necessary characteristics to generate a competitive advantage that will not only succeed, but outperform other business models, in a post COVID-19 era. Our modelling and scenario analysis results suggest that point-to-point ULH services, with access to a strong domestic feeder system, will not only require minimal adjustments to cope with COVID-19, but will simultaneously produce higher seat-load factors and yields, heightened network flexibility, and unique health benefits tied to its ability to bypass densely populated hub airports.

Work disability, a common problem in rheumatoid arthritis (RA), is known to be associated with demographic variables such as occupation, age, and formal education, as well as with disease duration. However, physical, radiographic and laboratory variables, which are included in the traditional “medical model” of work disability and collected routinely in the application process, have not been studied for their capacity to explain whether patients are working or receiving work disability payments. A cross-sectional database which included an extensively characterized group of patients with RA was examined to determine possible associations of demographic, functional, physical, radiographic and laboratory variables with work disability status. All these variables differed in patients who were receiving work disability payments and those who were working full time, but in multivariate analyses, work or disability status was best identified by demographic and functional variables. Physical, radiographic, and laboratory data did not add significantly to explanation of work disability status beyond the demographic and functional variables and disease duration, despite the fact that receipt of disability payments was used as the criterion for work disability status.

To characterize survivorship among patients with giant cell arteritis in a well-defined, multicenter cohort.Follow-up was obtained for 205 (95.8%) of the 214 patients enrolled in the 1990 American College of Rheumatology vasculitis classification study. Standardized mortality ratios (SMR) were calculated comparing mortality data from this group of patients with giant cell arteritis versus the general population.There were 49 deaths (33 women and 16 men among the 205 patients available for follow-up. Survivorship was virtually identical to that of the general population (SMR = 1.034 +/- 0.121), and was similar for women (SMR = 1.022 +/- 0.149) and men (SMR = 1.078 +/- 0.206) (SMR = 1 indicates that expected and observed survival are identical).The life expectancy of patients with giant cell arteritis is the same as that of the general population.

Abstract Toxicity Index scores were computed from symptoms, laboratory abnormalities, and hospitalizations attributed to nonsteroidal antiinflammatory drug (NSAID) therapy in 2,747 patients with rheumatoid arthritis receiving 5,642 courses of 11 NSAIDs over 8,481 patient‐years. Substantial differences in overall toxicity were found, the differences between drugs often being clinically significant (2‐3 times as toxic) and highly statistically significant. The results strengthened after adjustment for differing patient characteristics, held generally across multiple ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) data bank centers, and persisted after use of different techniques for the weighting of side effects. The most toxic side effects were experienced by patients taking indomethacin (mean ± SEM score 3.99 ± 0.58), tolmetin sodium (3.96 ± 0.74), and meclofenamate sodium (3.86 ± 0.66). Least toxic were coated or buffered aspirin (1.19 ± 0.10), salsalate (1.28 ± 0.34), and ibuprofen (1.94 ± 0.43). The most toxic drugs were generally taken in the lowest relative doses. There are statistical differences in overall toxicity between different NSAIDs as used in rheumatoid arthritis, and these differences are both clinically and statistically significant.

Objective: The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test–retest reliability), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability).Methods: Forty-eight MR examinations of the knee from normal subjects, patients with different stages of symptomatic knee osteoarthritis (OA), and a subset of duplicate images were independently and blindly quantified by three readers using the imaging system. The following cartilage areas were analyzed to compute volumes: global cartilage, medial and lateral compartments, and medial and lateral femoral condyles.Results: Between-reader agreement of measurements was excellent, as shown by intra-class correlation (ICC) coefficients ranging from 0.958 to 0.997 for global cartilage (P<0.0001), 0.974 to 0.998 for the compartments (P<0.0001), and 0.943 to 0.999 for the condyles(P<0.0001). Test–retest reliability of within-reader data was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). Patient positioning reliability was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001).Conclusions: The results of this study establish the reliability of this MR imaging system. Test–retest reliability, between-reader agreement, and patient positioning reliability were all extremely high. This study represents a first step in the overall validation of an imaging system designed to follow progression of human knee OA.

The Challenger space shuttle explosion in January 1986 offered an opportunity to determine what, if any, symptoms of posttraumatic stress disorder (PTSD) and bereavement normal latency-age children and adolescents would develop after a distant, horrifying event.With a structured interview, the authors assessed the symptoms of 153 randomly selected children from Concord, N.H., and Porterville, Calif. Responses were statistically compared between East Coast children, who saw the event on television and who generally cared more about the teacher aboard Challenger, and West Coast children, who heard about it first; between latency-age children and adolescents; and between children seen 5-7 weeks later and those same children seen 14 months later.More than 60% of the subjects feared at least one stimulus related to Challenger within the first 5-7 weeks of the explosion. The East Coast and latency-age groups appeared significantly more symptomatic than did the West Coast and adolescent groups. Over the 14-month study period, most symptoms dramatically faded. However, adolescents' diminished expectations for the future in general increased, and latency-age children's changed approach to space careers held relatively steady. Three East Coast latency-age children met the DSM-III-R symptom requirements for PTSD in 1986; no children met these in 1987.Children's symptomatic patterns after Challenger relate to the patterns for PTSD listed in diagnostic manuals and to three symptoms not in the DSM-IV list. To the authors, distant traumas appear to be one of a newly defined spectrum of trauma-related conditions that include relatively evanescent symptoms and a few longer-lasting ones. These symptoms may affect large numbers of normal children.

Background. The unique pharmacological properties of buprenorphine may make it a useful maintenance therapy for opiate addiction. This meta‐analysis considers the effectiveness of buprenorphine relative to methadone. Methods. A systematic literature search identified five randomized clinical trials comparing buprenorphine to methadone. Data from these trials were obtained. Retention in treatment was analyzed with a Cox proportional hazards regression. Urinalyses for opiates were studied with analysis of variance and a common method of handling missing values. A meta‐analysis was used to combine these results. Results. Subjects who received 8‐12 mg/day buprenorphine had 1.26 times the relative risk of discontinuing treatment (95% confidence interval 1.01‐1.57) and 8.3% more positive urinalyses (95% confidence interval 2.7‐14%) than subjects receiving 50‐80 mg/day methadone. Buprenophrine was more effective than 20‐35 mg/day methadone. There was substantial variation in outcomes in the different trials. Conclusions. The variation between trials may be due to differences in dose levels, patient exclusion criteria and provision of psychosocial treatment. The difference in the effectiveness of buprenorphine and methadone may be statistically significant, but the differences are small compared to the wide variance in outcomes achieved in different methadone treatment programs. Further research is needed to determine if buprenorphine treatment is more effective than methadone in particular settings or in particular subgroups of patients.

OBJECTIVE : To develop and validate the Physical Performance and Mobility Examination (PPME), an observer‐administered, performance‐based instrument assessing 6 domains of physical functioning and mobility for hospitalized elderly. DESIGN : Development of a pass‐fail and 3‐level scoring system and training manuals for the PPME instrument for use in both clinical and research settings. Two patient samples were used to assess construct validity and interrater reliability of the PPME. A third sample was selected to assess the test‐retest reliability of the instrument. SETTING/PATIENTS : (1) 146 subjects ≥65 years of age with impaired mobility admitted to Medical Units of Stanford University Hospital. (2) 352 subjects ≥65 admitted to acute Medical and Surgical Services of the Palo Alto VA Medical Center. Patient samples were obtained during hospitalization and followed until 3 months post‐discharge. To study test‐retest reliability, 50 additional patients, whose clinical condition was stable, were selected from both settings. METHODS : An expert panel selected 6 mobility tasks integral to daily life: bed mobility, transfer skills, multiple stands from chair, standing balance, step‐up, and ambulation. Tasks were piloted with frail hospitalized subjects for appropriateness and safety. Test‐retest and interrater reliability and construct validity were evaluated. Construct validity was tested using the Folstein Mini‐Mental State Examination, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Geriatric Depression Scale, and modified Medical Outcomes Study Measure of Physical Functioning (MOS‐PFR). Two scoring schema were developed for each task: (1) dichotomous pass‐fail and (2) 3‐level high pass, low pass, and fail. A summary scale was developed for each method of scoring. MAIN RESULTS : High interrater reliability and intrarater reliability were demonstrated for individual tasks. The mean percent agreement (interrater) for each pass/fail task ranged from 96 to 100% and from 90 to 100% for the 3 pairs of raters for each task using the 3‐level scoring. Kappas for individual pairs of raters ranged from .80 to 1.0 for pass‐fail scoring and from .75 to 1.0 for 3‐level scoring (all P &lt; 0.01). Intraclass correlation coefficients for 3‐level scoring by pairs of raters ranged from .66 to 1.0. For summary scales, the mean intraclass correlation was .99 for both scoring schema. Test‐retest reliability for summary scales using kappa coefficients was .99 for both pass‐fail and 3‐level scoring, and .99 and .98, respectively, using Pearson Product Moment Correlation. Correlations of PPME with other instruments (construct validity) suggest that the PPME adds a unique dimension of mobility beyond that measured by self‐reported ADLs and physical functioning, and it is not greatly influenced by mood or mental status ( r = 0.70 (ADL), r = 0.43 (IADL), r = 0.36 (MMSE), r = 0.71 (MOS‐PFR), r = 0.23 (GDS)). The 3‐level summary scale was sensitive to the variability in the patient population and exhibited neither ceiling nor floor effects. CONCLUSIONS : The PPME is a reliable and valid performance‐based instrument measuring physical functioning and mobility in hospitalized and frail elderly.

The appropriate size threshold for endovascular repair of small abdominal aortic aneurysms (AAA) is unclear. We studied the outcome of endovascular aneurysm repair (EVAR) as a function of preoperative aneurysm diameter to determine the relationship between aneurysm size and long-term outcome of endovascular repair.We reviewed the results of 923 patients treated in a prospective, multicenter clinical trial of EVAR. Small aneurysms were defined according to two size thresholds of 5.5 cm and 5.0 cm. Two-way analysis was used to compare patients with small aneurysms (<5.5 cm, n = 441) to patients with large aneurysms (> or =5.5 cm, n = 482). An ordered three-way analysis was used to compare patients with small AAA (<5.0 cm, n = 145), medium AAA (5.0 to 5.9 cm, n = 461), and large AAA (> or =6.0 cm, n = 317). The primary outcome measures of rupture, AAA-related death, surgical conversion, secondary intervention, and survival were compared using Kaplan-Meier estimates at 5 years.Median aneurysm size was 5.5 cm. The two-way comparison showed that 5 years after EVAR, patients with small aneurysms (<5.5 cm) had a lower AAA-related death rate (1% vs 6%, P = .006), a higher survival rate (69% vs 57%, P = .0002), and a lower secondary intervention rate (25% vs 32%, P = .03) than patients with large aneurysms (> or =5.5 cm). Three-way analysis revealed that patients with small AAAs (<5.0 cm) were younger (P < .0001) and were more likely to have a family history of aneurysm (P < .05), prior coronary intervention (P = .003), and peripheral occlusive disease (P = .008) than patients with larger AAAs. Patients with smaller AAAs also had more favorable aortic neck anatomy (P < .004). Patients with large AAAs were older (P < .0001), had higher operative risk (P = .01), and were more likely to have chronic obstructive pulmonary disease (P = .005), obesity (P = .03), and congestive heart failure (P = .004). At 5 years, patients with small AAAs had better outcomes, with 100% freedom from rupture vs 97% for medium AAAs and 93% for large AAAs (P = .02), 99% freedom from AAA-related death vs 97% for medium AAAs and 92% for large AAAs (P = .02) and 98% freedom from conversion vs 92% for medium AAAs and 89% for large AAAs (P = .01). Survival was significantly improved in small (69%) and medium AAAs (68%) compared to large AAAs (51%, P < .0001). Multivariate Cox proportional hazards modeling revealed that aneurysm size was a significant independent predictor of rupture (P = .04; hazard ratio [HR], 2.195), AAA-related death (P = .03; HR, 2.007), surgical conversion (P = .007; HR, 1.827), and survival (P = .001; HR, 1.351). There were no significant differences in secondary intervention, endoleak, or migration rates between small, medium, and large AAAs.Preoperative aneurysm size is an important determinant of long-term outcome following endovascular repair. Patients with small AAAs (<5.0 cm) are more favorable candidates for EVAR and have the best long-term outcomes, with 99% freedom from AAA death at 5 years. Patients with large AAAs (> or =6.0 cm) have shorter life expectancy and have a higher risk of rupture, surgical conversion, and aneurysm-related death following EVAR compared to patients with smaller aneurysms. Nonetheless, 92% of patients with large AAAs are protected from AAA-related death at 5 years. Patients with AAAs of intermediate size (5 to 6 cm) represent most of the patients treated with EVAR and have a 97% freedom from AAA-related death at 5 years.

The objective of this article was to estimate the prevalence of Paget's disease of bone in the United States from a statistically derived sample of the general population. Pelvic radiographs obtained in the First National Health and Nutrition Examination Survey (NHANES-I) were reviewed for the presence of Paget's disease. Age, sex, and geographic distribution of Paget's disease of the pelvic region were determined. The overall prevalence of Paget's disease in the United States was estimated. Pelvic Paget's disease is estimated to be present in 0.71 + 0.18% of the radiographs of the general population. The disease was higher in frequency in people who were in the older decades of life with the highest prevalence of 2.32 + 0.54% in the 65- to 74-year-old people. There is a slight male predominance in the 45- to 74-year age group. The regional distribution suggests the highest prevalence in the Northeast (1.48 + 0.52%) with the lowest prevalence in the South (0.26+0.25%). The prevalence was equal in white people and black people. An estimate of the overall prevalence of Paget's disease in the United States was at least 1% and perhaps as much as 2 % of the general population with near equal sex distribution and the highest prevalence in the northeastern United States.

OBJECTIVE: To determine survivorship in Wegener's granulomatosis (WG) in a well-defined multicenter cohort. METHODS: Follow-up was obtained for 77 of the 85 patients enrolled in the 1990 American College of Rheumatology vasculitis classification study. RESULTS: There were 28 deaths (10 females and 18 males) among the 77 patients available for follow-up. Standardized mortality ratios (SMR) were calculated with mortality data from the general population and from this group of patients with WG (an SMR of 1 indicates that expected and observed survival are identical). Overall survivorship among patients with WG was substantially reduced in this cohort (SMR = 4.685 ± 0.65; for females SMR = 6.814 ± 1.571; for males SMR = 3.998 ± 0.69). CONCLUSION: The life expectancy of patients with WG is reduced compared with the general population. To determine survivorship in Wegener's granulomatosis (WG) in a well-defined multicenter cohort. Follow-up was obtained for 77 of the 85 patients enrolled in the 1990 American College of Rheumatology vasculitis classification study. There were 28 deaths (10 females and 18 males) among the 77 patients available for follow-up. Standardized mortality ratios (SMR) were calculated with mortality data from the general population and from this group of patients with WG (an SMR of 1 indicates that expected and observed survival are identical). Overall survivorship among patients with WG was substantially reduced in this cohort (SMR = 4.685 ± 0.65; for females SMR = 6.814 ± 1.571; for males SMR = 3.998 ± 0.69). The life expectancy of patients with WG is reduced compared with the general population.

To evaluate the effectiveness of a health promotion program in a retiree population in terms of health risk reduction and reduction in medical costs.Randomized controlled trial.Bank of America retirees (n = 4,712), divided into 33 retiree club regions, were randomized into 3 groups and followed for 24 months by patient report and claims experience. Group 1, the intervention group, received a low-cost ($30/year), individualized, serially reinforcing health promotion program including risk appraisal, recommendation letters, and self-management materials, delivered entirely through the mail. Group 2 received risk appraisals only, without feedback, for the first 12 months and subsequently the full intervention for the second 12 months. Group 3 was followed with claims data only. Participation rates of 57% at 1 year and 47% at 2 years were achieved.Overall health risk scores improved by 12% at 12 months compared with control (p < 0.001) and by 23% (from baseline) at 24 months (p < 0.001). Individual health habit changes were favorable for all parameters studied, and were highly statistically significant for most variables. Similar health risk reductions were seen in age groups of 55 to 65 years, 65 to 75 years, and over 75. Cost reduction differences were more than 20% by self-report (p < 0.01) and 10% by claims experience (p = 0.02) at 12 months. For the randomized controlled period of the first 12 months, reductions averaged $164 in the intervention group contrasted with an average increase of $15 in the combined control groups.Risk reduction programs directed at retiree populations can improve health risk status and can reduce costs.

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We present a measurement of the shape of the boson rapidity distribution for p¯p→Z/γ∗→e+e−+X events at a center-of-mass energy of 1.96 TeV. The measurement is made for events with electron-positron mass 71<Mee<111 GeV and uses 0.4 fb−1 of data collected at the Fermilab Tevatron collider with the D0 detector. This measurement significantly reduces the uncertainties on the rapidity distribution in the forward region compared with previous measurements. Predictions of next-to-next-to-leading order (NNLO) QCD are found to agree well with the data over the full rapidity range.Received 16 February 2007DOI:https://doi.org/10.1103/PhysRevD.76.012003©2007 American Physical Society

A data sample corresponding to an integrated luminosity of 2.1 fb−1 collected by the DØ detector at the Fermilab Tevatron Collider was analyzed to search for squarks and gluinos produced in pp¯ collisions at a center-of-mass energy of 1.96 TeV. No evidence for the production of such particles was observed in topologies involving jets and missing transverse energy, and 95% C.L. lower limits of 379 GeV and 308 GeV were set on the squark and gluino masses, respectively, within the framework of minimal supergravity with tanβ=3, A0=0, and μ<0. The corresponding previous limits are improved by 54 GeV and 67 GeV.

The D0 Collaboration presents first evidence for the production of single top quarks at the Fermilab Tevatron pp[over ] collider. Using a 0.9 fb(-1) dataset, we apply a multivariate analysis to separate signal from background and measure sigma(pp[over ]-->tb+X,tqb+X)=4.9+/-1.4 pb. The probability to measure a cross section at this value or higher in the absence of a signal is 0.035%, corresponding to a 3.4 standard deviation significance. We use the cross section measurement to directly determine the Cabibbo-Kobayashi-Maskawa matrix element that describes the Wtb coupling and find 0.68<|V(tb)|</=1 at 95% C.L. within the standard model.

To report the FLEXX trial, the first well-controlled study assessing the safety and efficacy of Euflexxa (1% sodium hyaluronate; IA-BioHA) therapy for knee osteoarthritis (OA) at 26 weeks.This was a randomized, double-blind, multicenter, saline-controlled study. Subjects with chronic knee OA were randomized to 3 weekly intra-articular (IA) injections of either buffered saline (IA-SA) or IA-BioHA (20 mg/2 ml). The primary efficacy outcome was subject recorded difference in least-squares means between IA-BioHA and IA-SA in subjects' change from baseline to week 26 following a 50-foot walk test, measured via 100-mm visual analog scale (VAS). Secondary outcome measures included Osteoarthritis Research Society International responder index, Western Ontario McMaster University Osteoarthritis Index VA 3.1 subscales, patient global assessment, rescue medication, and health-related quality of life (HRQoL) by the SF-36. Safety was assessed by monitoring and reporting vital signs, physical examination of the target knee following injection, adverse events, and concomitant medications.Five hundred eighty-eight subjects were randomized to either IA-BioHA (n = 293) or IA-SA (n = 295), with an 88% 26 week completion rate. No statistical differences were noted between the treatment groups at baseline. In the IA-BioHA group, mean VAS scores decreased by 25.7 mm, compared with 18.5 mm in the IA-SA group. This corresponded to a median reduction of 53% from baseline for IA-BioHA and a 38% reduction for IA-SA. The difference in least-squares means was -6.6 mm (P = 0.002). Secondary outcome measures were consistent with significant improvement in Osteoarthritis Research Society International responder index, HRQoL, and function. Both IA-SA and IA-BioHA injections were well tolerated, with a low incidence of adverse events that were equally distributed between groups. Injection-site reactions were reported by 1 (<1%) subject in the IA-SA group and 2 (1%) in the IA-BioHA group.IA-BioHA therapy resulted in significant OA knee pain relief at 26 weeks compared with IA-SA. Subjects treated with IA-BioHA also experienced significant improvements in joint function, treatment satisfaction, and HRQoL.

We present a measurement of the shape of the $Z/{\ensuremath{\gamma}}^{*}$ boson transverse momentum (${q}_{T}$) distribution in $p\overline{p}\ensuremath{\rightarrow}Z/{\ensuremath{\gamma}}^{*}\ensuremath{\rightarrow}{e}^{+}{e}^{\ensuremath{-}}+X$ events at a center-of-mass energy of 1.96 TeV using $0.98\text{ }\text{ }{\mathrm{fb}}^{\ensuremath{-}1}$ of data collected with the D0 detector at the Fermilab Tevatron collider. The data are found to be consistent with the resummation prediction at low ${q}_{T}$, but above the perturbative QCD calculation in the region of ${q}_{T}&gt;30\text{ }\text{ }\mathrm{GeV}/c$. Using events with ${q}_{T}&lt;30\text{ }\text{ }\mathrm{GeV}/c$, we extract the value of ${g}_{2}$, one of the nonperturbative parameters for the resummation calculation. Data at large boson rapidity $y$ are compared with the prediction of resummation and with alternative models that employ a resummed form factor with modifications in the small Bjorken $x$ region of the proton wave function.

We report the first direct observation of the strange b baryon Xi(b)- (Xi(b)+). We reconstruct the decay Xi(b)- -->J/psiXi-, with J/psi-->mu+mu-, and Xi--->Lambdapi--->ppi-pi- in pp collisions at square root of s =1.96 TeV. Using 1.3 fb(-1) of data collected by the D0 detector, we observe 15.2 +/- 4.4(stat)(-0.4)(+1.9)(syst) Xi(b)- candidates at a mass of 5.774 +/- 0.011(stat) +/- 0.015(syst) GeV. The significance of the observed signal is 5.5 sigma, equivalent to a probability of 3.3 x 10(-8) of it arising from a background fluctuation. Normalizing to the decay Lambda(b)-->J/psiLambda, we measure the relative rate sigma(Xi(b-) x B(Xi)b})- -->J/psiXi-)/sigma(Lambda(b)) x B(Lambda(b)-->J/psiLambda) = 0.28+/-0.09(stat)(-0.08)(+0.09)(syst).

While we agree with the general message of the Thompson and Walter paper on the use and value of kappa, the mathematical bases of these conclusions, their equations, tables, and figures are based on mathematical assumptions so limiting that their application to real data is questionable. As a result, several of their specific conclusions are misleading. Some of the same results are here obtained without the limiting restrictions. From these results, the value of kappa as a measure of reliability, validity and (possibly) of general 2 x 2 association is demonstrated.

We present first evidence for the production of single top quarks in the D0 detector at the Fermilab Tevatron ppbar collider. The standard model predicts that the electroweak interaction can produce a top quark together with an antibottom quark or light quark, without the antiparticle top quark partner that is always produced from strong coupling processes. Top quarks were first observed in pair production in 1995, and since then, single top quark production has been searched for in ever larger datasets. In this analysis, we select events from a 0.9 fb-1 dataset that have an electron or muon and missing transverse energy from the decay of a W boson from the top quark decay, and two, three, or four jets, with one or two of the jets identified as originating from a b hadron decay. The selected events are mostly backgrounds such as W+jets and ttbar events, which we separate from the expected signals using three multivariate analysis techniques: boosted decision trees, Bayesian neural networks, and matrix element calculations. A binned likelihood fit of the signal cross section plus background to the data from the combination of the results from the three analysis methods gives a cross section for single top quark production of 4.7 +- 1.3 pb. The probability to measure a cross section at this value or higher in the absence of signal is 0.014%, corresponding to a 3.6 standard deviation significance. The measured cross section value is compatible at the 10% level with the standard model prediction for electroweak top quark production.

Algorithms distinguishing jets originating from b quarks from other jet flavors are important tools in the physics program of the D0 experiment at the Fermilab Tevatron p-pbar collider. This article describes the methods that have been used to identify b-quark jets, exploiting in particular the long lifetimes of b-flavored hadrons, and the calibration of the performance of these algorithms based on collider data.

Abstract We present examples of the usage of regression trees for censored response via two real world datasets, one a rheumatoid arthritis survival study and the other a hip replacement study, and draw comparisons with the results of Cox proportional hazards modelling. The two methods pursue different goals. Motivation of the tree techniques is the desire to extract meaningful prognostic groups while the proportional hazards model enables assessment of the impact of risk factors. The methods are thus complementary. For the arthritis study the two techniques corroborate one another, although the flavour of the conclusions derived differ. For the hip replacement study, however, the regression tree approach reveals structure that would not emerge from a routine proportional hazards analysis. We also discuss the treatment of data analytic issues such as the handling of missing values and influence in the presence of non‐uniform censoring.

Four hundred ninety-eight long-distance runners aged 50 to 72 years were compared with 365 community control subjects to examine associations of repetitive, long-term physical impact (running) with musculoskeletal disability and medical service utilization in a cross-section study. Runners had less physical disability than age-matched control subjects (p less than 0.01) and maintained more functional capacity (p less than 0.001) as measured by a modified Health Assessment Questionnaire Disability Index. Runners sought medical services less often, but one third of the visits that they did make were for running-related injuries. No differences were found between groups in conditions thought to predispose to osteoarthritis and musculoskeletal disability. Ligamentous laxity and family history of arthritis were similar in both groups. Runners demonstrated better cardiovascular fitness and weighed less. Differences persisted after adjustment for age, occupation, and sex, and after inclusion or exclusion of subjects with major medical problems. Musculoskeletal disability appeared to develop with age at a lower rate in runners (0.003 units per year versus 0.028) than in community control subjects, and the decreased rate was observed with both lower extremity and upper extremity functions. These data suggest positive effects of systematic aerobic running activity upon functional aspects of musculoskeletal aging.

A fully reconstructed Bc-->J/psipi signal is observed with the D0 detector at the Fermilab Tevatron pp[over] collider using 1.3 fb(-1) of integrated luminosity. The signal consists of 54+/-12 candidates with a significance that exceeds 5 standard deviations, and confirms earlier observations of this decay. The measured mass of the Bc meson is 6300+/-14(stat)+/-5(syst) MeV/c2.

The CMS detector at the CERN LHC features a silicon pixel detector as its innermost subdetector. The original CMS pixel detector has been replaced with an upgraded pixel system (CMS Phase-1 pixel detector) in the extended year-end technical stop of the LHC in 2016/2017. The upgraded CMS pixel detector is designed to cope with the higher instantaneous luminosities that have been achieved by the LHC after the upgrades to the accelerator during the first long shutdown in 2013–2014. Compared to the original pixel detector, the upgraded detector has a better tracking performance and lower mass with four barrel layers and three endcap disks on each side to provide hit coverage up to an absolute value of pseudorapidity of 2.5. This paper describes the design and construction of the CMS Phase-1 pixel detector as well as its performance from commissioning to early operation in collision data-taking.

Abstract Measurements of standing balance were determined for 92 children and adolescents, 5–18 years old, while they stood on a force plate with eyes open or eyes closed. The measurements included center‐of‐pressure calculations for path length per second, average radial displacement, anterior‐posterior and me‐diolateral amplitudes, area per second, mean frequency of sway, Brownian random motion measure of short‐term diffusion coefficient, and long‐term scaling exponent. All balance parameters improved from youngest to oldest subjects, and the parameters improved when measured with the subjects' eyes open compared with closed. The mean values for data from three trials varied by only 5% when compared with the mean values from 10 trials. Data from this study suggest that force‐plate center‐of‐pressure data can be used to determine differences in standing balance between children and adolescents of different ages and those with movement and balance abnormalities.

To determine whether the outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia (PCP), and respiratory failure has changed, we studied patients admitted to the intensive care units an San Francisco General Hospital from 1981 to 1988. We compared the course of patiente with PCP and respiratory failure admitted to the intensive care unit from 1986 to 1988 with a similar cohort hospitalized from 1981 to 1985. The hospital survival rate for the 35 patiente in the 1986 to 1988 cohort was 40%, compared with 14% for the 42 patiente in the 1981 to 1985 cohort (p < 0.01). Age, episode of PCP, time since AIDS diagnosis, anti-PCP therapy, and important clinical variables were similar in both cohorts. Corticosteroids were used commonly in the recent era. Patiente who received steroids had an in-hospital survival rate of 46%, compared with 22% for those who did not receive steroids (p = NS). In a stepwise logistic regression model, ICU care in the recent era and higher serum albumin at the time of ICU admission were the only variables significantly associated with survival. The hospital survival of patienta with PCP and respiratory failure has improved. The improvement could not be explained by patient selection or by better anti-PCP therapy. The apparent beneficial effect of corticosteroids deserves further study. The improvement in ICU outcome was reflected in increased ICU utilization by patiente with AIDS, PCP, and respiratory failure.

Arthritis & RheumatismVolume 33, Issue 1 p. 121-130 ArticleFree to Read A toxicity index for comparison of side effects among different drugs James F. Fries MD, Corresponding Author James F. Fries MD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Stanford University Medical Center, HRP Building, Room 109C, Stanford, CA 94305Search for more papers by this authorPatricia W. Spitz Rn, Ms, Patricia W. Spitz Rn, Ms Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorCatherine A. Williams MA, Catherine A. Williams MA Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorDaniel A. Bloch PhD, Daniel A. Bloch PhD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorGurkirpal Singh MD, Gurkirpal Singh MD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorHelen B. Hubert Mph, Phd, Helen B. Hubert Mph, Phd Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this author James F. Fries MD, Corresponding Author James F. Fries MD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Stanford University Medical Center, HRP Building, Room 109C, Stanford, CA 94305Search for more papers by this authorPatricia W. Spitz Rn, Ms, Patricia W. Spitz Rn, Ms Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorCatherine A. Williams MA, Catherine A. Williams MA Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorDaniel A. Bloch PhD, Daniel A. Bloch PhD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorGurkirpal Singh MD, Gurkirpal Singh MD Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorHelen B. Hubert Mph, Phd, Helen B. Hubert Mph, Phd Division of Immunology and Rheumatology, Department of Medicien, Stanford University School of Medicine, Stanford, California.Search for more papers by this author First published: January 1990 https://doi.org/10.1002/art.1780330117Citations: 67AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Fries JF, Spitz P, Kraines RG, Holman HR: Measurement of patient outcome in arthritis. Arthritis Rheum 23: 137–145, 1980 2 Fries JF, Spitz PW, Mitchell DM, Roth SH, Wolfe F, Bloch DA: Impact of specific therapy upon rheumatoid arthritis. Arthritis Rheum 29: 620–627, 1986 3 Wolfe F, Kleinheksel SM, Cathey MA, Hawley DJ, Spitz PW, Fries JF: The clinical value of the Stanford Health Assessment Questionnaire functional disability index in patients with rheumatoid arthritis. J Rheumatol 15: 1480–1488, 1988 4 Borg G, Allander E, Lund B, Berg E, Brodin U, Pettersson H, Trang L: Auranofin improves outcome in early rheumatoid arthritis: results from a 2-year, double blind, placebo controlled study. J Rheumatol 15: 1747–1754, 1988 5 Fries JF, Miller SR, Spitz PW, Williams CA, Hubert HB, Bloch DA: Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use. Gastroenterology 96: 647–655, 1989 6 Fries JF, Spitz PW, Young DY: The dimensions of health outcomes: the Health Assessment Questionnaire, disability and pain scales. J Rheumatol 9: 789–793, 1982 7 Fries JF: Toward an understanding of patient outcome measurement. Arthritis Rheum 26: 697–704, 1983 8 Fries JF: The chronic disease data bank: first principles to future directions. J Philos Med 9: 161–180, 1984 9 Fries JF: The ARAMIS (American Rheumatism Association Medical Information System) post-marketing surveillance program. Drug Info J 19: 257–262, 1985 10 Fries JF: Alternatives in medical record formats. Med Care 12: 871–881, 1974 11 Pincus T, Callahan LF: Formal education as a marker for increased mortality and morbidity in rheumatoid arthritis. J Chronic Dis 38: 973–984, 1985 12 Winer BJ: Statistical Principles in Experimental Design. New York, McGraw-Hill, 1971 13 Bloch DA, Segal MR: Empirical comparison of approaches to forming strata: using classification trees to adjust for covariates. J Am Stat Assoc (in press) 14 Fries JF, Bloch DA, Segal MR, Spitz PW, Williams CA, Lane NE: Postmarketing surveillance in rheumatology: analysis of purpura and upper abdominal pain. J Rheumatol 15: 348–355, 1988 15 Moses LE: Think and Explain with Statistics. Reading, MA, Addison-Wesley, 1986 16 Baum C, Kennedy DL, Forbes MB, Jones JK: Drug use in the United States in 1981. JAMA 251: 1293–1297, 1984 17 Coles LS, Fries JF, Kraines RG, Roth SH: From experiment to experience: side effects of non-steroidal anti-inflammatory drugs. Am J Med 74: 820–828, 1983 18 Faich GA, Dreis M, Tomita D: National adverse drug reaction surveillance 1986. Arch Intern Med 148: 785–787, 1988 19 Silman AJ, Petrie J, Hazleman B, Evans SJW: Lymphoproliferative cancer and other malignancy in patients with rheumatoid arthritis treated with azathioprine: a 20-year follow-up study. Ann Rheum Dis 47: 988–992, 1988 20 Summons DPM: Neoplasia in rheumatoid arthritis. J Rheumatol 15: 1319–1322, 1988 Citing Literature Volume33, Issue1January 1990Pages 121-130 ReferencesRelatedInformation

Hadronic decays of Z0 bosons are studied in the Delphi detector. Global event variables and singel particles inclusive distributions are compared with QCD-based predictions. The mean charged multiplicity is found to be 20.6±1.0 (stat+syst). The mean values of the sphericity, aplanarity, thrust, minor value, pinT and poutT are compared with values found at lower energy e+e− colliders.

OBJECTIVE: To assess the utility of geriatric targeting criteria in predicting survival and health care utilization in a cohort of hospitalized older veterans. DESIGN: A prospective cohort study assessing geriatric targeting criteria, e.g., polypharmacy, falls, or confusion, with respect to adverse outcomes at 12 months. SETTING A Tertiary Care VA Medical Center. PATIENTS: 507 acutely hospitalized male veterans aged 65 years or more. MAIN OUTCOME MEASURES: Survival status, nursing home placement, and total hospital days during 12 months following hospital admission. RESULTS: Patients who had a higher number of targeting criteria at admission showed a significantly increasing trend toward death ( P ≤ .001), nursing home placement ( P ≤ .01), and longer hospital stays ( P ≤ .01) at 12 months. In univariate analyses, weight loss (relative hazard 3.8, 95% CI 2.4, 5.9), appetite loss (relative hazard 3.3, 95% CI 1.9, 5.8), depression (relative hazard 2.5, 95% CI 1.4, 4.5), falls (relative hazard 2.2, 95% CI 1.2, 4.1), confusion (relative hazard 2.2, 95% CI 1.2, 4.0), and socioeconomic problems (relative hazard 1.6, 95% CI 1.0, 2.5) predicted death. Polypharmacy (OR 3.4, 95% CI 1.3, 8.8), confusion (OR 4.4, 95% CI 1.5, 13.0), and prolonged bedrest (OR 7.6, 95% CI 1.5, 39.3) predicted nursing home placement. Confusion (Beta 12.0, 95% CI 2.9, 21.3), falls (Beta 14.2, 95% CI 4.2, 24.3), and prolonged bedrest (Beta 22.4, 95% CI 3.9, 41.0) predicted total hospital days. In multivariate analyses, weight loss, depression, and socioeconomic problems predicted death; confusion and polypharmacy predicted nursing home placements; and falls predicted total hospital days. CONCLUSION: This prospective cohort study of hospitalized older veterans demonstrated geriatric targeting criteria as predictors of adverse hospital outcomes. Our findings suggest screening acutely hospitalized patients using chart abstracted geriatric targeting criteria is useful in identifying patients at risk for adverse outcomes of hospitalization. J Am Geriatr Soc 44:914–921, 1996.

The cross section for the inclusive production of isolated photons has been measured in pp¯ collisions at s=1.96TeV with the DØ detector at the Fermilab Tevatron Collider. The photons span transverse momenta 23 to 300 GeV and have pseudorapidity |η|<0.9. The cross section is compared with the results from two next-to-leading order perturbative QCD calculations. The theoretical predictions agree with the measurement within uncertainties.

<b><i>Objective: </i></b> This prospective, randomized, controlled study was designed to investigate the safety, feasibility, and preliminary efficacy of long-term CSF drainage via a low-flow ventriculoperitoneal shunt in subjects suffering from AD. <b><i>Methods: </i></b> Twenty-nine subjects selected for probable AD (National Institute of Neurological and Communicative Diseases and Stroke–Alzheimer’s Disease and Related Dementias Association criteria) were screened to exclude normal pressure hydrocephalus or other etiologies of dementia and randomized to treatment (shunt) or no treatment groups. The study endpoint was the comparison of group performance on psychometric testing at quarterly intervals for 1 year. Shunted subjects had CSF withdrawn for MAP-tau and Aβ_(1-42) assays at the same time intervals. <b><i>Results: </i></b> There was no mortality from the surgical procedure, and no patient sustained a subdural hematoma. Five notable postoperative adverse events, which resolved without permanent neurologic deficit, were reported in the shunt group. Group mean Mattis Dementia Rating Scale total scores showed little change over the year in the shunt-treatment group, in contrast to a decline in the control group (<i>p</i> = 0.06). Mini-Mental State Examination mean scores supported a trend in favor of shunt treatment (<i>p</i> = 0.1). There was a concomitant decrease in ventricular CSF concentrations of AD biomarkers MAP-tau and Aβ_(1-42). <b><i>Conclusions: </i></b> The surgical procedure and the device are reasonably safe. Adverse events were consistent with shunt procedures for hydrocephalus in this older population. The endpoint data show a trend in favor of the treated group. A larger, randomized, double-blinded, controlled, clinical trial is underway.

ABSTRACT Aims To conduct a preliminary evaluation of the safety and efficacy of tiagabine, sertraline or donepezil versus an unmatched placebo control as a treatment for cocaine dependence. Design A 10‐week out‐patient study was conducted using the Cocaine Rapid Efficacy and Safety Trial (CREST) study design. Setting This study was conducted at the Cincinnati Medication Development Research Unit (MDRU) and at an affiliated site in Dayton, Ohio. Participants Participants met Diagnostic and Statistical Manual version IV (DSM‐IV) criteria for cocaine dependence. Sixty‐seven participants were enrolled with 55 completing final study measures. Intervention The targeted daily doses of medication were tiagabine 20 mg, sertraline 100 mg and donepezil 10 mg. All participants received 1 hour of manualized individual cognitive behavioral therapy on a weekly basis. Measurements Primary outcome measures of efficacy included urine benzoylecgonine (BE) level, Cocaine Clinical Global Impression Scale–Observer and self‐report of cocaine use. Safety measures included adverse events, ECGs, vital signs and laboratory tests. Findings Subjective measures of cocaine dependence indicated significant improvement for all study groups. Generalized estimating equations analysis indicated that the tiagabine group showed a trend toward a significant decrease in urine BE level from baseline to weeks 5–8 ( P = 0.10) and non‐significant changes for the other study groups. No pattern of physical or laboratory abnormalities attributable to treatment with any of the medications was identified. There were three serious adverse events reported, none of which were related to study procedures. Conclusions The present findings suggest that tiagabine may be worthy of further study as a cocaine dependence treatment.

Abstract Objective . To analyze changes in functional status and the factors contributing to disability in a national inception cohort of 257 patients with polymyositis/dermatomyositis (PM/DM). Methods . Data were gathered from patients' self‐reports on questionnaires: one concerning disease‐ and treatment‐related complications, and the other concerning disability, as reflected by a disability index (DI) derived from the Health Assessment Questionnaire (HAQ). Results . Based on certain characteristics that differentiated disability patterns, 3 groups of patients were identified. Group 1 patients (n = 153) were ≥60 years old and never had avascular necrosis (AVN) or a vertebral compression fracture (CF), Group 2 patients were &gt;60 and never had AVN or a vertebral CF, and Group 3 patients reported AVN or a vertebral CF irrespective of age. As measured by the HAQ DI, disability increased very gradually over time in Group 1 patients and more rapidly in Group 2 and Group 3 patients. The increase in disability in patients experiencing AVN was greater than that in patients with similar pre‐AVN disease characteristics who did not develop AVN ( P = 0.003). Conclusion . In this prospective study of disease course and iatrogenic factors related to functional disability in PM/DM, the HAQ DI increased with disease duration. Corticosteroid‐related morbidity, as reflected by the development of AVN or CF, significantly contributed to patient‐reported functional disability.

We conducted a cost identification analysis on 164 consecutive patients with systemic lupus erythematosus (SLE) who entered the Montreal General Hospital Lupus Registry between January 1977 and January 1990, compared their costs to the population of Quebec, and determined the predictors of cost.In January 1990 and 1991, participants completed questionnaires on health services utilization and on employment history over the preceding 6 months, as well as on functional, psychological, and social well-being. The societal burden of SLE was determined in terms of direct costs (all resources consumed in patient care) and indirect costs (wages lost due to lack of work force participation because of morbidity).The mean total annual cost for 1989, as assessed in January 1990 and expressed in 1990 Canadian dollars, was $13,094. Although only 44% of the patients were fully employed, indirect costs were responsible for 54% of this total ($7,071). Ambulatory costs, primarily diagnostic procedures, medications, and visits to health care professionals, comprised 55% of direct costs ($3,331). The results of the 1990 cost determination were similar. On average, hospitalizations among SLE patients were 4 times more frequent than among the general population of Quebec (matched for age and sex), and the number of ambulatory visits to physicians was double that for the average resident of Quebec. Higher 1989 values of creatinine and a poorer level of physical functioning were the best predictors of higher 1990 direct costs (R2 = 0.29). A poorer SLE well-being score, a combination of education and employment status, and a weaker level of social support were the best predictors of higher indirect costs (R2 = 0.29).The direct and indirect costs for patients with SLE are substantial, and their respective predictors are distinct. Direct costs arise from organic complications which induce functional disability. Predictors of indirect costs are potentially amenable to psychological or social interventions and may be more easily modified than the determinants of direct costs, thereby improving patient outcome while simultaneously reducing disease costs.

This paper presents an analysis of the multiplicity distributions of charged particles produced inZ 0 hadronic decays in the DELPHI detector. It is based on a sample of 25364 events. The average multiplicity is <n ch>=20.71±0.04(stat)±0.77(syst) and the dispersionD=6.28±0.03(stat)±0.43(syst). The data are compared with the results at lower energies and with the predictions of phenomenological models. The Lund parton shower model describes the data reasonably well. The multiplicity distributions show approximate KNO-scaling. They also show positive forward-backward correlations that are strongest in the central region of rapidity and for particles of opposite charge.

Correlations in the azimuthal angle between the two largest transverse momentum jets have been measured using the D0 detector in $p\overline{p}$ collisions at a center-of-mass energy $\sqrt{s}=1.96\text{ }\text{ }\mathrm{TeV}$. The analysis is based on an inclusive dijet event sample in the central rapidity region corresponding to an integrated luminosity of $150\text{ }\text{ }{\mathrm{pb}}^{\ensuremath{-}1}$. Azimuthal correlations are stronger at larger transverse momenta. These are well described in perturbative QCD at next-to-leading order in the strong coupling constant, except at large azimuthal differences where contributions with low transverse momentum are significant.

All primary condylar total knee replacement arthroplasties (TKAs) performed from 1977 to 1984 at the authors' institution were divided into two groups based on the use of continuous passive motion (CPM) in the immediate postoperative period. The control group consisted of 73 patients who were treated with 95 TKAs without postoperative CPM. The average age was 65.4 years. The study group consisted of 38 patients who had 51 TKAs in which CPM was used postoperatively. The mean patient age was 62.8 years. The most common diagnoses in both groups were osteoarthritis and rheumatoid arthritis. Range of motion (ROM) was recorded preoperatively, at discharge, at three months, one year, two years, and at the last follow-up visit. There were no statistically significant differences in the ROM between the two groups at any of these time periods. At two years, the mean flexion and extension in the study group were 99° and −4°, respectively, compared to 103° and −5° in the control group. The average hospital stay was 11.2 days in the study group, whereas it was 15.1 days in control group. In the control group, there was one superficial infection, no deep infections, and four pulmonary emboli compared with three superficial infections, two deep infections, and no pulmonary emboli in the study group. There was no difference in the transfusion requirements between the two groups. CPM is advocated by the authors to help achieve discharge ROM earlier, but the protocol has been changed to begin CPM on the second postoperative day to allow the wound to stabilize.

Patients with radiculopathy, with or without back pain, often do not respond to conservative care and may be considered for epidural steroid injection therapy or a disc decompression procedure. Plasma disc decompression (PDD) using the Coblation SpineWand device is a percutaneous, minimally invasive interventional procedure. The purpose of this study was to evaluate clinical outcomes with PDD as compared with standard care using fluoroscopy-guided transforaminal epidural steroid injection (TFESI) over the course of 2 years.This was a multicenter randomized controlled clinical study. Ninety patients (18-66 years old) who had sciatica (visual analog scale score > or = 50) associated with a single-level lumbar contained disc herniation were enrolled. In all cases, their condition was refractory to initial conservative care and 1 epidural steroid injection had failed. Participants were randomly assigned to receive either PDD (46 patients) or TFESI (44 patients, up to 2 injections).The patients in the PDD Group had significantly greater reduction in leg pain scores and significantly improved Oswestry Disability Index and 36-Item Short Form Health Survey ([SF-36], physical function, bodily pain, social function, and physical components summary) scores than those in the TFESI Group. During the 2-year follow-up, 25 (56%) of the patients in the PDD Group and 11 (28%) of those in the TFESI Group remained free from having a secondary procedure following the study procedure (log-rank p = 0.02). A significantly higher percentage of patients in the PDD Group showed minimum clinically important change in scores for leg and back pain and SF-36 scores that exceeded literature-based minimum clinically important changes. Procedure-related adverse events, including injection site pain, increased leg or back pain, weakness, and lightheadedness, were observed in 5 patients in the PDD Group (7 events) and 7 in the TFESI Group (14 events).In study patients who had radicular pain associated with a contained lumbar disc herniation, those patients treated with PDD had significantly reduced pain and better quality of life scores than those treated using repeated TFESI. In addition, significantly more PDD patients than TFESI patients avoided having to undergo a secondary procedure during the 2-year study follow-up.

We report the direct observation of the excited $L=1$ state ${B}_{s2}^{*}$ in fully reconstructed decays to ${B}^{+}{K}^{\ensuremath{-}}$. The mass of the ${B}_{s2}^{*}$ meson is measured to be $5839.6\ifmmode\pm\else\textpm\fi{}1.1(\mathrm{stat})\ifmmode\pm\else\textpm\fi{}0.7(\mathrm{syst})\text{ }\text{ }\mathrm{MeV}/{c}^{2}$, and its production rate relative to the ${B}^{+}$ meson is measured to be $[1.15\ifmmode\pm\else\textpm\fi{}0.23(\mathrm{stat})\ifmmode\pm\else\textpm\fi{}0.13(\mathrm{syst})]%$.

We present a measurement of the muon charge asymmetry from W boson decays using 0.3 fb−1 of data collected at s=1.96 GeV between 2002 and 2004 with the D0 detector at the Fermilab Tevatron pp¯ Collider. We compare our findings with expectations from next-to-leading-order calculations performed using the CTEQ6.1M and MRST04 NLO parton distribution functions. Our findings can be used to constrain future parton distribution function fits.Received 27 September 2007DOI:https://doi.org/10.1103/PhysRevD.77.011106©2008 American Physical Society

This report comprises the outcome of five working groups that have studied the physics potential of the high-luminosity phase of the LHC (HL-LHC) and the perspectives for a possible future high-energy LHC (HE-LHC).The working groups covered a broad range of topics: Standard Model measurements, studies of the properties ofthe Higgs boson, searches for phenomena beyond the Standard Model, flavor physics of heavy quarks and leptonsand studies of QCD matter at high density and temperature.The work is prepared as an input to the ongoing process of updating the European Strategy for Particle Physics,a process that will be concluded in May 2020.