Amount of KETO, MP and PP in sample was calculated by comparing t

Amount of KETO, MP and PP in sample was calculated by comparing the mean Rf for standard and sample solution by formula no. 2. Amount of KETO, MP and PP in sample (mg) was calculated by following formula: equation(2) AmountofdrugKETO,MPandPP(mL)estimated(mg)=Meanamountestimated(μg)inappliedvolumeVolumeofsamplesolutionapplied(μL)×Volumeofstocksolution Amount of the

drug recovered (mg) and % recovery was SB203580 solubility dmso calculated and results of recovery studies and statistically are shown in Table 4 and Table 5. Intra-day precision was determined by analyzing Gel sample solutions at different time intervals on the same day. Gel sample solution was prepared and analyzed in the similar manner as described under analysis of the gel formulation. Inter-day precision was determined by analyzing Gel sample solutions on three different days. Gel sample solution was prepared and analyzed in the similar manner as described in analysis of the gel formulation. Results of intra-day precision and inter-day precision are shown in Table 6 and Table 7, respectively. The LOD and LOQ were separately determined

which is based on the standard deviation of response of the calibration curve. The standard deviation of y-intercept and slope of the calibration curves were used to calculate the LOD and LOQ. Results are shown in Table 8. To evaluate the robustness of the proposed method, small but deliberate variations in the optimized method parameters were done. The effect of change in flow rate and mobile phase ratio on retention time and tailing factor were studied. The solution containing 25 μg/mL of KETO, 12.5 μg/mL of MP and 0.5 μg/mL of PP was injected (in triplicate) PS 341 into sample injector of HPLC three times under the varied conditions. Robustness data is given in Table 9. Amount of gel equivalent to about 25 mg KETO was separately transferred to five different 25.0 mL volumetric flasks (Flask no. 1, 2,

3, 4 and 5), added 5.0 mL of 0.1 M HCl, 0.1 M NaOH and 3% H2O2 to Flask no. 1, 2 and 3, respectively. Solution in flask no. 1, 2, and 3 were heated in water bath for 3 h at 80 °C. Flask no. 4 containing gel was kept at 60 °C for 24 h to study the effect of heat on Gel sample (heat degradation). The forced degradation was performed in the dark to exclude the possible degradative effect of light. Flask no. 5 was exposed to ultraviolet radiations isothipendyl at 254 nm for 24 h in a UV-chamber. All the flasks were removed Gel samples were treated and analyzed in similar manner as described under analysis of gel formulation. The typical densitogram is shown in Fig. 9, Fig. 10, Fig. 11, Fig. 12 and Fig. 13for acidic, alkaline, oxide, heat and UV exposure, respectively. Results of forced (stress) degradation studies are shown in Table 10. In the present work, new method namely, simultaneous equation method and quick high-performance liquid chromatography (HPLC) method were developed and validated for the simultaneous determination of three compounds in a formulated gel.

The collected samples were stored at 4 °C Starch degrading micro

The collected samples were stored at 4 °C. Starch degrading microbes were isolated using Strach Agar Medium (SAM). The isolates showing maximum clear halo zone were sub-cultured.7 Selective isolates with maximum starch degrading activities were identified up to species level.8 and 9 The most potent isolates were finally chosen for further studies. The inoculum for further enzyme modulation and other studies was prepared using Luria

Broth (LB) medium. The fresh overnight culture was used as an inoculum for the production of amylase.10 The inoculated medium was incubated at 37 °C for 48 h by shake flask fermentation method at 200 rpm. The culture broth was then centrifuge at 8000 × g 10 min at 4 °C. The free cell supernatant BIBW2992 was used as an extracellular crude enzyme. 11 Total protein concentrations were determined by Bradford’s method using Bovine Serum Albumin (BSA) as the protein standard.12 α-Amylase activity was determined by measuring the formation of reducing sugars released during starch hydrolysis. The amount of liberated reducing sugar was determined by Dinitrosalicylic acid (DNS) method. Glucose was used to construct this website the standard curve.4 Five percent bacterial inoculum was added aseptically to 500 ml of sterile growth

medium and incubated at 37 °C at 150 rpm. Twenty ml of culture was taken periodically for 48 h at every 6 h intervals. The amylase activity was determined in the culture filtrate. The effect of pH on amylase activity was determined at different pH (6.5, 7, 7.5, 8, 8.5 and 9) and the effect of temperature on enzyme activity was determined using different temperature (26 °C, 29 °C, 32 °C, 35 °C, 38 °C and 41 °C).11

Different carbon and nitrogen sources (both at concentration of 10 g/L) were used in minimal medium, pH 7 and incubated at 32 °C for 24 h. Similarly different amino acids like glycine, alanine, aspartic acid and cysteine were used in the medium for optimization.13 The culture filtrates were assayed for total protein content else and amylase activity. The culture filtrate was precipitated using 80% w/v Ammonium sulfate precipitation method.14 Then the precipitate was separated by centrifugation at around 6700 × g for 10 min. The pretreatment of the dialysis membrane was done Ashwini et al, 2011. Genomic DNA was extracted using phenol–chloroform extraction method. The PCR parameters for the amplification of 16S ribosomal DNA were optimized. 50 μl of PCR master mix contained universal primer set 27 F- (5′-AG AGT TTG ATC MTG GCT CAG-3′)/1492 R- (5′-G GYT ACC TTG TTA CGA CTT-3′), 10 mM dNTPS, 10× PCR Buffer, 1 U Taq DNA polymerase, 2 mM Mg+ and (100–200 ng) template DNA. PCR steps included initial denaturation at 95 °C for 5 min, 35 cycles of denaturation at 95 °C for 1 min, annealing at 56 °C for 2 min, elongation at 72 °C for 1 min and final extension at 72 °C for 10 min. Approximately 1.5 kb amplicons were generated.

C perfringens toxinotype B is the etiologic agent of dysentery i

C. perfringens toxinotype B is the etiologic agent of dysentery in newborn lambs and haemorrhagic enteritis and enterotoxemia in goats, calves and foals [2] and [3]. More recently, toxinotype B has been detected in a human with a clinical presentation of multiple sclerosis, providing clues for environment triggers of the disease [4]. C. perfringens toxinotype D affects mainly sheep and lambs but also causes infections in goats and calves [2] and [3]. The most important factor in initiating disease is the disruption of the microbial

balance in the gut due to overeating carbohydrate rich food, which causes proliferation of C. PI3K inhibitor perfringens and consequent overproduction of the toxin [2] and [5]. Overproduction of Etx causes increased intestinal permeability, facilitating entry of the toxin into the bloodstream and its spread into various organs, including the brain, lungs and kidneys. While infection of the central nervous system results in neurological disorders, the fatal effects on the organs often lead to sudden

death [6] and [7]. For full activity of the toxin, proteolytic processing is required, with carboxy-terminal and amino-terminal peptides removed. Toxin activation typically occurs in the gut either by digestive proteases MK2206 of the host, such as trypsin and chymotrypsin [8], or by λ-protease produced by C. perfringens itself [9] and [10]. To prevent Etx-induced enterotoxemia in domesticated livestock, a number of commercial vaccines are available that have been used extensively over the past decades. These vaccines are based on either formaldehyde treated C. perfringens type D culture filtrate or formaldehyde-inactivated recombinant wild type toxin [11] and [12]. These vaccine preparations have several disadvantages: (1) complete removal of free formaldehyde is required to avoid possible toxic side effects, (2) toxoiding using formaldehyde can

show considerable batch to batch variation in immunogenicity of these vaccines [12], (3) inflammatory responses following vaccination can lead to reduced feed consumption [13] and (4) reversion MRIP to toxicity may occur in incompletely inactivated bacterial toxins. Therefore, there is a need to identify Etx variants with reduced toxicity relative to wild type toxin. One approach to solving this problem is to develop recombinant vaccines based on site-directed mutants with markedly reduced toxicity. Amino acid residues Y30 and Y196 have previously been identified to play key roles in cell binding and thus, cytotoxicity of Etx [14] and [15]. Therefore, this study aimed to determine the potential of a site-directed mutant of Etx with mutations Y30A and Y196A combined, termed Y30A-Y196A, to be exploited as a recombinant vaccine against enterotoxemia. The gene encoding epsilon prototoxin, etxD, from C.

The vaccine protection persists even with very low antibody level

The vaccine protection persists even with very low antibody levels [18]. This suggests that an initial high titer serological response from the current bivalent and quadrivalent vaccines may provide prolonged protection, even after waning of antibody levels. Current HPV vaccines are produced using recombinant

technology, by inserting the L1 gene into a host (e.g. yeast or baculovirus), which then produces L1 proteins in abundance. These L1 proteins self-assemble into empty shells or virus like particles (VLPs). VLPs are similar in shape and size to the HPV virion, but do not contain viral DNA, and are therefore non-infectious and non-oncogenic [22] and [23]. Currently there are two HPV vaccines on the market: the bivalent vaccine Cervarix™, containing VLP antigens for HPV types 16 (20 μg) and 18 (20 μg); and the quadrivalent vaccine Gardasil™,

SB431542 concentration containing VLP antigens for HPV types 16 (40 μg) and 18 (20 μg), as well as non-oncogenic HPV types 6 (20 μg) and 11 (40 μg). The VLPs are combined with an adjuvant to enhance the immune response. The bivalent vaccine is formulated with a unique adjuvant, ASO4, including 3-O-desacyl-4′monophosphoryl lipid A and aluminium salt. The quadrivalent vaccine uses a classical adjuvant, amorphous aluminium hydroxyl-phosphate sulphate [22], [23] and [24]. Both vaccines are given in a three-dose schedule as intramuscular injection: 0, 1 and 6 months for the bivalent vaccine and 0, 2 Epigenetics inhibitor and 6 months for the quadrivalent vaccine [22]. Both vaccines have been found to be safe and well tolerated. Local reactions like pain, swelling and redness can occur, but are usually of short duration.

Systemic adverse reactions could include fever, nausea, dizziness, fatigue, headache and myalgia. The vaccines can be safely administered with other paediatric Thymidine kinase and adolescent vaccines [22]; they can also be safely administered to boys [25] and [26]. The quadrivalent vaccine has been evaluated in two phase III studies, FUTURE I and FUTURE II [27]. The bivalent vaccine has been evaluated in two phase III studies, PATRICIA and the Costa Rica HPV vaccine trial [28] and [29]. Clinical efficacy against infection and cervical lesions associated with HPV16 and HPV18 has been demonstrated up to 8.4 years with the bivalent vaccine, and up to 5 years with the quadrivalent vaccine [24], [30], [31] and [32]. High efficacy was obtained with the quadrivalent vaccine in the FUTURE I and II trials (Table 1), associated with HPV16/18. The lower efficacy observed in the Intention To Treat (ITT) analysis, as compared to the IIT-naïve analysis, is explained by the inclusion of women with prevalent infection at entry. Irrespective of HPV type, the efficacy was 43.0% (95% CI: 13.0–63.2) against CIN3 in the ITT-naïve and 16.4% in the ITT analysis [30]. High efficacy was obtained with the bivalent vaccine in the PATRICIA trial (Table 2) associated with HPV16/18.

The results depicted in Table 1, clearly indicated that all the d

The results depicted in Table 1, clearly indicated that all the dependent variables are strongly dependent on the selected independent variables as they shown wide variation among the 9 batches (F1–F9). The fitted equations (full

models) relating the responses to the transformed factor are shown in Table 2. The polynomial equations can be used to draw conclusions after considering Veliparib datasheet the magnitude of coefficient and the mathematically expressed positive or negative. The high values of correlation coefficient for the dependent variables indicate a good fit. The influence of CS ratio (A) and amount of GA (B) on dependent variables were shown in response surface plot in Fig. 3 (a–d). optimized batch was identified KRX0401 in the experimental design with constraints on dependent variables is shown in Fig. 3(e). The microspheres of all the batches were spherical, free flowing, discrete and uniform size under optical microscopy. Particle size ranges from 48.63 ± 0.47 to 62.31 ± 0.25 μm. The scanning electron micrograph (SEM) of microspheres (F7) is illustrated

in Fig. 1, utilized to observe the surface morphology which is uneven and some crystals scattered on the surface of microspheres contribute to a burst release and helps to achieve effective concentration quickly after oral administration. The swelling index, percentage mucoadhesion and drug entrapment efficiency ranges from 1.04 ± 0.25 to 2.12 ± 0.56, 62.39 ± 0.57 to 76.89 ± 0.91% and 46.33 ± 0.12 to 73.50 ± 0.27% respectively. Swelling studies indicated that with an increase in crosslinking, the swelling ability decreased. Extent of crosslinking exhibited an inverse relation to drug release rate as well as mucoadhesion, whereas CS concentration exhibited an inverse correlation with drug release rate and mucoadhesion. The results of multiple regression Methisazone analysis and F-statistics revealed that for obtaining sustained release, the microspheres should be prepared by using relatively lower level of GA and higher level of CS. The optimized formulation F7 which is more suitable for sustained release upto 12 h, follows zero order kinetics (R2 0.985), best fitted with Korsmeyer–Peppas

(R2 0.995) model and non-fickian diffusion (n value 0.735) dominates the drug release through the swellable matrix and hydrophilic pores. Drug- excipient compatibility studies reveals that no interaction between the CP and CS. Stability studies (F7) shows absence of appreciable changes in drug content and release which were stored at various temperatures, proved that stability of microspheres in normal storage condition. The X-ray photographs of in vivo mucoadhesive study were shown in Fig. 5. At 0 h, microspheres remains as such, after 3 h and 6 h it increases in size, proves the swelling ability of microspheres in gastric fluid and extensive mucoadhesion which helps for gastric retention. This observation reveals that chitosan microspheres are more suitable for gastroretentive system.

1) At 9 dpi, groups B and C, both vaccinated only with LV showed

1). At 9 dpi, groups B and C, both vaccinated only with LV showed the highest levels of CD8+ T cells in caecal tonsils (Fig. 4). Before challenge, low levels of CD8+ T cells were detected (Fig. 4), suggesting that levels of CD8+ cells returned to basal levels during the interval between vaccination and challenge, as seen before [36] and [42]. After challenge, the population of CD8+ T cells constantly increased in groups B and C. This may suggest a controlled clonal expansion of memory CD8+ cells in these vaccinated birds. Furthermore, high numbers of CD8+ T cells persisted for longer periods, in birds that were vaccinated only with the LV (groups B and

C). Otherwise, the combination of LV and KV (group E), generated lower levels of CD8+ T cells, similarly to the PFI-2 solubility dmso KV (group D), whereas unvaccinated birds had rapid influx of cytotoxic T cells in the liver, possibly attracted by invasive bacteria in this organ. Birds which received one dose of LV (group

B) showed the highest levels of IFN-γ in spleen before challenge. This cytokine is important for macrophage activation [42] and [43], however after challenge of vaccinated birds, the levels of this Smad inhibitor cytokine decreased. This may be related to the development of acquired immunity mechanisms, obviously different from the innate immune response that is triggered in unvaccinated birds after primary infection (Fig. 3). Paratyphoid salmonellosis is frequently limited to the gastrointestinal tract; thus the control of bacterial invasion must occur primarily at the intestinal mucosae and gut associated lymphoid tissue (GALT), specifically the caecal tonsils. Considering this, the highest production of IFN-γ in the caecal tonsils was seen in groups C and E (Fig. 4). At 6 dpi, the expression of IFN-γ was significantly higher in group E, which could be associated with the

ability of birds in this group to control the first phase of SE infection; colonization and invasion. As shown in Fig. 1, control of SE in caecal contents was clearly faster in groups C and E than in the control groups A and D. The association these of IFN-γ production and clearance of primary Salmonella infection was suggested previously [35], [42] and [44]. However, in this study, IFN-γ levels decreased after challenge (1 dpi) of vaccinated birds, reaching similar levels to the unvaccinated group A, suggesting that the development of acquired immunity in vaccinated birds is not solely dependant on IFN-γ. IL-12 has an important role in stimulating the production of IFN-γ, recruiting naïve CD8+ T cells and CTLs and developing the CD8+ memory cells [45] and [46]. The present study detected high expression of this cytokine in vaccinated birds before challenge (Fig. 3). At 1 dbi IL-12 levels in caecal tonsils were elevated in all vaccinated groups in comparison with unvaccinated birds (group A).

Beads were washed twice and incubated with biotinylated antibodie

Beads were washed twice and incubated with biotinylated antibodies (25 μl/well) for 1 h. After removal of excess antibodies, streptavidin-PE was added for 30 min. The plate was then washed and analysed. The lower detection limits of the assay defined by the manufacturer were 6, 3, 5, 5 and 10 ρg/ml

for IL-2, IL-5, IL-10, IFN-γ and TNF-α, respectively. Differential counts were performed on EDTA-treated blood by using ABX Pentra 60 Hematology Analyzer (Horiba Diagnostic buy SCH727965 Group, France). Due to logistic challenges in the laboratory, haematological analyses were only conducted on blood samples collected after 24 October 2009. Samples with an improper separation and gating of the detected cell subsets as assessed by visual inspection of the scatter plot produced by the ABX Pentra60 were repeated if sufficient amount of blood was available; poor quality analyses were excluded. From the DBSs, RBP and CRP were measured concurrently by a combined simple sandwich ELISA method [8] and [9]. The samples were tested in duplicates with the paired baseline and follow-up samples in the same assay. Samples with

a coefficient of variance >20% were repeated in duplicates. Data was analysed using STATA 12 (StataCorp LP, College Station, TX, USA). As in our previous study [4], cytokine outcomes were categorised as below versus above the median, and analysed by Poisson regression with robust estimate variance providing prevalence ratios (PR) of being above the median in OPV0 + BCG versus BCG alone recipients. The prevalence of BCG scars or local reactions was analysed by Poisson regression with robust estimate variance. BCG scar PR-171 cell line size was analysed by linear regression. For every plate analysed on the Luminex instrument, the range of the cytokine analysis assay was defined by the lower and upper range of the standard series after censoring for standard concentrations outside a recovery limit of 80–120% (observed concentration versus expected concentration). If the lower detection limit as defined by the manufacturer was higher than the lower limit inferred from the standard series, the

former was applied. Observations outside this range were considered as non-detectable. Cytokine outcomes with >50% detectable measurements were log-transformed and analysed with Tobit regression to account for observations much below or above the detection range of the Luminex assay [10]. The estimates were back-transformed to give the geometric mean ratios (GMR) comparing OPV0 + BCG with BCG alone. Hence, a GMR or a PR > 1 may be interpreted as OPV increasing the given outcome. Log-transformed haematological data was analysed with linear regression using bootstrap to obtain confidence intervals (CI). CRP and RBP were analysed by Poisson regression as the risk of having a CRP measurement >5 μg/ml or a RBP level <0.83 μmol/l (vitamin A-deficient [11]). RBP was log-normally distributed and analysed by linear regression.

caninum On the other hand, a non exacerbated Th1 immune response

caninum. On the other hand, a non exacerbated Th1 immune response profile seems to be more appropriate

JQ1 to control neosporosis, since our previous study showed that vaccination with NcESA alone or combined with ODN-CpG adjuvant resulted in a strong cellular immune response associated with high levels of IFN-γ and inflammation, rendering mice more susceptible to parasite challenge [29]. Also, immunization of BALB/c mice with soluble N. caninum tachyzoite antigens entrapped in nonionic surfactant vesicles or administered with Freund’s adjuvant had clinical neurological disease and increased numbers of brain lesions compared to groups of mice this website inoculated with adjuvants alone or non-immunized controls, following virulent parasite challenge [41]. These findings were associated with increased IL-4 secretion and IL-4/IFN-γ ratio in vitro as well as increased IgG1/IgG2a ratio in vivo, showing that the induction of a type 2 immune response is not protective to neosporosis [41]. Although the best way to infer about a Th1 or Th2 biased immune response should be the IFN-γ/IL-4 ratio determination,

we have demonstrated in our previous study [29] that IL-4 was consistently undetectable in supernatants from C57BL/6 mouse spleen cell cultures, even using high sensitivity commercially available kits with a limit of detection of 15 pg/ml. Thus, the IFN-gamma/IL-10 ratio was adopted in an attempt to verify the balance between pro-inflammatory and anti-inflammatory cytokines. As we observed that the highest IFN-gamma/IL-10 ratio was found for the NLA + ArtinM group Thymidine kinase followed by the ArtinM group in relation to the remaining groups, these data could indicate a profile of Th1-biased pro-inflammatory

immune response, supporting the role of ArtinM as a strong inducer of Th1-type immune responses, as demonstrated in other infection models [15] and [16]. In the present study, a protective pattern of Th1-biased pro-inflammatory immune response can have influenced the survival of the animals after parasite challenge, given that mice immunized with NLA + ArtinM presented the greatest survival and the lowest brain parasite load, indicating that increased IgG2a levels before challenge, higher IgG2a/IgG1 ratio after challenge and higher IFN-γ/IL-10 ratio after immunization can be associated with protection against infection. However, the mouse groups that received ArtinM with or without antigen presented the highest morbidity scores and weight changes from baseline. It is noteworthy that these parameters were more remarkable during the acute phase of infection (from 7 to 12 days after challenge), being the higher rates of body weight losses coincident with the peak of morbidity scores.

Four studies have investigated inter-rater reliability of physiot

Four studies have investigated inter-rater reliability of physiotherapy clinical performance assessment instruments. Intraclass correlations (2,1) of 0.87 for the total Clinical Performance Instrument (CPI) score were found for joint evaluators of physiotherapy students and 0.77 for joint assessments of physiotherapy assistants (Task Force for the Development of Student Clinical Performance Docetaxel in vitro Instruments

2002). Coote et al (2007) reported an ICC of 0.84 for the Common Assessment Form (CAF), and Meldrum et al (2008) reported an ICC of 0.84 for a predecessor to the CAF. Loomis (1985) reported ICCs of 0.62 and 0.59 for third and fourth year total scores respectively on the Evaluation of Clinical Competence form. A range of expressions of test

reliability have been provided in this study. Although the ICC and SEM are related, they do not convey the same information. The ICC provides information on the level of agreement, whereas the SEM provides information on the magnitude of error expressed in the scale units of measurement. The SEM for the APP (3.2) represents 4% of the 0–80 scale width. The reliability of the APP compares favourably with reliability estimates reported by others who have developed instruments for see more assessing competency to practise physiotherapy. Coote et al (2007) and Meldrum et al (2008) reported data that enabled calculation of the SEM and it appears that for the Common Assessment Form and its predecessor this was also 3% to 4% on a 0–80 scale. The evidence suggests that clinicians are reasonably consistent in their judgements of student ability to practise and that this consistency is evident across different scales, countries, and practice conditions. The 95% confidence band around a single score for this data was 6.5 APP points. The high retest correlations shown in this study

provide evidence that educators using the APP are consistent in rating the relative ability of students. This is important for conferral of academic awards and for monitoring improvement in performance relative to peers. With a scale width of 0–80, an error margin of 6.5 Mephenoxalone (95% CI) is acceptable. This error enables a high level of accuracy in ranking student performance as evidenced by the test/ retest correlation of 0.92. Additionally in other data that we have collected (Dalton 2011), students commencing workplace-based education typically obtain mean scores of approximately 45 APP points; by the end of their clinical training average scores are in the order of 60 APP points. Hence an error margin of 6.5 allows a clear view of average student progress across the workplace practice period. Across the practice period 77% of students change by more than the MDC90 of 8 points.

Using exploratory factor analysis on an individual item level, tw

Using exploratory factor analysis on an individual item level, two studies obtained a five factor solution (Tuttle et al 1991, Swartzman et al 1994). Recognising the small samples used in previous studies, item level exploratory factor analysis was performed on the CSQ from a large sample of 965 patients CLBP revealing a six factor solution similar to the subscales originally derived in the CSQ (Robinson et al 1997). Riley and Robinson (1997) compared the five and six factor solutions for the CSQ using linear structural equation modelling. From the results, Riley and Robinson (1997) recommended a

revision of the coping strategy SCR7 mw questionnaire (CSQ-R) retaining 27 items from the original CSQ. This included all six items of the catastrophising subscale, five items from each of the ignoring selleck products pain and reinterpreting

pain sensations subscales, four items from coping self-statements and diverting attention subscales, and three items related to praying factors. In a recent study on patients with cancer related pain, Utne et al (2009) also showed less factorial variance in the CSQ-R than the original CSQ and recommends the CSQ-R for use in clinical research. Monitoring coping strategies is of clinical importance as they have been shown to mediate the influence of pain

intensity on functional disability and quality of life (Abbott et al 2010) and to influence the adjustment of pain (Rosenstiel & Keefe 1983). The CSQ has been shown to be valid for use in several different patient groups such as osteoarthritis, knee replacement surgery, rheumatoid arthritis, fibromyalgia, low back pain, lumbar spine surgery, and even cancer-related pain. The CSQ is a useful clinical tool for the screening of coping styles. It provides information for patients and clinicians on the efficacy of coping strategies already and those strategies needing addressing to help facilitate pain control and mediate improvement of functional outcomes. Data on the CSQ-R sensitivity of change is lacking. More research using the CSQ-R is needed to improve the questionnaire’s validity as an outcome measure and provide more extensive normative data. “
“Latest update: February 2009. Next update: Not specifically stated, but will be planned when the evidence base has progressed sufficiently to alter the guideline. Patient group: Individuals diagnosed with Rheumatoid Arthritis (RA). Intended audience: UK healthcare professionals, people with RA and their carers, patient support groups, community organisations, and service providers.