Injection Laryngoplasty Using Micronized Acellular Dermis for Vocal Fold Paralysis: Long-term Voice Outcomes.

PubMed

Hernandez, Stephen C; Sibley, Haley; Fink, Daniel S; Kunduk, Melda; Schexnaildre, Mell; Kakade, Anagha; McWhorter, Andrew J

2016-05-01

Micronized acellular dermis has been used for nearly 15 years to correct glottic insufficiency. With previous demonstration of safety and efficacy, this study aims to evaluate intermediate and long-term voice outcomes in those who underwent injection laryngoplasty for unilateral vocal fold paralysis. Technique and timing of injection were also reviewed to assess their impact on outcomes. Case series with chart review. Tertiary care center. Patients undergoing injection laryngoplasty from May 2007 to September 2012 were reviewed for possible inclusion. Pre- and postoperative Voice Handicap Index (VHI) scores, as well as senior speech-language pathologists' blinded assessment of voice, were collected for analysis. The final sample included patients who underwent injection laryngoplasty for unilateral vocal fold paralysis, 33 of whom had VHI results and 37 of whom had voice recordings. Additional data were obtained, including technique and timing of injection. Analysis was performed on those patients above with VHI and perceptual voice grades before and at least 6 months following injection. Mean VHI improved by 28.7 points at 6 to 12 months and 22.8 points at >12 months (P = .001). Mean perceptual voice grades improved by 17.6 points at 6 to 12 months and 16.3 points at >12 months (P < .001). No statistically significant difference was found with technique or time to injection. Micronized acellular dermis is a safe injectable that improved both patient-completed voice ratings and blinded reviewer voice gradings at intermediate and long-term follow-up. Further investigation may be warranted regarding technique and timing of injection. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults

PubMed Central

Weintrob, Amy; Bebu, Ionut; Agan, Brian; Diem, Alona; Johnson, Erica; Lalani, Tahaniyat; Wang, Xun; Bavaro, Mary; Ellis, Michael; Mende, Katrin; Crum-Cianflone, Nancy

2015-01-01

Background HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons. Methods 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population. Trial Registration ClinicalTrials.gov NCT00631566 PMID:26018036

Distant memories: a prospective study of vantage point of trauma memories.

PubMed

Kenny, Lucy M; Bryant, Richard A; Silove, Derrick; Creamer, Mark; O'Donnell, Meaghan; McFarlane, Alexander C

2009-09-01

Adopting an observer perspective to recall trauma memories may function as a form of avoidance that maintains posttraumatic stress disorder (PTSD). We conducted a prospective study to analyze the relationship between memory vantage point and PTSD symptoms. Participants (N= 947) identified the vantage point of their trauma memory and reported PTSD symptoms within 4 weeks of the trauma; 730 participants repeated this process 12 months later. Initially recalling the trauma from an observer vantage point was related to more severe PTSD symptoms at that time and 12 months later. Shifting from a field to an observer perspective a year after trauma was associated with greater PTSD severity at 12 months. These results suggest that remembering trauma from an observer vantage point is related to both immediate and ongoing PTSD symptoms.

Spatial Representativeness of Surface-Measured Variations of Downward Solar Radiation

NASA Astrophysics Data System (ADS)

Schwarz, M.; Folini, D.; Hakuba, M. Z.; Wild, M.

2017-12-01

When using time series of ground-based surface solar radiation (SSR) measurements in combination with gridded data, the spatial and temporal representativeness of the point observations must be considered. We use SSR data from surface observations and high-resolution (0.05°) satellite-derived data to infer the spatiotemporal representativeness of observations for monthly and longer time scales in Europe. The correlation analysis shows that the squared correlation coefficients (R2) between SSR times series decrease linearly with increasing distance between the surface observations. For deseasonalized monthly mean time series, R2 ranges from 0.85 for distances up to 25 km between the stations to 0.25 at distances of 500 km. A decorrelation length (i.e., the e-folding distance of R2) on the order of 400 km (with spread of 100-600 km) was found. R2 from correlations between point observations and colocated grid box area means determined from satellite data were found to be 0.80 for a 1° grid. To quantify the error which arises when using a point observation as a surrogate for the area mean SSR of larger surroundings, we calculated a spatial sampling error (SSE) for a 1° grid of 8 (3) W/m2 for monthly (annual) time series. The SSE based on a 1° grid, therefore, is of the same magnitude as the measurement uncertainty. The analysis generally reveals that monthly mean (or longer temporally aggregated) point observations of SSR capture the larger-scale variability well. This finding shows that comparing time series of SSR measurements with gridded data is feasible for those time scales.

Memory network plasticity after temporal lobe resection: a longitudinal functional imaging study

PubMed Central

Sidhu, Meneka K.; Stretton, Jason; Winston, Gavin P.; McEvoy, Andrew W.; Symms, Mark; Thompson, Pamela J.; Koepp, Matthias J.

2016-01-01

Abstract Anterior temporal lobe resection can control seizures in up to 80% of patients with temporal lobe epilepsy. Memory decrements are the main neurocognitive complication. Preoperative functional reorganization has been described in memory networks, but less is known of postoperative reorganization. We investigated reorganization of memory-encoding networks preoperatively and 3 and 12 months after surgery. We studied 36 patients with unilateral medial temporal lobe epilepsy (19 right) before and 3 and 12 months after anterior temporal lobe resection. Fifteen healthy control subjects were studied at three equivalent time points. All subjects had neuropsychological testing at each of the three time points. A functional magnetic resonance imaging memory-encoding paradigm of words and faces was performed with subsequent out-of-scanner recognition assessments. Changes in activations across the time points in each patient group were compared to changes in the control group in a single flexible factorial analysis. Postoperative change in memory across the time points was correlated with postoperative activations to investigate the efficiency of reorganized networks. Left temporal lobe epilepsy patients showed increased right anterior hippocampal and frontal activation at both 3 and 12 months after surgery relative to preoperatively, for word and face encoding, with a concomitant reduction in left frontal activation 12 months postoperatively. Right anterior hippocampal activation 12 months postoperatively correlated significantly with improved verbal learning in patients with left temporal lobe epilepsy from preoperatively to 12 months postoperatively. Preoperatively, there was significant left posterior hippocampal activation that was sustained 3 months postoperatively at word encoding, and increased at face encoding. For both word and face encoding this was significantly reduced from 3 to 12 months postoperatively. Patients with right temporal lobe epilepsy showed increased left anterior hippocampal activation on word encoding from 3 to 12 months postoperatively compared to preoperatively. On face encoding, left anterior hippocampal activations were present preoperatively and 12 months postoperatively. Left anterior hippocampal and orbitofrontal cortex activations correlated with improvements in both design and verbal learning 12 months postoperatively. On face encoding, there were significantly increased left posterior hippocampal activations that reduced significantly from 3 to 12 months postoperatively. Postoperative changes occur in the memory-encoding network in both left and right temporal lobe epilepsy patients across both verbal and visual domains. Three months after surgery, compensatory posterior hippocampal reorganization that occurs is transient and inefficient. Engagement of the contralateral hippocampus 12 months after surgery represented efficient reorganization in both patient groups, suggesting that the contralateral hippocampus contributes to memory outcome 12 months after surgery. PMID:26754787

Assessment of on-time vaccination coverage in population subgroups: A record linkage cohort study.

PubMed

Moore, Hannah C; Fathima, Parveen; Gidding, Heather F; de Klerk, Nicholas; Liu, Bette; Sheppeard, Vicky; Effler, Paul V; Snelling, Thomas L; McIntyre, Peter; Blyth, Christopher C

2018-05-31

Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2-4-6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996-2012, combining individual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2-4-6 month dose; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7-10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2-4-6 month schedule is only 50-60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness. Copyright © 2018. Published by Elsevier Ltd.

ERRATUM: In vivo evaluation of a neural stem cell-seeded prosthesis In vivo evaluation of a neural stem cell-seeded prosthesis

NASA Astrophysics Data System (ADS)

Purcell, E. K.; Seymour, J. P.; Yandamuri, S.; Kipke, D. R.

2009-08-01

In the published article, an error was made in figure 5. Specifically, the three-month, NSC-seeded image is a duplicate of the six-week image, and the one-day, probe alone image is a duplicate of the three-month image. The corrected figure is reproduced below. Figure 5 Figure 5. Glial encapsulation of each probe condition over the 3 month time course. Ox-42 labeled microglia and GFAP labeled astrocytes are shown. Images are taken from probes implanted in the same animal at each time point. NSC seeding was associated with reduced non-neuronal density at 1 day post-implantation in comparison to alginate coated probes and at the 1 week time point in comparison to untreated probes (P < 0.001). Glial activation is at its overall peak 1 week after insertion. A thin encapsulation layer surrounds probes at the 6 week and 3 month time points, with NSC-seeded probes having the greatest surrounding non-neuronal density P < 0.001). Interestingly, microglia appeared to have a ramified, or `surveilling', morphology surrounding a neural stem cell-alginate probe initially, whereas activated cells with an amoeboid structure were found near an alginate probe in the same hemisphere of one animal (left panels).

Using the Inflection Points and Rates of Growth and Decay to Predict Levels of Solar Activity

NASA Technical Reports Server (NTRS)

Wilson, Robert M.; Hathaway, David H.

2008-01-01

The ascending and descending inflection points and rates of growth and decay at specific times during the sunspot cycle are examined as predictors for future activity. On average, the ascending inflection point occurs about 1-2 yr after sunspot minimum amplitude (Rm) and the descending inflection point occurs about 6-7 yr after Rm. The ascending inflection point and the inferred slope (including the 12-mo moving average (12-mma) of (Delta)R (the month-to-month change in the smoothed monthly mean sunspot number (R)) at the ascending inflection point provide strong indications as to the expected size of the ongoing cycle s sunspot maximum amplitude (RM), while the descending inflection point appears to provide an indication as to the expected length of the ongoing cycle. The value of the 12-mma of (Delta)R at elapsed time T = 27 mo past the epoch of RM (E(RM)) seems to provide a strong indication as to the expected size of Rm for the following cycle. The expected Rm for cycle 24 is 7.6 +/- 4.4 (the 90-percent prediction interval), occurring before September 2008. Evidence is also presented for secular rises in selected cycle-related parameters and for preferential grouping of sunspot cycles by amplitude and/or period.

Alcohol consumption patterns among vocational school students in central Thailand.

PubMed

Chaveepojnkamjorn, Wisit

2012-11-01

The objective of this study was to evaluate alcohol consumption patterns among vocational school students in central Thailand. We conducted a cross sectional study among 1,803 vocational students (80.4 % aged < 17 years) in central Thailand using a self-administered questionnaire which consisted of 2 parts: sociodemographic factors and alcohol drinking behavior from December 2007 to February 2008. Descriptive statistics, a chi-square test and multiple logistic regression were used to analyze the data. The results of this study showed 40.9% of male students and 20.9% of female students drank alcoholic beverages. Multiple logistic regression analysis revealed 2 factors were associated with alcohol consumption among male subjects: field of study (OR 1.5, 95% CI 1.1-2.0), and GPA (OR < 2 = 1.8; 95% CI 1.2-2.7; OR > 3 = 0.6; 95% CI 0.4-0.9). The three most popular venues for drinking were at parties (43.1%), at home/in the dormitory (34.9%) and in bars or saloons near the school (20.9%). Fifty-three point two percent of males drinks alcohol 1-2 times per month and time, 47% drank > 2 times per month. Nearly 78% of female students drink alcohol 1-2 times per month and 22% drink alcohol > 2 time per month. Forty point nine percent of male students consumed 1-2 drinks per time and 36% consumed more than 4 drinks per time. Fifty point four percent of females drank 2 drinks per month. One-third of male students said they engaged in binge drinking in a 2-week period and 14% of girls said they binge drank in a 2-week period. Alcohol consumption is a significant problem among Thai vocational school students. Measures for managing this problem are discussed.

Early arthroscopic release in stiff shoulder

PubMed Central

Sabat, Dhananjaya; Kumar, Vinod

2008-01-01

Purpose: To evaluate the results of early arthroscopic release in the patients of stiff shoulder Methods: Twenty patients of stiff shoulder, who had symptoms for at least three months and failed to improve with steroid injections and physical therapy of 6 weeks duration, underwent arthroscopic release. The average time between onset of symptoms and the time of surgery was 4 months and 2 weeks. The functional outcome was evaluated using ASES and Constant and Murley scoring systems. Results: All the patients showed significant improvement in the range of motion and relief of pain by end of three months following the procedure. At 12 months, mean improvement in ASES score is 38 points and Constant and Murley score is 4O.5 points. All patients returned to work by 3-5 months (average -4.5 months). Conclusion: Early arthroscopic release showed promising results with reliable increase in range of motion, early relief of symptoms and consequent early return to work. So it is highly recommended in properly selected patients. Level of evidence: Level IV PMID:20300309

Trajectories of marital, parent-child, and sibling conflict during pediatric cancer treatment.

PubMed

Katz, Lynn Fainsilber; Fladeboe, Kaitlyn; Lavi, Iris; King, Kevin; Kawamura, Joy; Friedman, Debra; Compas, Bruce; Breiger, David; Lengua, Liliana; Gurtovenko, Kyrill; Stettler, Nicole

2018-05-28

The stress of having a child with cancer can impact the quality of relationships within the family. The current study describes the longitudinal trajectory of marital, parent-child, and sibling conflict beginning around the time of diagnosis through the first year of treatment. We examined the average level of marital, parent-child, and sibling conflict at each monthly time point in the first year of treatment; the proportion of families that fall into the distressed range of marital, parent-child, and sibling conflict at each time point; the typical trajectory of conflict during the first year of treatment and whether there are differences in trajectories across families. A total of 160 families of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective longitudinal study. Primary caregivers provided monthly reports of marital, parent-child, and sibling conflict. Using multilevel modeling (MLM), most families showed stability in quality of family relationships, although considerable between-family variability was observed. For married couples, 25-36% of couples were in the distressed range at one time point over the first year of treatment. For married couples, more distress occurred at earlier months, particularly month 3. For parent-child and sibling dyads, the most difficult time periods were during later months. Implications for development of interventions that target at-risk family relationships are discussed. Identifying processes that predict between-family variability in trajectories of family relationships is an important next step, particularly for the marital relationship. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Effects of a DVD-delivered exercise program on patterns of sedentary behavior in older adults: a randomized controlled trial.

PubMed

Fanning, J; Porter, G; Awick, E A; Wójcicki, T R; Gothe, N P; Roberts, S A; Ehlers, D K; Motl, R W; McAuley, E

2016-06-01

In the present study, we examined the influence of a home-based, DVD-delivered exercise intervention on daily sedentary time and breaks in sedentary time in older adults. Between 2010 and 2012, older adults (i.e., aged 65 or older) residing in Illinois (N = 307) were randomized into a 6-month home-based, DVD-delivered exercise program (i.e., FlexToBa; FTB) or a waitlist control. Participants completed measurements prior to the first week (baseline), following the intervention period (month 6), and after a 6 month no-contact follow-up (month 12). Sedentary behavior was measured objectively using accelerometers for 7 consecutive days at each time point. Differences in daily sedentary time and breaks between groups and across the three time points were examined using mixed-factor analysis of variance (mixed ANOVA) and analysis of covariance (ANCOVA). Mixed ANOVA models revealed that daily minutes of sedentary time did not differ by group or time. The FTB condition, however, demonstrated a greater number of daily breaks in sedentary time relative to the control condition (p = .02). ANCOVA models revealed a non-significant effect favoring FTB at month 6, and a significant difference between groups at month 12 (p = .02). While overall sedentary time did not differ between groups, the DVD-delivered exercise intervention was effective for maintaining a greater number of breaks when compared with the control condition. Given the accumulating evidence emphasizing the importance of breaking up sedentary time, these findings have important implications for the design of future health behavior interventions.

Using Multivariate Regression Model with Least Absolute Shrinkage and Selection Operator (LASSO) to Predict the Incidence of Xerostomia after Intensity-Modulated Radiotherapy for Head and Neck Cancer

PubMed Central

Ting, Hui-Min; Chang, Liyun; Huang, Yu-Jie; Wu, Jia-Ming; Wang, Hung-Yu; Horng, Mong-Fong; Chang, Chun-Ming; Lan, Jen-Hong; Huang, Ya-Yu; Fang, Fu-Min; Leung, Stephen Wan

2014-01-01

Purpose The aim of this study was to develop a multivariate logistic regression model with least absolute shrinkage and selection operator (LASSO) to make valid predictions about the incidence of moderate-to-severe patient-rated xerostomia among head and neck cancer (HNC) patients treated with IMRT. Methods and Materials Quality of life questionnaire datasets from 206 patients with HNC were analyzed. The European Organization for Research and Treatment of Cancer QLQ-H&N35 and QLQ-C30 questionnaires were used as the endpoint evaluation. The primary endpoint (grade 3+ xerostomia) was defined as moderate-to-severe xerostomia at 3 (XER3m) and 12 months (XER12m) after the completion of IMRT. Normal tissue complication probability (NTCP) models were developed. The optimal and suboptimal numbers of prognostic factors for a multivariate logistic regression model were determined using the LASSO with bootstrapping technique. Statistical analysis was performed using the scaled Brier score, Nagelkerke R2, chi-squared test, Omnibus, Hosmer-Lemeshow test, and the AUC. Results Eight prognostic factors were selected by LASSO for the 3-month time point: Dmean-c, Dmean-i, age, financial status, T stage, AJCC stage, smoking, and education. Nine prognostic factors were selected for the 12-month time point: Dmean-i, education, Dmean-c, smoking, T stage, baseline xerostomia, alcohol abuse, family history, and node classification. In the selection of the suboptimal number of prognostic factors by LASSO, three suboptimal prognostic factors were fine-tuned by Hosmer-Lemeshow test and AUC, i.e., Dmean-c, Dmean-i, and age for the 3-month time point. Five suboptimal prognostic factors were also selected for the 12-month time point, i.e., Dmean-i, education, Dmean-c, smoking, and T stage. The overall performance for both time points of the NTCP model in terms of scaled Brier score, Omnibus, and Nagelkerke R2 was satisfactory and corresponded well with the expected values. Conclusions Multivariate NTCP models with LASSO can be used to predict patient-rated xerostomia after IMRT. PMID:24586971

Using multivariate regression model with least absolute shrinkage and selection operator (LASSO) to predict the incidence of Xerostomia after intensity-modulated radiotherapy for head and neck cancer.

PubMed

Lee, Tsair-Fwu; Chao, Pei-Ju; Ting, Hui-Min; Chang, Liyun; Huang, Yu-Jie; Wu, Jia-Ming; Wang, Hung-Yu; Horng, Mong-Fong; Chang, Chun-Ming; Lan, Jen-Hong; Huang, Ya-Yu; Fang, Fu-Min; Leung, Stephen Wan

2014-01-01

The aim of this study was to develop a multivariate logistic regression model with least absolute shrinkage and selection operator (LASSO) to make valid predictions about the incidence of moderate-to-severe patient-rated xerostomia among head and neck cancer (HNC) patients treated with IMRT. Quality of life questionnaire datasets from 206 patients with HNC were analyzed. The European Organization for Research and Treatment of Cancer QLQ-H&N35 and QLQ-C30 questionnaires were used as the endpoint evaluation. The primary endpoint (grade 3(+) xerostomia) was defined as moderate-to-severe xerostomia at 3 (XER3m) and 12 months (XER12m) after the completion of IMRT. Normal tissue complication probability (NTCP) models were developed. The optimal and suboptimal numbers of prognostic factors for a multivariate logistic regression model were determined using the LASSO with bootstrapping technique. Statistical analysis was performed using the scaled Brier score, Nagelkerke R(2), chi-squared test, Omnibus, Hosmer-Lemeshow test, and the AUC. Eight prognostic factors were selected by LASSO for the 3-month time point: Dmean-c, Dmean-i, age, financial status, T stage, AJCC stage, smoking, and education. Nine prognostic factors were selected for the 12-month time point: Dmean-i, education, Dmean-c, smoking, T stage, baseline xerostomia, alcohol abuse, family history, and node classification. In the selection of the suboptimal number of prognostic factors by LASSO, three suboptimal prognostic factors were fine-tuned by Hosmer-Lemeshow test and AUC, i.e., Dmean-c, Dmean-i, and age for the 3-month time point. Five suboptimal prognostic factors were also selected for the 12-month time point, i.e., Dmean-i, education, Dmean-c, smoking, and T stage. The overall performance for both time points of the NTCP model in terms of scaled Brier score, Omnibus, and Nagelkerke R(2) was satisfactory and corresponded well with the expected values. Multivariate NTCP models with LASSO can be used to predict patient-rated xerostomia after IMRT.

Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique.

PubMed

Stahnke, Katharina; Nikulka, Constanze; Diederichs, Gerd; Haneveld, Hendrik; Scheibel, Markus; Gerhardt, Christian

2016-05-01

So far, recurrent rotator cuff defects are described to occur in the early postoperative period after arthroscopic repair. The aim of this study was to evaluate the musculotendinous structure of the supraspinatus, as well as bone marrow edema or osteolysis after arthroscopic double-row repair. Therefore, magnetic resonance (MR) images were performed at defined intervals up to 2 years postoperatively. Case series; Level of evidence, 3. MR imaging was performed within 7 days, 3, 6, 12, 26, 52 and 108 weeks after surgery. All patients were operated using an arthroscopic modified suture bridge technique. Tendon integrity, tendon retraction ["foot-print-coverage" (FPC)], muscular atrophy and fatty infiltration (signal intensity analysis) were measured at all time points. Furthermore, postoperative bone marrow edema and signs of osteolysis were assessed. MR images of 13 non-consecutive patients (6f/7m, ∅ age 61.05 ± 7.7 years) could be evaluated at all time points until ∅ 108 weeks postoperatively. 5/6 patients with recurrent defect at final follow-up displayed a time of failure between 12 and 24 months after surgery. Predominant mode of failure was medial cuff failures in 4/6 cases. The initial FPC increased significantly up to 2 years follow-up (p = 0.004). Evaluations of muscular atrophy or fatty infiltration were not significant different comparing the results of all time points (p > 0.05). Postoperative bone marrow edema disappeared completely at 6 months after surgery, whereas signs of osteolysis appeared at 3 months follow-up and increased to final follow-up. Recurrent defects after arthroscopic reconstruction of supraspinatus tears in modified suture bridge technique seem to occur between 12 and 24 months after surgery. Serial MRI evaluation shows good muscle structure at all time points. Postoperative bone marrow edema disappears completely several months after surgery. Signs of osteolysis seem to appear caused by bio-absorbable anchor implantations.

Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry.

PubMed

Whitmore, Robert G; Curran, Jill N; Ali, Zarina S; Mummaneni, Praveen V; Shaffrey, Christopher I; Heary, Robert F; Kaiser, Michael G; Asher, Anthony L; Malhotra, Neil R; Cheng, Joseph S; Hurlbert, John; Smith, Justin S; Magge, Subu N; Steinmetz, Michael P; Resnick, Daniel K; Ghogawala, Zoher

2015-10-01

The authors have established a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures using prospectively collected outcomes. Collection of these data requires an extensive commitment of resources from each site. The aim of this study was to determine whether outcomes data from shorter-interval follow-up could be used to accurately estimate long-term outcome following lumbar discectomy. An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level lumbar discectomy for treatment of disc herniation were included. SF-36 and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Quality-adjusted life year (QALY) data were calculated using SF-6D utility scores. Correlations among outcomes at each follow-up time point were tested using the Spearman rank correlation test. One hundred forty-eight patients were enrolled over 1 year. Their mean age was 46 years (49% female). Eleven patients (7.4%) required a reoperation by 1 year postoperatively. The overall 1-year follow-up rate was 80.4%. Lumbar discectomy was associated with significant improvements in ODI and SF-36 scores (p < 0.0001) and with a gain of 0.246 QALYs over the 1-year study period. The greatest gain occurred between baseline and 3-month follow-up and was significantly greater than improvements obtained between 3 and 6 months or 6 months and 1 year(p < 0.001). Correlations between 3-month, 6-month, and 1-year outcomes were similar, suggesting that 3-month data may be used to accurately estimate 1-year outcomes for patients who do not require a reoperation. Patients who underwent reoperation had worse outcomes scores and nonsignificant correlations at all time points. This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. Three-month outcome data may be used to accurately estimate outcome at future time points and may lower costs associated with registry data collection. This registry effort provides a practical foundation for the acquisition of outcome data following lumbar discectomy.

The automaticity of vantage point shifts within a synaesthetes' spatial calendar.

PubMed

Jarick, Michelle; Jensen, Candice; Dixon, Michael J; Smilek, Daniel

2011-09-01

Time-space synaesthetes report that time units (e.g., months, days, hours) occupy idiosyncratic spatial locations. For the synaesthete (L), the months of the year are projected out in external space in the shape of a 'scoreboard 7', where January to July extend across the top from left to right and August to December make up the vertical segment from top to bottom. Interestingly, L can change the mental vantage point (MVP) from where she views her month-space depending on whether she sees or hears the month name. We used a spatial cueing task to demonstrate that L's attention could be directed to locations within her time-space and change vantage points automatically - from trial to trial. We also sought to eliminate any influence of strategy on L's performance by shortening the interval between the cue and target onset to only 150 ms, and have the targets fall in synaesthetically cued locations on only 15% of trials. If L's performance was attributable to intentionally using the cue to predict target location, these manipulations should eliminate any cueing effects. In two separate experiments, we found that L still showed an attentional bias consistent with her synaesthesia. Thus, we attribute L's rapid and resilient cueing effects to the automaticity of her spatial forms. ©2011 The British Psychological Society.

Comparing Change in Anterior Curvature after Corneal Cross-Linking Using Scanning-Slit and Scheimpflug Technology.

PubMed

Lang, Paul Z; Thulasi, Praneetha; Khandelwal, Sumitra S; Hafezi, Farhad; Randleman, J Bradley

2018-05-02

To evaluate the correlation between anterior axial curvature difference maps following corneal cross-linking (CXL) for progressive keratoconus obtained from Scheimpflug-based tomography and Placido-based topography. Between-devices reliability analysis of randomized clinical trial data METHODS: Corneal imaging was collected at a single center institution pre-operatively and at 3, 6, and 12 months post-operatively using Scheimpflug-based tomography (Pentacam, Oculus Inc., Lynnwood, WA) and Scanning-slit, Placido-based topography (Orbscan II, Bausch & Lomb, Rochester, NY) in patients with progressive keratoconus receiving standard protocol CXL (3mW/cm 2 for 30 minutes). Regularization index (RI), absolute maximum keratometry (K Max), and change in (ΔK Max) were compared between the two devices at each time point. 51 eyes from 36 patients were evaluated at all time points. values were significantly different at all time points [56.01±5.3D Scheimpflug vs. 55.04±5.1D scanning-slit pre-operatively (p=0.003); 54.58±5.3D Scheimpflug vs. 53.12±4.9D scanning-slit at 12 months (p<0.0001)] but strongly correlated between devices (r=0.90-0.93) at all time points. The devices were not significantly different at any time point for either ΔK Max or RI but were poorly correlated at all time points (r=0.41-0.53 for ΔK Max, r=0.29-0.48 for RI). At 12 months, 95% LOA was 7.51D for absolute, 8.61D for ΔK Max, and 19.86D for RI. Measurements using Scheimpflug and scanning-slit Placido-based technology are correlated but not interchangeable. Both devices appear reasonable for separately monitoring the cornea's response to CXL; however, caution should be used when comparing results obtained with one measuring technology to the other. Copyright © 2018 Elsevier Inc. All rights reserved.

Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score.

PubMed

Lowe, Jeremiah T; Li, Xinning; Fasulo, Sydney M; Testa, Edward J; Jawa, Andrew

2017-03-01

Patient-reported outcome measures (PROMs) are valuable tools for quantifying outcomes of orthopedic surgery. However, when baseline scores are not obtained, there is considerable controversy about whether PROMs can be administered retrospectively for patients to recall their preoperative state. We investigated the accuracy of patient recall after total shoulder arthroplasty (TSA) using the American Shoulder and Elbow Surgeons (ASES) assessment score. Recalled ASES scores were collected postoperatively at 6 weeks, 3 months, 6 months, and 12 months from 169 patients who previously completed baseline scores before TSA. The ASES total score was divided into its two subcomponents: functional ability and visual analog scale (VAS) for pain. We compared preoperative and recalled scores for each subcomponent and the total ASES score. Recalled ASES function scores were comparable to corresponding preoperative scores across all time points (analysis of variance, P = .21), but recalled VAS pain was significantly higher at all time points beyond 6 weeks after surgery (P = .0001 at 3 months; P = .005 at 6 months; and P = .001 at 12 months). As a result, the ASES total score was only comparable at 6 weeks after surgery (P = .39) and differed at all time points thereafter. Patients are able to recall preoperative function with considerable accuracy for up to 12 months after TSA. However, beyond 6 weeks postoperatively, patients recall having worse pain than they originally reported, and recalled ASES total scores are unreliable as a result. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics

PubMed Central

Zhou, Changxi; Wu, Lei; Liu, Qinghui; An, Huaijie; Jiang, Bin; Zuo, Fan; Zhang, Li; He, Yao

2017-01-01

Abstract This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases. A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis. With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis. The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up. PMID:29049178

In utero programming alters adult response to chronic mild stress: part 3 of a longitudinal study.

PubMed

Baker, Stephanie L; Mileva, Guergana; Huta, Veronika; Bielajew, Catherine

2014-11-07

Exposure to stress before birth may lay the foundation for the development of sensitivities or protection from psychiatric disorders while later stress exposure may trigger either their expression or suppression. This report, part three of a longitudinal study conducted in our laboratory, aimed to examine the interaction between early and adult stress and their effects on measures of anxiety and depression. In parts one and two, we reported the effects of gestational stress (GS) in Long Evans rat dams and their juvenile and young adult offspring. In this third and final installment, we evaluated the effects of GS and chronic mild stress (CMS) in the adult female offspring at 6 month and 12 month time-points. The two by two design included a combination of GS and CMS and the appropriate control groups. Using Hierarchical Linear Modeling, main effects of GS on corticosterone level at the 12 month time-point was found while main effects of CMS were seen in body weight, sucrose preference, and corticosterone, and significant interactions between group at the 6 and 12 month time-points. The GS group had the lowest sucrose preference during CMS at 6 months supporting a cumulative effect of early and later life stress. The GS/CMS group showed lower corticosterone at 12 months than the GS/noCMS group indicating a possible mismatch between prenatal programming and later life stress. These results highlight the importance of early life factors in exerting potentially protective effects in models involving later life stress. Copyright © 2014 Elsevier B.V. All rights reserved.

Volumetric Trends Associated with MR-guided Stereotactic Laser Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy

PubMed Central

Patel, Nitesh V; Sundararajan, Sri; Keller, Irwin; Danish, Shabbar

2018-01-01

Objective: Magnetic resonance (MR)-guided stereotactic laser amygdalohippocampectomy is a minimally invasive procedure for the treatment of refractory epilepsy in patients with mesial temporal sclerosis. Limited data exist on post-ablation volumetric trends associated with the procedure. Methods: 10 patients with mesial temporal sclerosis underwent MR-guided stereotactic laser amygdalohippocampectomy. Three independent raters computed ablation volumes at the following time points: pre-ablation (PreA), immediate post-ablation (IPA), 24 hours post-ablation (24PA), first follow-up post-ablation (FPA), and greater than three months follow-up post-ablation (>3MPA), using OsiriX DICOM Viewer (Pixmeo, Bernex, Switzerland). Statistical trends in post-ablation volumes were determined for the time points. Results: MR-guided stereotactic laser amygdalohippocampectomy produces a rapid rise and distinct peak in post-ablation volume immediately following the procedure. IPA volumes are significantly higher than all other time points. Comparing individual time points within each raters dataset (intra-rater), a significant difference was seen between the IPA time point and all others. There was no statistical difference between the 24PA, FPA, and >3MPA time points. A correlation analysis demonstrated the strongest correlations at the 24PA (r=0.97), FPA (r=0.95), and 3MPA time points (r=0.99), with a weaker correlation at IPA (r=0.92). Conclusion: MR-guided stereotactic laser amygdalohippocampectomy produces a maximal increase in post-ablation volume immediately following the procedure, which decreases and stabilizes at 24 hours post-procedure and beyond three months follow-up. Based on the correlation analysis, the lower inter-rater reliability at the IPA time point suggests it may be less accurate to assess volume at this time point. We recommend post-ablation volume assessments be made at least 24 hours post-selective ablation of the amygdalohippocampal complex (SLAH).

Temporal Dependence of Chromosomal Aberration on Radiation Quality and Cellular Genetic Background

NASA Technical Reports Server (NTRS)

Lu, Tao; Zhang, Ye; Krieger, Stephanie; Yeshitla, Samrawit; Goss, Rosalin; Bowler, Deborah; Kadhim, Munira; Wilson, Bobby; Wu, Honglu

2017-01-01

Radiation induced cancer risks are driven by genetic instability. It is not well understood how different radiation sources induce genetic instability in cells with different genetic background. Here we report our studies on genetic instability, particularly chromosome instability using fluorescence in situ hybridization (FISH), in human primary lymphocytes, normal human fibroblasts, and transformed human mammary epithelial cells in a temporal manner after exposure to high energy protons and Fe ions. The chromosome spread was prepared 48 hours, 1 week, 2 week, and 1 month after radiation exposure. Chromosome aberrations were analyzed with whole chromosome specific probes (chr. 3 and chr. 6). After exposure to protons and Fe ions of similar cumulative energy (??), Fe ions induced more chromosomal aberrations at early time point (48 hours) in all three types of cells. Over time (after 1 month), more chromosome aberrations were observed in cells exposed to Fe ions than in the same type of cells exposed to protons. While the mammary epithelial cells have higher intrinsic genetic instability and higher rate of initial chromosome aberrations than the fibroblasts, the fibroblasts retained more chromosomal aberration after long term cell culture (1 month) in comparison to their initial frequency of chromosome aberration. In lymphocytes, the chromosome aberration frequency at 1 month after exposure to Fe ions was close to unexposed background, and the chromosome aberration frequency at 1 month after exposure to proton was much higher. In addition to human cells, mouse bone marrow cells isolated from strains CBA/CaH and C57BL/6 were irradiated with proton or Fe ions and were analyzed for chromosome aberration at different time points. Cells from CBA mice showed similar frequency of chromosome aberration at early and late time points, while cells from C57 mice showed very different chromosome aberration rate at early and late time points. Our results suggest that relative biological effectiveness (RBE) of radiation are different for different radiation sources, for different cell types, and for the same cell type with different genetic background at different times after radiation exposure. Caution must be taken in using RBE value to estimate biological effects from radiation exposure.

Work status and disability trajectories over 12 months after injury among workers in New Zealand.

PubMed

Langley, John; Lilley, Rebbecca; Samaranayaka, Ari; Derrett, Sarah

2014-03-07

To describe work and disability trajectories over 12 months following injury among workers. Workers injured at work or elsewhere (n=2626) were sourced from the Prospective Outcomes of Injury Study, a longitudinal cohort study in New Zealand, with the primary objective of identifying factors associated with disability following injury. Work and disability status was assessed at 3- and 12-months post injury. The measure of disability was the brief WHODAS II 12-item instrument. Participants were dichotomised into 'disability' or 'no disability' groups based on whether their WHODAS score was greater than, or equal to, 10. In terms of 12-month work status, there are 16 different scenarios. These were grouped into 4 categories: sustained work (SW), delayed return to work (RTW), non-sustained RTW, and sustained off-work. We had complete information for 1975 workers. The largest group (68%) was SW, 32% of which had disability at either time point. The second largest group consisted of 17% of workers who were classified as delayed RTW, 76% of whom were disabled at either time point. Among the non-sustained RTW group (7%), 52% had disability at either time point. Of the sustained off-work group (8%), 80% were disabled at either 3- or 12-months. Although return to work is a useful provider performance indicator of injury compensation and rehabilitation it is inadequate from a wider societal perspective and needs to be complemented by other important outcome measures such as disability status.

Spatially localized phosphorous metabolism of skeletal muscle in Duchenne muscular dystrophy patients: 24-month follow-up.

PubMed

Hooijmans, M T; Doorenweerd, N; Baligand, C; Verschuuren, J J G M; Ronen, I; Niks, E H; Webb, A G; Kan, H E

2017-01-01

To assess the changes in phosphodiester (PDE)-levels, detected by 31P magnetic resonance spectroscopy (MRS), over 24-months to determine the potential of PDE as marker for muscle tissue changes in Duchenne Muscular Dystrophy (DMD) patients. Spatially resolved phosphorous datasets were acquired in the right lower leg of 18 DMD patients (range: 5-15.4 years) and 12 age-matched healthy controls (range: 5-14 years) at three time-points (baseline, 12-months, and 24-months) using a 7T MR-System (Philips Achieva). 3-point Dixon images were acquired at 3T (Philips Ingenia) to determine muscle fat fraction. Analyses were done for six muscles that represent different stages of muscle wasting. Differences between groups and time-points were assessed with non-parametric tests with correction for multiple comparisons. Coefficient of variance (CV) were determined for PDE in four healthy adult volunteers in high and low signal-to-noise ratio (SNR) datasets. PDE-levels were significantly higher (two-fold) in DMD patients compared to controls in all analyzed muscles at almost every time point and did not change over the study period. Fat fraction was significantly elevated in all muscles at all time points compared to healthy controls, and increased significantly over time, except in the tibialis posterior muscle. The mean within subject CV for PDE-levels was 4.3% in datasets with high SNR (>10:1) and 5.7% in datasets with low SNR. The stable two-fold increase in PDE-levels found in DMD patients in muscles with different levels of muscle wasting over 2-year time, including DMD patients as young as 5.5 years-old, suggests that PDE-levels may increase very rapidly early in the disease process and remain elevated thereafter. The low CV values in high and low SNR datasets show that PDE-levels can be accurately and reproducibly quantified in all conditions. Our data confirms the great potential of PDE as a marker for muscle tissue changes in DMD patients.

Spatially localized phosphorous metabolism of skeletal muscle in Duchenne muscular dystrophy patients: 24–month follow-up

PubMed Central

Doorenweerd, N.; Baligand, C.; Verschuuren, J. J. G. M.; Ronen, I.; Niks, E. H.; Webb, A. G.; Kan, H. E.

2017-01-01

Objectives To assess the changes in phosphodiester (PDE)-levels, detected by 31P magnetic resonance spectroscopy (MRS), over 24-months to determine the potential of PDE as marker for muscle tissue changes in Duchenne Muscular Dystrophy (DMD) patients. Methods Spatially resolved phosphorous datasets were acquired in the right lower leg of 18 DMD patients (range: 5–15.4 years) and 12 age-matched healthy controls (range: 5–14 years) at three time-points (baseline, 12-months, and 24-months) using a 7T MR-System (Philips Achieva). 3-point Dixon images were acquired at 3T (Philips Ingenia) to determine muscle fat fraction. Analyses were done for six muscles that represent different stages of muscle wasting. Differences between groups and time-points were assessed with non-parametric tests with correction for multiple comparisons. Coefficient of variance (CV) were determined for PDE in four healthy adult volunteers in high and low signal-to-noise ratio (SNR) datasets. Results PDE-levels were significantly higher (two-fold) in DMD patients compared to controls in all analyzed muscles at almost every time point and did not change over the study period. Fat fraction was significantly elevated in all muscles at all time points compared to healthy controls, and increased significantly over time, except in the tibialis posterior muscle. The mean within subject CV for PDE-levels was 4.3% in datasets with high SNR (>10:1) and 5.7% in datasets with low SNR. Discussion and conclusion The stable two-fold increase in PDE-levels found in DMD patients in muscles with different levels of muscle wasting over 2-year time, including DMD patients as young as 5.5 years-old, suggests that PDE-levels may increase very rapidly early in the disease process and remain elevated thereafter. The low CV values in high and low SNR datasets show that PDE-levels can be accurately and reproducibly quantified in all conditions. Our data confirms the great potential of PDE as a marker for muscle tissue changes in DMD patients. PMID:28763477

Hierarchical and symmetric infant image registration by robust longitudinal-example-guided correspondence detection

PubMed Central

Wu, Yao; Wu, Guorong; Wang, Li; Munsell, Brent C.; Wang, Qian; Lin, Weili; Feng, Qianjin; Chen, Wufan; Shen, Dinggang

2015-01-01

Purpose: To investigate anatomical differences across individual subjects, or longitudinal changes in early brain development, it is important to perform accurate image registration. However, due to fast brain development and dynamic tissue appearance changes, it is very difficult to align infant brain images acquired from birth to 1-yr-old. Methods: To solve this challenging problem, a novel image registration method is proposed to align two infant brain images, regardless of age at acquisition. The main idea is to utilize the growth trajectories, or spatial-temporal correspondences, learned from a set of longitudinal training images, for guiding the registration of two different time-point images with different image appearances. Specifically, in the training stage, an intrinsic growth trajectory is first estimated for each training subject using the longitudinal images. To register two new infant images with potentially a large age gap, the corresponding images patches between each new image and its respective training images with similar age are identified. Finally, the registration between the two new images can be assisted by the learned growth trajectories from one time point to another time point that have been established in the training stage. To further improve registration accuracy, the proposed method is combined with a hierarchical and symmetric registration framework that can iteratively add new key points in both images to steer the estimation of the deformation between the two infant brain images under registration. Results: To evaluate image registration accuracy, the proposed method is used to align 24 infant subjects at five different time points (2-week-old, 3-month-old, 6-month-old, 9-month-old, and 12-month-old). Compared to the state-of-the-art methods, the proposed method demonstrated superior registration performance. Conclusions: The proposed method addresses the difficulties in the infant brain registration and produces better results compared to existing state-of-the-art registration methods. PMID:26133617

Outcomes of operative treatment of unstable ankle fractures: a comparison of metallic and biodegradable implants.

PubMed

Noh, Jung Ho; Roh, Young Hak; Yang, Bo Gyu; Kim, Seong Wan; Lee, Jun Suk; Oh, Moo Kyung

2012-11-21

Biodegradable implants for internal fixation of ankle fractures may overcome some disadvantages of metallic implants, such as imaging interference and the potential need for additional surgery to remove the implants. The purpose of this study was to evaluate the outcomes after fixation of ankle fractures with biodegradable implants compared with metallic implants. In this prospectively randomized study, 109 subjects with an ankle fracture underwent surgery with metallic (Group I) or biodegradable implants (Group II). Radiographic results were assessed by the criteria of the Klossner classification system and time to bone union. Clinical results were assessed with use of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Short Musculoskeletal Function Assessment (SMFA) dysfunction index, and the SMFA bother index at three, six, and twelve months after surgery. One hundred and two subjects completed the study. At a mean of 19.7 months, there were no differences in reduction quality between the groups. The mean operative time was 30.2 minutes in Group I and 56.4 minutes in Group II (p < 0.001). The mean time to bone union was 15.8 weeks in Group I and 17.6 weeks in Group II (p = 0.002). The mean AOFAS score was 87.5 points in Group I and 84.3 points in Group II at twelve months after surgery (p = 0.004). The mean SMFA dysfunction index was 8.7 points in Group I and 10.5 points in Group II at twelve months after surgery (p = 0.060). The mean SMFA bother index averaged 3.3 points in Group I and 4.6 points in Group II at twelve months after surgery (p = 0.052). No difference existed between the groups with regard to clinical outcomes for the subjects with an isolated lateral malleolar fracture. The outcomes after fixation of bimalleolar ankle fractures with biodegradable implants were inferior to those after fixation with metallic implants in terms of the score on the AOFAS scale and time to bone union. However, the difference in the final AOFAS score between the groups may not be clinically important. The outcomes associated with the use of biodegradable implants for the fixation of isolated lateral malleolar fractures were comparable with those for metallic implants.

Phase 1/2 Trial of 5-Fraction Stereotactic Radiosurgery With 5-mm Margins With Concurrent and Adjuvant Temozolomide in Newly Diagnosed Supratentorial Glioblastoma: Health-Related Quality of Life Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pollom, Erqi L.; Fujimoto, Dylann; Wynne, Jacob

Purpose: We report a longitudinal assessment of health-related quality of life (HRQOL) in patients with glioblastoma (GBM) treated on a prospective dose escalation trial of 5-fraction stereotactic radiosurgery (25-40 Gy in 5 fractions) with concurrent and adjuvant temozolomide. Methods: HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire core-30 (QLQ-C30) general, the EORTC quality of life questionnaire-brain cancer specific module (QLQ-BN20), and the M.D. Anderson Symptom Inventory–Brain Tumor (MDASI-BT). Questionnaires were completed at baseline and at every follow-up visit after completion of radiosurgery. Changes from baseline for 9 predefined HRQOL measures (globalmore » quality of life, physical functioning, social functioning, emotional functioning, motor dysfunction, communication deficit, fatigue, insomnia, and future uncertainty) were calculated at every time point. Results: With a median follow-up time of 10.4 months (range, 0.4-52 months), 139 total HRQOL questionnaires were completed by the 30 patients on trial. Compliance with HRQOL assessment was 76% at 12 months. Communication deficit significantly worsened over time, with a decline of 1.7 points per month (P=.008). No significant changes over time were detected in the other 8 scales of our primary analysis, including global quality of life. Although 8 patients (27%) experienced adverse radiation effects (ARE) on this dose escalation trial, it was not associated with a statistically significant decline in any of the primary HRQOL scales. Disease progression was associated with communication deficit, with patients experiencing an average worsening of 13.9 points per month after progression compared with 0.7 points per month before progression (P=.01). Conclusion: On this 5-fraction dose escalation protocol for newly diagnosed GBM, overall HRQOL remained stable and appears similar to historical controls of 30 fractions of radiation therapy. Tumor recurrence was associated with worsening communication deficit, and ARE did not correlate with a decline in HRQOL.« less

A study of the relative responsiveness of five sensibility tests for assessment of recovery after median nerve injury and repair.

PubMed

Jerosch-Herold, Christina

2003-06-01

A longitudinal dynamic cohort study was conducted on patients with median nerve injuries to evaluate the relative responsiveness of five sensibility tests: touch threshold using the WEST (monofilaments), static two-point discrimination, locognosia, a pick-up test and an object recognition test. Repeated assessments were performed starting at 6 months after surgery. In order to compare the relative responsiveness of each test, effect size and the standard response mean were calculated for sensibility changes occurring between 6 and 18 months after repair. Large effect sizes (>0.8) and standard response means (>0.8) were obtained for the WEST, locognosia, pick-up and object recognition tests. Two-point discrimination was hardly measurable at any time point and exhibited strong flooring effects. Further analysis of all time points was undertaken to assess the strength of the monotonic relationship between test scores and time elapsed since surgery. Comparison of monotonicity between the five tests indicated that the WEST performed best, whereas two-point discrimination performed worst. These results suggest that the monofilament test (WEST), locognosia test, Moberg pick-up test and tactile gnosis test capture sensibility changes over time well and should be considered for inclusion in the outcome assessment of patients with median nerve injury.

The long-term outcome of tick-borne encephalitis in Central Europe.

PubMed

Bogovič, Petra; Stupica, Daša; Rojko, Tereza; Lotrič-Furlan, Stanka; Avšič-Županc, Tatjana; Kastrin, Andrej; Lusa, Lara; Strle, Franc

2018-02-01

Information on the long-term outcome of tick-borne encephalitis (TBE) is limited. To assess the frequency and severity of post-encephalitic syndrome (PES) at different time points after TBE, and to determine the parameters associated with unfavourable outcome. Adult patients diagnosed with TBE in Slovenia in the period 2007-2012 were followed-up for 12 months and also examined 2-7 years after TBE. Each patient was asked to refer a person of similar age without a history of TBE to serve as control. A total of 420 patients and 295 control persons participated in the study. The proportion of patients with PES (defined as the presence of ≥ 2 subjective symptoms that newly developed or worsened since the onset of TBE and which had no other known medical explanation, and/or ≥ 1 objective neurological sign) was higher (P < 0.001) at the follow-up visit 6 months after the acute illness (127/304, 42%, 95% CI: 36-47%) than at 12 months (68/207, 33%, 95% CI: 26-40%); the proportion at 12 months was the same as at 2-7 years after TBE (137/420, 33%, 95% CI: 28-37%). However, the proportion of severe PES at the last two time points differed (9.7% vs 4.3%, P = 0.008). Multivariate logistic regression showed that unfavourable outcome at 6 months was associated with CSF leukocyte count (OR = 1.003, 95% CI: 1.001-1.005%, P = 0.017), at 12 months with the disease outcome at 6 months (OR = 115.473, 95% CI: 26.009-512.667%, P < 0.001), and at the final visit with disease outcome at 6 months (OR = 3.808, 95% CI: 1.151-12.593%, P = 0.028) and 12 months (OR = 26.740, 95% CI: 8.648-82.680%, P < 0.001). Unspecific symptoms that occurred within the four weeks before the final examination were more frequent and more constant in patients than in the control group. The frequency of PES diminished over time and stabilized 12 months after the acute illness, whereas the severity of PES continued to decline. Unfavourable outcomes at 12 months and at the final visit were strongly associated with the presence of PES at previous time points. Copyright © 2017 Elsevier GmbH. All rights reserved.

[Multiple time scales analysis of spatial differentiation characteristics of non-point source nitrogen loss within watershed].

PubMed

Liu, Mei-bing; Chen, Xing-wei; Chen, Ying

2015-07-01

Identification of the critical source areas of non-point source pollution is an important means to control the non-point source pollution within the watershed. In order to further reveal the impact of multiple time scales on the spatial differentiation characteristics of non-point source nitrogen loss, a SWAT model of Shanmei Reservoir watershed was developed. Based on the simulation of total nitrogen (TN) loss intensity of all 38 subbasins, spatial distribution characteristics of nitrogen loss and critical source areas were analyzed at three time scales of yearly average, monthly average and rainstorms flood process, respectively. Furthermore, multiple linear correlation analysis was conducted to analyze the contribution of natural environment and anthropogenic disturbance on nitrogen loss. The results showed that there were significant spatial differences of TN loss in Shanmei Reservoir watershed at different time scales, and the spatial differentiation degree of nitrogen loss was in the order of monthly average > yearly average > rainstorms flood process. TN loss load mainly came from upland Taoxi subbasin, which was identified as the critical source area. At different time scales, land use types (such as farmland and forest) were always the dominant factor affecting the spatial distribution of nitrogen loss, while the effect of precipitation and runoff on the nitrogen loss was only taken in no fertilization month and several processes of storm flood at no fertilization date. This was mainly due to the significant spatial variation of land use and fertilization, as well as the low spatial variability of precipitation and runoff.

Longitudinal assessment of local and global functional connectivity following sports-related concussion.

PubMed

Meier, Timothy B; Bellgowan, Patrick S F; Mayer, Andrew R

2017-02-01

Growing evidence suggests that sports-related concussions (SRC) may lead to acute changes in intrinsic functional connectivity, although most studies to date have been cross-sectional in nature with relatively modest sample sizes. We longitudinally assessed changes in local and global resting state functional connectivity using metrics that do not require a priori seed or network selection (regional homogeneity; ReHo and global brain connectivity; GBC, respectively). A large sample of collegiate athletes (N = 43) was assessed approximately one day (1.74 days post-injury, N = 34), one week (8.44 days, N = 34), and one month post-concussion (32.47 days, N = 30). Healthy contact sport-athletes served as controls (N = 51). Concussed athletes showed improvement in mood symptoms at each time point (p's < 0.05), but had significantly higher mood scores than healthy athletes at every time point (p's < 0.05). In contrast, self-reported symptoms and cognitive deficits improved over time following concussion (p's < 0.001), returning to healthy levels by one week post-concussion. ReHo in sensorimotor, visual, and temporal cortices increased over time post-concussion, and was greatest at one month post-injury. Conversely, ReHo in the frontal cortex decreased over time following SRC, with the greatest decrease evident at one month post-concussion. Differences in ReHo relative to healthy athletes were primarily observed at one month post-concussion rather than the more acute time points. Contrary to our hypothesis, no significant cross-sectional or longitudinal differences in GBC were observed. These results are suggestive of a delayed onset of local connectivity changes following SRC.

Association Between Decline in Slow Vital Capacity and Respiratory Insufficiency, Use of Assisted Ventilation, Tracheostomy, or Death in Patients With Amyotrophic Lateral Sclerosis

PubMed Central

Meng, Lisa; Kulke, Sarah F.; Rudnicki, Stacy A.; Wolff, Andrew A.; Bozik, Michael E.; Malik, Fady I.; Shefner, Jeremy M.

2017-01-01

Importance The prognostic value of slow vital capacity (SVC) in relation to respiratory function decline and disease progression in patients with amyotrophic lateral sclerosis (ALS) is not well understood. Objective To investigate the rate of decline in percentage predicted SVC and its association with respiratory-related clinical events and mortality in patients with ALS. Design, Setting, and Participants This retrospective study included 893 placebo-treated patients from 2 large clinical trials (EMPOWER and BENEFIT-ALS, conducted from March 28, 2011, to November 1, 2012, and from October 23, 2012, to March 21, 2014, respectively) and an ALS trial database (PRO-ACT, containing studies completed between 1990 and 2010) to investigate the rate of decline in SVC. Data from the EMPOWER trial (which enrolled adults with possible, probable, or definite ALS; symptom onset within 24 months before screening; and upright SVC at least 65% of predicted value for age, height, and sex) were used to assess the relationship of SVC to respiratory-related clinical events; 456 patients randomized to placebo were used in this analysis. The 2 clinical trials included patients from North America, Australia, and Europe. Main Outcomes and Measures Clinical events included the earlier of time to death or time to decline in the Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised (ALSFRS-R) respiratory subdomain, time to onset of respiratory insufficiency, time to tracheostomy, and all-cause mortality. Results Among 893 placebo-treated patients with ALS, the mean (SD) patient age was 56.7 (11.2) years, and the mean (SD) SVC was 90.5% (17.1%) at baseline; 65.5% (585 of 893) were male, and 20.5% (183 of 893) had bulbar-onset ALS. In EMPOWER, average decline of SVC from baseline through 1.5-year follow-up was −2.7 percentage points per month. Steeper declines were found in patients older than 65 years (−3.6 percentage points per month [P = .005 vs <50 years and P = .007 vs 50-65 years) and in patients with an ALSFRS-R total score of 39 or less at baseline (−3.1 percentage points per month [P < .001 vs >39]). When the rate of decline of SVC was slower by 1.5 percentage points per month in the first 6 months, risk reductions for events after 6 months were 19% for decline in the ALSFRS-R respiratory subdomain or death after 6 months, 22% for first onset of respiratory insufficiency or death after 6 months, 23% for first occurrence of tracheostomy or death after 6 months, and 23% for death at any time after 6 months (P < .001 for all). Conclusions and Relevance The rate of decline in SVC is associated with meaningful clinical events in ALS, including respiratory failure, tracheostomy, or death, suggesting that it is an important indicator of clinical progression. PMID:29181534

Metabolic changes in serum steroids induced by total-body irradiation of female C57B/6 mice.

PubMed

Moon, Ju-Yeon; Shin, Hee-June; Son, Hyun-Hwa; Lee, Jeongae; Jung, Uhee; Jo, Sung-Kee; Kim, Hyun Sik; Kwon, Kyung-Hoon; Park, Kyu Hwan; Chung, Bong Chul; Choi, Man Ho

2014-05-01

The short- and long-term effects of a single exposure to gamma radiation on steroid metabolism were investigated in mice. Gas chromatography-mass spectrometry was used to generate quantitative profiles of serum steroid levels in mice that had undergone total-body irradiation (TBI) at doses of 0Gy, 1Gy, and 4Gy. Following TBI, serum samples were collected at the pre-dose time point and 1, 3, 6, and 9 months after TBI. Serum levels of progestins, progesterone, 5β-DHP, 5α-DHP, and 20α-DHP showed a significant down-regulation following short-term exposure to 4Gy, with the exception of 20α-DHP, which was significantly decreased at each of the time points measured. The corticosteroids 5α-THDOC and 5α-DHB were significantly elevated at each of the time points measured after exposure to either 1 or 4Gy. Among the sterols, 24S-OH-cholestoerol showed a dose-related elevation after irradiation that reached significance in the high dose group at the 6- and 9-month time points. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pharmacy students' retention of knowledge and skills following training in automated external defibrillator use.

PubMed

Kopacek, Karen Birckelbaw; Dopp, Anna Legreid; Dopp, John M; Vardeny, Orly; Sims, J Jason

2010-08-10

To assess pharmacy students' retention of knowledge about appropriate automated external defibrillator use and counseling points following didactic training and simulated experience. Following a lecture on sudden cardiac arrest and automated external defibrillator use, second-year doctor of pharmacy (PharmD) students were assessed on their ability to perform basic life support and deliver a shock at baseline, 3 weeks, and 4 months. Students completed a questionnaire to evaluate recall of counseling points for laypeople/the public. Mean time to shock delivery at baseline was 74 ± 25 seconds, which improved significantly at 3 weeks (50 ± 17 seconds, p < 0.001) and was maintained at 4 months (47 ± 18 seconds, p < 0.001). Recall of all signs and symptoms of sudden cardiac arrest and automated external defibrillator counseling points was diminished after 4 months. Pharmacy students can use automated external defibrillators to quickly deliver a shock and are able to retain this ability after 4 months. Refresher training/courses will be required to improve students' retention of automated external defibrillator counseling points to ensure their ability to deliver appropriate patient education.

Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review.

PubMed

Jones, Matthew; Lewis, Sarah; Parrott, Steve; Wormall, Stephen; Coleman, Tim

2016-06-01

In pregnant smoking cessation trial participants, to estimate (1) among women abstinent at the end of pregnancy, the proportion who re-start smoking at time-points afterwards (primary analysis) and (2) among all trial participants, the proportion smoking at the end of pregnancy and at selected time-points during the postpartum period (secondary analysis). Trials identified from two Cochrane reviews plus searches of Medline and EMBASE. Twenty-seven trials were included. The included trials were randomized or quasi-randomized trials of within-pregnancy cessation interventions given to smokers who reported abstinence both at end of pregnancy and at one or more defined time-points after birth. Outcomes were validated biochemically and self-reported continuous abstinence from smoking and 7-day point prevalence abstinence. The primary random-effects meta-analysis used longitudinal data to estimate mean pooled proportions of re-starting smoking; a secondary analysis used cross-sectional data to estimate the mean proportions smoking at different postpartum time-points. Subgroup analyses were performed on biochemically validated abstinence. The pooled mean proportion re-starting at 6 months postpartum was 43% [95% confidence interval (CI) = 16-72%, I(2)  = 96.7%] (11 trials, 571 abstinent women). The pooled mean proportion smoking at the end of pregnancy was 87% (95% CI = 84-90%, I(2)  = 93.2%) and 94% (95% CI = 92-96%, I(2)  = 88%) at 6 months postpartum (23 trials, 9262 trial participants). Findings were similar when using biochemically validated abstinence. In clinical trials of smoking cessation interventions during pregnancy only 13% are abstinent at term. Of these, 43% re-start by 6 months postpartum. © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Health-Related Quality of Life in Elderly Patients With Newly Diagnosed Glioblastoma Treated With Short-Course Radiation Therapy Plus Concomitant and Adjuvant Temozolomide

DOE Office of Scientific and Technical Information (OSTI.GOV)

Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it; Department of Neurological Sciences, Neuromed Institute, Pozzilli; Scaringi, Claudia

2013-06-01

Purpose: To describe the quality of life (QOL) in elderly patients with glioblastoma (GBM) treated with an abbreviated course of radiation therapy (RT; 40 Gy in 15 fractions) plus concomitant and adjuvant temozolomide (TMZ). Methods and Materials: Health-related QOL (HRQOL) was assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30, version 3) and EORTC Quality of Life Questionnaire Brain Cancer Module (QLQ-BN20). Changes from baseline in the score of 9 preselected domains (global QLQ, social functioning, cognitive functioning, emotional functioning, physical functioning, motor dysfunction, communication deficit, fatigue, insomnia) were determined 4 weeksmore » after RT and thereafter every 8 weeks during the treatment until disease progression. The proportion of patients with improved HRQOL scores, defined as a change of 10 points or more, and duration of changes were recorded. Results: Sixty-five patients completed the questionnaires at baseline. The treatment was consistently associated with improvement or stability in most of the preselected HRQOL domains. Global health improved over time; mean score differed by 9.6 points between baseline and 6-month follow-up (P=.03). For social functioning and cognitive functioning, mean scores improved over time, with a maximum difference of 10.4 points and 9.5 points between baseline and 6-month follow-up (P=.01 and P=.02), respectively. By contrast, fatigue worsened over time, with a difference in mean score of 5.6 points between baseline and 4-month follow-up (P=.02). Conclusions: A short course of RT in combination with TMZ in elderly patients with GBM was associated with survival benefit without a negative effect on HRQOL until the time of disease progression.« less

Evidence of increased brain amyloid in severe TBI survivors at 1, 12, and 24 months after injury: report of 2 cases.

PubMed

Gatson, Joshua W; Stebbins, Cari; Mathews, Dana; Harris, Thomas S; Madden, Christopher; Batjer, Hunt; Diaz-Arrastia, Ramon; Minei, Joseph P

2016-06-01

Traumatic brain injury (TBI) is a major risk factor for Alzheimer's disease. With respect to amyloid deposition, there are no published serial data regarding the deposition rate of amyloid throughout the brain after TBI. The authors conducted serial (18)F-AV-45 (florbetapir F18) positron emission tomography (PET) imaging in 2 patients with severe TBI at 1, 12, and 24 months after injury. A total of 12 brain regions were surveyed for changes in amyloid levels. Case 1 involved a 50-year-old man who experienced a severe TBI. Compared with the 1-month time point, of the 12 brain regions that were surveyed, a decrease in amyloid (as indicated by standard uptake value ratios) was only observed in the hippocampus (-16%, left; -12%, right) and caudate nucleus (-18%, left; -18%, right), suggesting that initial amyloid accumulation in the brain was cleared between time points 1 and 12 months after injury. Compared to the scan at 1 year, a greater increase in amyloid (+15%) was observed in the right hippocampus at the 24-month time point. The patient in Case 2 was a 37-year-old man who suffered severe trauma to the head and a subsequent stroke; he had poor cognitive/functional outcomes and underwent 1.5 years of rehabilitation. Due to a large infarct area on the injured side of the brain (right side), the authors focused primarily on brain regions affected within the left hemisphere. Compared with the 1-month scan, they only found an increase in brain amyloid within the left anterior putamen (+11%) at 12 months after injury. In contrast, decreased amyloid burden was detected in the left caudate nucleus (-48%), occipital cortex (-21%), and precuneus (-19%) brain regions at the 12-month time point, which is indicative of early accumulation and subsequent clearance. In comparison with 12-month values, more clearance was observed, since a reduction in amyloid was found at 24 months after trauma within the left anterior putamen (-12%) and occipital cortex (-15%). Also, by 24 months, most of the amyloid had been cleared and the patient demonstrated improved results on the Rivermead symptom questionnaire, Glasgow Outcome Scale-Extended, and Disability Rating Scale. With respect to APOE status, the patient in Case 1 had two ε3 alleles and the patient in Case 2 had one ε2 and one ε3 allele. In comparison to the findings of the initial scan at 1 month after TBI, by 12 and 24 months after injury amyloid was cleared in some brain regions and increased in others. Serial imaging conducted here suggests that florbetapir F18 PET imaging may be useful in monitoring amyloid dynamics within specific brain regions following severe TBI and may be predictive of cognitive deficits.

Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial.

PubMed

González Isasi, A; Echeburúa, E; Limiñana, J M; González-Pinto, A

2014-03-01

The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological+psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. Forty patients were randomly assigned to either an Experimental group-under combined treatment - or a Control group - under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points. Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P=0.015). The Experimental group showed lower depression and anxiety in the 6-month (P=0.006; P=0.019), 12-month (P=0.001; P<0.001) and 5-year (P<0.001, P<0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P=0.009; P<0.001) and were sustained throughout the study (6-month: P=0.006, P<0.001; 12-month: P<0.001, P<0.001; 5-year: P=0.004, P<0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning. A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented. Published by Elsevier Masson SAS.

Effects of cow milk versus extensive protein hydrolysate formulas on infant cognitive development.

PubMed

Mennella, Julie A; Trabulsi, Jillian C; Papas, Mia A

2016-03-01

Little research has focused on infant developmental effects, other than growth, of formulas that differ substantially in the form of protein. To examine development of infants fed formulas differing in free amino acid content, we randomized 0.5-month-old infants (n = 79) to either a control group who fed only cow milk formula (CMF) during the first 8 months (CMF8), or to one of two experimental groups: one experimental group fed extensively protein hydrolyzed formula (EHF) for 1-3 months during first 4.5 months (EHF1-3) of life, and the other fed EHF for 8 months (EHF8). The Mullen Scales of Early Learning were administered monthly from 1.5 to 8.5 months to assess fine (FM) and gross (GM) motor control, receptive (RL) and expressive (EL) language, visual reception (VR), and an early learning composite (ELC). Across the 5.5-8.5-month time period, when compared to CMF8 infants, GM scores in EHF1-3 infants averaged 1.5 points higher (95 % CI 0.1, 3.0) and in EHF8 infants 2.2 points higher (95 % CI 0.3, 4.0). Similarly, VR scores averaged 1.9 points higher (95 % CI 0.1, 3.8) in EHF1-3 infants and 2.2 points higher (95 % CI -0.2, 4.5) in EHF8 infants. EHF8 infants' RL scores averaged 1.8 points lower (95 % CI 0.1, 3.6) than CMF8 infants. These data suggest that the form of protein in infant formula may impact cognitive development and that the higher free amino acid content in breast milk may be a contributing factor to the differential cognitive development between breastfed and CMF-fed infants. clinicaltrials.gov NCT00994747.

Physical activity and post-treatment weight trajectory in anorexia nervosa

PubMed Central

Gianini, Loren M; Klein, Diane A; Call, Christine; Walsh, B. Timothy; Wang, Yuanjia; Wu, Peng; Attia, Evelyn

2015-01-01

Objective This study compared an objective measurement of physical activity (PA) in individuals with anorexia nervosa (AN) at low-weight, weight-restored, and post-treatment time points, and also compared PA in AN with that of healthy controls (HC). Method Sixty-one female inpatients with AN wore a novel accelerometer (the IDEEA) which measured PA at three time points: a) low-weight, b) weight-restored, and c) one month post-hospital discharge. Twenty-four HCs wore the IDEEA at one time point. Results Inpatients with AN became more physically active than they were at low-weight at weight restoration and following treatment discharge. Post-treatment patients with AN were more physically active than HCs during the day and less active at night, which was primarily accounted for by amount of time spent on feet, including standing and walking. Greater time spent on feet during the weight-restoration time point of inpatient treatment was associated with more rapid decrease in BMI over the 12 months following treatment discharge. Fidgeting did not differ between patients and controls, did not change with weight restoration, and did not predict post-treatment weight change. Discussion Use of a novel accelerometer demonstrated greater PA in AN than in healthy controls. PA following weight restoration in AN, particularly time spent in standing postures, may contribute to weight loss in the year following hospitalization. PMID:26712105

Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence.

PubMed

Wakefield, Melanie A; Durkin, Sarah; Spittal, Matthew J; Siahpush, Mohammad; Scollo, Michelle; Simpson, Julie A; Chapman, Simon; White, Victoria; Hill, David

2008-08-01

We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

Impact of Tobacco Control Policies and Mass Media Campaigns on Monthly Adult Smoking Prevalence

PubMed Central

Wakefield, Melanie A.; Durkin, Sarah; Spittal, Matthew J.; Siahpush, Mohammad; Scollo, Michelle; Simpson, Julie A.; Chapman, Simon; White, Victoria; Hill, David

2008-01-01

Objectives. We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. Methods. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws. Results. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence. Conclusions. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence. PMID:18556601

A Three-Dose Intramuscular Injection Schedule of Anthrax Vaccine Adsorbed Generates Sustained Humoral and Cellular Immune Responses to Protective Antigen and Provides Long-Term Protection against Inhalation Anthrax in Rhesus Macaques

PubMed Central

Sabourin, Carol L.; Niemuth, Nancy A.; Li, Han; Semenova, Vera A.; Rudge, Thomas L.; Mayfield, Heather J.; Schiffer, Jarad; Mittler, Robert S.; Ibegbu, Chris C.; Wrammert, Jens; Ahmed, Rafi; Brys, April M.; Hunt, Robert E.; Levesque, Denyse; Estep, James E.; Barnewall, Roy E.; Robinson, David M.; Plikaytis, Brian D.; Marano, Nina

2012-01-01

A 3-dose (0, 1, and 6 months) intramuscular (3-IM) priming series of a human dose (HuAVA) and dilutions of up to 1:10 of anthrax vaccine adsorbed (AVA) provided statistically significant levels of protection (60 to 100%) against inhalation anthrax for up to 4 years in rhesus macaques. Serum anti-protective antigen (anti-PA) IgG and lethal toxin neutralization activity (TNA) were detectable following a single injection of HuAVA or 1:5 AVA or following two injections of diluted vaccine (1:10, 1:20, or 1:40 AVA). Anti-PA and TNA were highly correlated (overall r2 = 0.89 for log10-transformed data). Peak responses were seen at 6.5 months. In general, with the exception of animals receiving 1:40 AVA, serum anti-PA and TNA responses remained significantly above control levels at 28.5 months (the last time point measured for 1:20 AVA), and through 50.5 months for the HuAVA and 1:5 and 1:10 AVA groups (P < 0.05). PA-specific gamma interferon (IFN-γ) and interleukin-4 (IL-4) CD4+ cell frequencies and T cell stimulation indices were sustained through 50.5 months (the last time point measured). PA-specific memory B cell frequencies were highly variable but, in general, were detectable in peripheral blood mononuclear cells (PBMC) by 2 months, were significantly above control levels by 7 months, and remained detectable in the HuAVA and 1:5 and 1:20 AVA groups through 42 months (the last time point measured). HuAVA and diluted AVA elicited a combined Th1/Th2 response and robust immunological priming, with sustained production of high-avidity PA-specific functional antibody, long-term immune cell competence, and immunological memory (30 months for 1:20 AVA and 52 months for 1:10 AVA). Vaccinated animals surviving inhalation anthrax developed high-magnitude anamnestic anti-PA IgG and TNA responses. PMID:22933399

A three-dose intramuscular injection schedule of anthrax vaccine adsorbed generates sustained humoral and cellular immune responses to protective antigen and provides long-term protection against inhalation anthrax in rhesus macaques.

PubMed

Quinn, Conrad P; Sabourin, Carol L; Niemuth, Nancy A; Li, Han; Semenova, Vera A; Rudge, Thomas L; Mayfield, Heather J; Schiffer, Jarad; Mittler, Robert S; Ibegbu, Chris C; Wrammert, Jens; Ahmed, Rafi; Brys, April M; Hunt, Robert E; Levesque, Denyse; Estep, James E; Barnewall, Roy E; Robinson, David M; Plikaytis, Brian D; Marano, Nina

2012-11-01

A 3-dose (0, 1, and 6 months) intramuscular (3-IM) priming series of a human dose (HuAVA) and dilutions of up to 1:10 of anthrax vaccine adsorbed (AVA) provided statistically significant levels of protection (60 to 100%) against inhalation anthrax for up to 4 years in rhesus macaques. Serum anti-protective antigen (anti-PA) IgG and lethal toxin neutralization activity (TNA) were detectable following a single injection of HuAVA or 1:5 AVA or following two injections of diluted vaccine (1:10, 1:20, or 1:40 AVA). Anti-PA and TNA were highly correlated (overall r(2) = 0.89 for log(10)-transformed data). Peak responses were seen at 6.5 months. In general, with the exception of animals receiving 1:40 AVA, serum anti-PA and TNA responses remained significantly above control levels at 28.5 months (the last time point measured for 1:20 AVA), and through 50.5 months for the HuAVA and 1:5 and 1:10 AVA groups (P < 0.05). PA-specific gamma interferon (IFN-γ) and interleukin-4 (IL-4) CD4(+) cell frequencies and T cell stimulation indices were sustained through 50.5 months (the last time point measured). PA-specific memory B cell frequencies were highly variable but, in general, were detectable in peripheral blood mononuclear cells (PBMC) by 2 months, were significantly above control levels by 7 months, and remained detectable in the HuAVA and 1:5 and 1:20 AVA groups through 42 months (the last time point measured). HuAVA and diluted AVA elicited a combined Th1/Th2 response and robust immunological priming, with sustained production of high-avidity PA-specific functional antibody, long-term immune cell competence, and immunological memory (30 months for 1:20 AVA and 52 months for 1:10 AVA). Vaccinated animals surviving inhalation anthrax developed high-magnitude anamnestic anti-PA IgG and TNA responses.

One year efficacy and safety of oral sildenafil treatment in severe pulmonary hypertension.

PubMed

Samarzija, Miroslav; Zuljević, Ervin; Jakopović, Marko; Sever, Branko; Knezević, Aleksandar; Dumija, Zeljko; Vidjak, Vinko; Samija, Mirko

2009-09-01

Severe pulmonary hypertension is a progressive disease which leads to limitations of functional status and poor survival. We evaluated efficacy and safety of a short (3 months) and a long term (12 months) sildenafil treatment in patients with severe pulmonary hypertension. We treated 12 patients with pulmonary hypertension with oral sildenafil. Patients were followed at three time points, at baseline, and after 3 and 12 months of treatment. Primary end point was improvement in functional exercise capacity assesed by 6-minute walk test, and secondary end points were changes in right ventricle hemodynamics. We found significant improvement in 6-minute walk test distance from 357 +/- 193 m at baseline to 431 +/- 179 m after three months and further improvement to 501 +/- 159 m after 12 months (p < 0.01); decrease in right ventricule pressure from 107 +/- 42 mmHg at baseline to 87 +/- 32 mmHg after 12 months (p < 0.01); and, decrease in right ventricule diameter from 3.2 +/- 1.1 cm to 2.76 +/- 0.86 cm after twelve months (p < 0.01). Drug-related adverse events were mild and transient in our group of patients. Long-term (12 months) sildenafil treatment is effective and safe in our patients with idiopathic and chronic thrombo-embolic pulmonary hypertension.

Transtheoretical Model Constructs for Physical Activity Behavior are Invariant across Time among Ethnically Diverse Adults in Hawaii

PubMed Central

Nigg, Claudio R; Motl, Robert W; Horwath, Caroline; Dishman, Rod K

2012-01-01

Objectives Physical activity (PA) research applying the Transtheoretical Model (TTM) to examine group differences and/or change over time requires preliminary evidence of factorial validity and invariance. The current study examined the factorial validity and longitudinal invariance of TTM constructs recently revised for PA. Method Participants from an ethnically diverse sample in Hawaii (N=700) completed questionnaires capturing each TTM construct. Results Factorial validity was confirmed for each construct using confirmatory factor analysis with full-information maximum likelihood. Longitudinal invariance was evidenced across a shorter (3-month) and longer (6-month) time period via nested model comparisons. Conclusions The questionnaires for each validated TTM construct are provided, and can now be generalized across similar subgroups and time points. Further validation of the provided measures is suggested in additional populations and across extended time points. PMID:22778669

Quality of Life During Treatment With Chemohormonal Therapy: Analysis of E3805 Chemohormonal Androgen Ablation Randomized Trial in Prostate Cancer.

PubMed

Morgans, Alicia K; Chen, Yu-Hui; Sweeney, Christopher J; Jarrard, David F; Plimack, Elizabeth R; Gartrell, Benjamin A; Carducci, Michael A; Hussain, Maha; Garcia, Jorge A; Cella, David; DiPaola, Robert S; Patrick-Miller, Linda J

2018-04-10

Purpose Chemohormonal therapy with docetaxel and androgen deprivation therapy (ADT+D) for metastatic hormone-sensitive prostate cancer improves overall survival as compared with androgen deprivation therapy (ADT) alone. We compared the quality of life (QOL) between patients with metastatic hormone-sensitive prostate cancer who were treated with ADT+D and those who were treated with ADT alone. Methods Men were randomly assigned to ADT+ D (six cycles) or to ADT alone. QOL was assessed by Functional Assessment of Cancer Therapy-Prostate (FACT-P), FACT-Taxane, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Brief Pain Inventory at baseline and at 3, 6, 9, and 12 months. The Wilcoxon signed rank test was used to examine changes over time. Mixed-effect models compared the QOL between arms at each time point. Results Seven hundred ninety men were randomly assigned (ADT+D [n = 397] and ADT[ n = 393]) and completed FACT-P (90% at baseline, 86% at 3 months, 83% at 6 months, 78% at 9 months, and 77% at 12 months). ADT+D patients reported a statistically significant decline in FACT-P at 3 months ( P < .001) but FACT-P did not differ significantly between baseline and 12 months ( P = .38). ADT+D FACT-P scores were significantly lower at 3 months ( P = .02) but significantly higher at 12 months ( P = .04) when compared with ADT FACT-P scores. Differences did not exceed the minimal clinically important difference at any time point. ADT+D patients reported significantly lower Functional Assessment of Chronic Illness Therapy-Fatigue scores at 3 months than did ADT patients ( P < .001). Over time, both arms reported significantly poorer FACT-Taxane scores ( P < .001) when compared with baseline. Brief Pain Inventory scores were similar between arms. Conclusion Although ADT+D was associated with statistically worse QOL at 3 months, QOL was better at 12 months for ADT+D patients than for ADT patients. Both arms reported a similar minimally changed QOL over time, suggesting that ADT+D is not associated with a greater long-term negative impact on QOL.

Relation of cardiac troponin I measurements at 24 and 48 hours to magnetic resonance-determined infarct size in patients with ST-elevation myocardial infarction.

PubMed

Hallén, Jonas; Buser, Peter; Schwitter, Jürg; Petzelbauer, Peter; Geudelin, Bernard; Fagerland, Morten W; Jaffe, Allan S; Atar, Dan

2009-12-01

Levels of circulating cardiac troponin I (cTnI) or T are correlated to extent of myocardial destruction after an acute myocardial infarction. Few studies analyzing this relation have employed a second-generation cTnI assay or cardiac magnetic resonance (CMR) as the imaging end point. In this post hoc study of the Efficacy of FX06 in the Prevention of Mycoardial Reperfusion Injury (F.I.R.E.) trial, we aimed at determining the correlation between single-point cTnI measurements and CMR-estimated infarct size at 5 to 7 days and 4 months after a first-time ST-elevation myocardial infarction (STEMI) and investigating whether cTnI might provide independent prognostic information regarding infarct size at 4 months even taking into account early infarct size. Two hundred twenty-seven patients with a first-time STEMI were included in F.I.R.E. All patients received primary percutaneous coronary intervention within 6 hours from onset of symptoms. cTnI was measured at 24 and 48 hours after admission. CMR was conducted within 1 week of the index event (5 to 7 days) and at 4 months. Pearson correlations (r) for infarct size and cTnI at 24 hours were r = 0.66 (5 days) and r = 0.63 (4 months) and those for cTnI at 48 hours were r = 0.67 (5 days) and r = 0.65 (4 months). In a multiple regression analysis for predicting infarct size at 4 months (n = 141), cTnI and infarct location retained an independent prognostic role even taking into account early infarct size. In conclusion, a single-point cTnI measurement taken early after a first-time STEMI is a useful marker for infarct size and might also supplement early CMR evaluation in prediction of infarct size at 4 months.

Histological outcomes of anal high-grade cytopredictions.

PubMed

Roberts, Jennifer Margaret; Jin, Fengyi; Poynten, Isobel Mary; Law, Carmella; Templeton, David James; Thurloe, Julia Kathleen; Garland, Suzanne Marie; Grulich, Andrew Edwin; Farnsworth, Annabelle; Hillman, Richard John

2018-02-01

Longitudinal studies of histological outcomes after anal cytological screening in men who have sex with men (MSM) are rare. This study measured the positive predictive values (PPVs) of each level of baseline cytological abnormality in MSM in Sydney, Australia, over a 12-month period. The Study of the Prevention of Anal Cancer is a 3-year prospective study of the natural history of anal human papillomavirus infection in MSM at least 35 years old. For each participant with a baseline cytological abnormality, the worst histology was recorded at the baseline high-resolution anoscopy and at 6 and 12 months. PPVs for a histological high-grade squamous intraepithelial lesion (HSIL) diagnosis were calculated for each level of baseline cytological abnormality at each time point. Among 424 men who completed 3 visits, the PPV of a cytological HSIL increased from 71.6% at the baseline to 86.4% at 6 months and to 92.6% at 12 months (P < .001). For cytological atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H), the PPV increased from 51.5% at the baseline to 69.7% at 6 months and to 75.8% at 12 months (P = .004). At each time point, the PPV of a cytological HSIL was significantly higher than the PPV of ASC-H. The PPV of low-grade cytology reports was significantly lower than the PPV of ASC-H at each time point. In a cohort of MSM, a baseline histological HSIL diagnosis after an HSIL cytoprediction is high, and it increases with further examinations over the course of 12 months. Lower levels of cytological abnormalities have significantly lower PPVs. These data can inform patient management and the quality assessment of each aspect of the screening pathway. Cancer Cytopathol 2018;126:136-44. © 2017 American Cancer Society. © 2017 American Cancer Society.

77 FR 14690 - Drawbridge Operation Regulation; New Jersey Intracoastal Waterway (NJICW), Point Pleasant Canal, NJ

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-13

.../Veterans Memorial Bridge across Point Pleasant Canal, NJICW mile 3.0, at Point Pleasant, NJ. This deviation... the Coast Guard, revealed that the bridge opened for vessels 1 and 0 times during the months of March...., Bridge Program Manager, Fifth Coast Guard District. [FR Doc. 2012-5978 Filed 3-12-12; 8:45 am] BILLING...

Long-term effectiveness of the preoperative smoking cessation programme at Western Health.

PubMed

Taylor, Hugh; Karahalios, Amalia; Bramley, David

2017-09-01

Smoking is associated with adverse effects in the perioperative period, including elevated risk of death. The perioperative period provides an opportunity to engage with patients who are smokers to encourage smoking cessation, often referred to as a 'teachable moment'. We developed a smoking intervention model for the pre-admission clinic (PAC) at Western Health, Victoria, Australia. This case series aimed to assess the impact of the smoking intervention model, which is standard of care, on the participant's smoking habits over four time points. We enrolled 50 consecutive participants for elective surgery who were smokers and had attended PAC at Western Health, Footscray. All smokers were offered a standard intervention package to address their smoking. Participants underwent a brief interview to elicit their current smoking behaviour on their day of surgery, 3 and 12 months post-operatively. We found a reduction at each time point post-intervention in the average number of cigarettes smoked per day by all participants with a 43% reduction at 12 months compared with PAC. We found that the number of participants who had quit increased at each time point, with 29% abstinent at 12 months post-operatively. At 12 months, we found 71% of participants had either quit or reduced the number of cigarettes smoked compared with the amount reported at PAC. This study adds to the evidence that a simple intervention preoperatively can contribute to long-term changes in smoking behaviour. © 2017 Royal Australasian College of Surgeons.

Memory for the September 11, 2001, terrorist attacks one year later in patients with Alzheimer's disease, patients with mild cognitive impairment, and healthy older adults.

PubMed

Budson, Andrew E; Simons, Jon S; Waring, Jill D; Sullivan, Alison L; Hussoin, Trisha; Schacter, Daniel L

2007-10-01

Although there are many opportunities to study memory in patients with Alzheimer's disease (AD) in the laboratory, there are few opportunities to study memory for real world events in these patients. The September 11, 2001 terrorist attacks provided one such opportunity. Patients with AD, patients with mild cognitive impairment (MCI), and healthy older adults were given a telephone questionnaire in the initial weeks after the event, again three to four months later, and finally one year afterwards to evaluate their memory for the September 11, 2001 terrorist attacks. We were particularly interested in using the attacks as an opportunity to examine the decline of episodic memory in patients with AD, patients with MCI, and older adult controls over a period of months. We found that compared to healthy older adults, patients with AD and MCI showed impaired memory at the initial time point, more rapid forgetting from the initial to the three-month time point, and very similar changes in memory from the three-month to the one-year time point. We speculated that these findings were consistent with patients with AD and MCI showing initial impaired encoding and a more rapid rate of forgetting compared with healthy older adults, but that once the memories had been consolidated, their decay rate became similar to that of healthy older adults. Lastly, although memory distortions were common among all groups, they were greatest in the patients with AD.

A Longitudinal Investigation of the Home Literacy Environment and Shared Book Reading in Young Children With Hearing Loss.

PubMed

DesJardin, Jean L; Stika, Carren J; Eisenberg, Laurie S; Johnson, Karen C; Hammes Ganguly, Dianne M; Henning, Shirley C; Colson, Bethany G

The principle goal of this longitudinal study was to examine parent perceptions of home literacy environment (e.g., frequency of book reading, ease of book reading with child) and observed behaviors during shared book reading (SBR) interactions between parents and their children with hearing loss (HL) as compared with parents and their children with normal hearing (NH) across 3 time points (12, 24, and 36 months old). Relationships were also explored among home literacy environment factors and SBR behaviors and later language outcomes, across all three time points for parents of children with and without HL. Participants were a group of parents and their children with HL (N = 17) and typically developing children with NH (N = 34). Parent perceptions about the home literacy environment were captured through a questionnaire. Observed parent behaviors and their use of facilitative language techniques were coded during videotaped SBR interactions. Children's oral language skills were assessed using a standardized language measure at each time point. No significant differences emerged between groups of parents (HL and NH) in terms of perceived home literacy environment at 12 and 36 months. However, significant group differences were evident for parent perceived ease of reading to their child at 24 months. Group differences also emerged for parental SBR behaviors for literacy strategies and interactive reading at 12 months and for engagement and interactive reading at 36 months, with parents of children with HL scoring lower in all factors. No significant relationships emerged between early home literacy factors and SBR behaviors at 12 months and oral language skills at 36 months for parents of children with NH. However, significant positive relationships were evident between early home literacy environment factors at 12 months and oral language skills at 36 months for parents and their children with HL. Although both groups of parents increased their frequency of SBR behaviors over time, parents of children with HL may need additional support to optimize SBR experiences to better guide their toddlers' and preschoolers' language skills. Early intervention efforts that focus on SBR interactions that are mutually enjoyed and incorporate specific ways to encourage parent-child conversations will be essential as children with HL acquire language.

Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach.

PubMed

Sun, Peter; Chang, Joanne; Zhang, Jie; Kahler, Kristijan H

2012-01-01

This study examines the evolutionary impact of valsartan initiation on medical costs. A retrospective time series study design was used with a large, US national commercial claims database for the period of 2004-2008. Hypertensive patients who initiated valsartan between the ages of 18 and 63, and had continuous enrollment for 24-month pre-initiation period and 24-month post-initiation period were selected. Patients' monthly medical costs were calculated based on individual claims. A novel time series model was devised with monthly medical costs as its dependent variables, autoregressive integrated moving average (ARIMA) as its stochastic components, and four indicative variables as its decomposed interventional components. The number of post-initiation months before a cost-offset point was also assessed. Patients (n = 18,269) had mean age of 53 at the initiation date, and 53% of them were female. The most common co-morbid conditions were dyslipidemia (52%), diabetes (24%), and hypertensive complications (17%). The time series model suggests that medical costs were increasing by approximately $10 per month (p < 0.01) before the initiation, and decreasing by approximately $6 per month (p < 0.01) after the initiation. After the 4th post-initiation month, medical costs for patients with the initiation were statistically significantly lower (p < 0.01) than forecasted medical costs for the same patients without the initiation. The study has its limitations in data representativeness, ability to collect unrecorded clinical conditions, treatments, and costs, as well as its generalizability to patients with different characteristics. Commercially insured hypertensive patients experienced monthly medical cost increase before valsartan initiation. Based on our model, the evolutionary impact of the initiation on medical costs included a temporary cost surge, a gradual, consistent, and statistically significant cost decrease, and a cost-offset point around the 4th post-initiation month.

Response to depression treatment in the Aging Brain Care Medical Home model.

PubMed

LaMantia, Michael A; Perkins, Anthony J; Gao, Sujuan; Austrom, Mary G; Alder, Cathy A; French, Dustin D; Litzelman, Debra K; Cottingham, Ann H; Boustani, Malaz A

2016-01-01

To evaluate the effect of the Aging Brain Care (ABC) Medical Home program's depression module on patients' depression severity measurement over time. Retrospective chart review. Public hospital system. Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program's depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time ( P <0.001); however, the effect differed by gender ( P =0.015). On average, women's scores (4.5 point drop at 1 month) improved faster than men's scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials.

Longitudinal relationship between physical activity and cardiometabolic factors in overweight and obese adults

PubMed Central

Choo, Jina; Elci, Okan U.; Yang, Kyeongra; Turk, Melanie W.; Styn, Mindi A.; Sereika, Susan M.; Music, Edvin; Burke, Lora E.

2012-01-01

Few studies have reported longitudinal relationships between physical activity (PA) and cardiometabolic risk factors over time using repeated assessments in overweight or obese adults. We conducted a longitudinal study in 127 participants (81% with body mass index > 30 kg/m2) who completed a 12-month behavioral intervention for weight loss between 2003 and 2005 in Pittsburgh, PA, USA. Using absolute change scores from baseline to each time point (i.e., 6 and 12 months) for all studied variables (Δ = time point – baseline), we performed mixed effects modeling to examine relationships between PA and cardiometabolic risk factors, after adjusting for body weight, energy intake and other covariates (i.e., age, gender, and ethnicity). PA was assessed as energy expenditure (kcal/week) using the Paffenbarger activity questionnaire. Over the 12-month period, energy expenditure increased (Δ1,370 kcal/week at 6 months vs. Δ886 kcal/week at 12 months); body weight decreased (Δ8.9 kg at 6 months vs. Δ8.4 kg at 12 months). The average increase in energy expenditure over 12 months was significantly and independently related to reductions in total cholesterol (F = 6.25, p = 0.013), low-density lipoprotein cholesterol (LDL-C) (F = 5.08, p = 0.025) and fasting blood glucose (F = 5.10, p = 0.025), but not to other risk factors (i.e., fasting insulin, high-density lipoprotein cholesterol, triglycerides, and waist circumference). In conclusion, among overweight and obese adults undergoing a weight loss intervention, increased energy expenditure over 12 months may improve total cholesterol and LDL-C, important coronary risk factors, and fasting blood glucose, a metabolic risk factor. PMID:19806358

A different outlook on time: visual and auditory month names elicit different mental vantage points for a time-space synaesthete.

PubMed

Jarick, Michelle; Dixon, Mike J; Stewart, Mark T; Maxwell, Emily C; Smilek, Daniel

2009-01-01

Synaesthesia is a fascinating condition whereby individuals report extraordinary experiences when presented with ordinary stimuli. Here we examined an individual (L) who experiences time units (i.e., months of the year and hours of the day) as occupying specific spatial locations (January is 30 degrees to the left of midline). This form of time-space synaesthesia has been recently investigated by Smilek et al. (2007) who demonstrated that synaesthetic time-space associations are highly consistent, occur regardless of intention, and can direct spatial attention. We extended this work by showing that for the synaesthete L, her time-space vantage point changes depending on whether the time units are seen or heard. For example, when L sees the word JANUARY, she reports experiencing January on her left side, however when she hears the word "January" she experiences the month on her right side. L's subjective reports were validated using a spatial cueing paradigm. The names of months were centrally presented followed by targets on the left or right. L was faster at detecting targets in validly cued locations relative to invalidly cued locations both for visually presented cues (January orients attention to the left) and for aurally presented cues (January orients attention to the right). We replicated this difference in visual and aural cueing effects using hour of the day. Our findings support previous research showing that time-space synaesthesia can bias visual spatial attention, and further suggest that for this synaesthete, time-space associations differ depending on whether they are visually or aurally induced.

"I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study.

PubMed

Giallo, Rebecca; Gartland, Deirdre; Woolhouse, Hannah; Brown, Stephanie

2016-02-01

Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period.

Pilot Analysis of Late Conversion to Belatacept in Kidney Transplant Recipients for Biopsy-Proven Chronic Tacrolimus Toxicity

PubMed Central

Rosales, Ivy

2018-01-01

Background Calcineurin inhibitors are associated with chronic nephrotoxicity, manifesting as interstitial fibrosis/tubular atrophy (IF/TA) and arteriolar hyalinosis. Conversion from tacrolimus to belatacept may be one strategy to preserve renal function. Methods We conducted a retrospective review of renal transplant patients followed at our institution who were converted to belatacept and found to have chronic tacrolimus toxicity on biopsy. The primary outcome was eGFR at conversion as compared to eGFR at 3, 6, 12, and 24 months after conversion. We also assessed incidence of infection and rates of allograft survival at 1 year. Results The average time between transplant and conversion was 11.9 years. There was no decrease in eGFR at any postconversion time point as compared with preconversion. The mean eGFR at time of preconversion was 32.9 mL/min, as compared with 35.6 mL/min at 3 months (p = 0.09), 34.1 mL/min at 6 months (p = 0.63), 34.9 mL/min at 12 months (p = 0.57), and 39.6 mL/min at 24 months after conversion (p = 0.92). Four of 7 patients had increases in their eGFR after conversion. All grafts were functioning at 1 year after conversion. Conclusion While this study was limited by a small number of patients, belatacept conversion stabilized eGFR at all time points in patients with late allograft function due to chronic tacrolimus toxicity, with a trend towards increased eGFR at 3 months. PMID:29854421

Pharmacy Students' Retention of Knowledge and Skills Following Training in Automated External Defibrillator Use

PubMed Central

Dopp, Anna Legreid; Dopp, John M.; Vardeny, Orly; Sims, J. Jason

2010-01-01

Objectives To assess pharmacy students' retention of knowledge about appropriate automated external defibrillator use and counseling points following didactic training and simulated experience. Design Following a lecture on sudden cardiac arrest and automated external defibrillator use, second-year doctor of pharmacy (PharmD) students were assessed on their ability to perform basic life support and deliver a shock at baseline, 3 weeks, and 4 months. Students completed a questionnaire to evaluate recall of counseling points for laypeople/the public. Assessment Mean time to shock delivery at baseline was 74 ± 25 seconds, which improved significantly at 3 weeks (50 ± 17 seconds, p < 0.001) and was maintained at 4 months (47 ± 18 seconds, p < 0.001). Recall of all signs and symptoms of sudden cardiac arrest and automated external defibrillator counseling points was diminished after 4 months. Conclusion Pharmacy students can use automated external defibrillators to quickly deliver a shock and are able to retain this ability after 4 months. Refresher training/courses will be required to improve students' retention of automated external defibrillator counseling points to ensure their ability to deliver appropriate patient education. PMID:21045951

Impact of adenotonsillectomy on vocal emission in children.

PubMed

Dimatos, Spyros Cardoso; Neves, Luciano Rodrigues; Beltrame, Jéssica Monique; Azevedo, Renata Rangel; Pignatari, Shirley Shizue Nagata

2016-01-01

Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children. To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils. This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic-noise ratio. A statistically significant change was found between shimmer and harmonic-noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation. Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer.

PubMed

Oates, Justine; Davies, Sarah; Roydhouse, Jessica K; Fethney, Judith; White, Kate

2014-01-01

To examine changes in health-related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients. Individual prospective cohort study. All newly diagnosed patients with oropharyngeal cancer treated with curative intent were routinely assessed. The European Organization for Research and Treatment of Cancer (EORTC) both the Main Module quality-of-life questionnaire (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H&N35) were administered at diagnosis and 3, 6, and 12 months thereafter. Complete case analysis was used following assessment of missing data. The proportion of patients with clinically significant deterioration (changes of ≥ 10 points) from baseline were calculated for each follow-up time point and compared by stage (I/II vs. III/IV) and then treatment type (chemotherapy and radiotherapy [CRT] vs. surgery and postoperative radiotherapy [S&PORT]). Deterioration in most domains was most frequent for stage III/IV patients at 3 months (both modules), whereas stage I/II patients experienced this at 6 months (QLQ-C30) and 12 months (H&N35). Among stage III/IV patients, this happened at all time points for S&PORT patients (QLQ-C30) versus 12 months for CRT patients (H&N35). The number of patients reporting deterioration was lower for most domains at 12 months compared to earlier periods, although dry mouth remained a problem for most patients (60%-85% across treatment/stage groups). Our preliminary findings suggest that general and disease-specific deterioration is of most concern for stage I/II patients at 6 and 12 months and at 3 months for advanced cancer patients. For stage III/IV patients receiving S&PORT, general deterioration remains a problem after diagnosis, whereas for CRT patients, disease-specific deterioration is of most concern at 12 months. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Longitudinal analysis of latent classes of psychopathology and patterns of class migration in survivors of severe injury.

PubMed

Forbes, David; Nickerson, Angela; Alkemade, Nathan; Bryant, Richard A; Creamer, Mark; Silove, Derrick; McFarlane, Alexander C; Van Hooff, Miranda; Fletcher, Susan L; O'Donnell, Meaghan

2015-09-01

Little research to date has explored the typologies of psychopathology following trauma, beyond development of particular diagnoses such as posttraumatic stress disorder (PTSD). The objective of this study was to determine the longitudinal patterns of these typologies, especially the movement of persons across clusters of psychopathology. In this 6-year longitudinal study, 1,167 hospitalized severe injury patients who were recruited between April 2004-February 2006 were analyzed, with repeated measures at baseline, 3 months, 12 months, and 72 months after injury. All patients met the DSM-IV criterion A1 for PTSD. Structured clinical interviews were used to assess psychiatric disorders at each follow-up point. Latent class analysis and latent transition analysis were applied to assess clusters of individuals determined by psychopathology. The Mini International Neuropsychiatric Interview (MINI) and Clinician-Administered PTSD Scale (CAPS) were employed to complete diagnoses. Four latent classes were identified at each time point: (1) Alcohol/Depression class (3 months, 2.1%; 12 months, 1.3%; and 72 months, 1.1%), (2) Alcohol class (3 months, 3.3%; 12 months, 3.7%; and 72 months, 5.4%), (3) PTSD/Depression class (3 months, 10.3%; 12 months, 11.5%; and 72 months, 6.4%), and (4) No Disorder class (3 months, 84.2%; 12 months, 83.5%; and 72 months, 87.1%). Latent transition analyses conducted across the 2 transition points (12 months and 72 months) found consistently high levels of stability in the No Disorder class (90.9%, 93.0%, respectively) but lower and reducing levels of consistency in the PTSD/Depression class (81.3%, 46.6%), the Alcohol/Depression class (59.7%, 21.5%), and the Alcohol class (61.0%, 36.5%), demonstrating high levels of between-class migration. Despite the array of psychiatric disorders that may develop following severe injury, a 4-class model best described the data with excellent classification certainty. The high levels of migration across classes indicate a complex pattern of psychopathology expression over time. The findings have considerable implications for tailoring multifocused interventions to class type, as well as flexible stepped care models, and for the potential development and delivery of transdiagnostic interventions targeting underlying mechanisms. © Copyright 2015 Physicians Postgraduate Press, Inc.

Women with breast cancer: self-reported distress in early survivorship.

PubMed

Lester, Joanne; Crosthwaite, Kara; Stout, Robin; Jones, Rachel N; Holloman, Christopher; Shapiro, Charles; Andersen, Barbara L

2015-01-01

To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. Descriptive, cross-sectional. A National Cancer Institute-designated comprehensive cancer center. 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. Distress scores, problem reports, and time groups. Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. Interventions to reduce or prevent distress may improve outcomes in early survivorship.

Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases

PubMed Central

Brown, Paul D.; Jaeckle, Kurt; Ballman, Karla V.; Farace, Elana; Cerhan, Jane H.; Anderson, S. Keith; Carrero, Xiomara W.; Barker, Fred G.; Deming, Richard; Burri, Stuart H.; Ménard, Cynthia; Chung, Caroline; Stieber, Volker W.; Pollock, Bruce E.; Galanis, Evanthia; Buckner, Jan C.; Asher, Anthony L.

2017-01-01

IMPORTANCE Whole brain radiotherapy (WBRT) significantly improves tumor control in the brain after stereotactic radiosurgery (SRS), yet because of its association with cognitive decline, its role in the treatment of patients with brain metastases remains controversial. OBJECTIVE To determine whether there is less cognitive deterioration at 3 months after SRS alone vs SRS plus WBRT. DESIGN, SETTING, AND PARTICIPANTS At 34 institutions in North America, patients with 1 to 3 brain metastases were randomized to receive SRS or SRS plus WBRT between February 2002 and December 2013. INTERVENTIONS The WBRT dose schedule was 30 Gy in 12 fractions; the SRS dose was 18 to 22 Gy in the SRS plus WBRT group and 20 to 24 Gy for SRS alone. MAIN OUTCOMES AND MEASURES The primary end point was cognitive deterioration (decline >1 SD from baseline on at least 1 cognitive test at 3 months) in participants who completed the baseline and 3-month assessments. Secondary end points included time to intracranial failure, quality of life, functional independence, long-term cognitive status, and overall survival. RESULTS There were 213 randomized participants (SRS alone, n = 111; SRS plus WBRT, n = 102) with a mean age of 60.6 years (SD, 10.5 years); 103 (48%) were women. There was less cognitive deterioration at 3 months after SRS alone (40/63 patients [63.5%]) than when combined with WBRT (44/48 patients [91.7%]; difference, −28.2%; 90% CI, −41.9% to −14.4%; P < .001). Quality of life was higher at 3 months with SRS alone, including overall quality of life (mean change from baseline, −0.1 vs −12.0 points; mean difference, 11.9; 95% CI, 4.8–19.0 points; P = .001). Time to intracranial failure was significantly shorter for SRS alone compared with SRS plus WBRT (hazard ratio, 3.6; 95% CI, 2.2–5.9; P < .001). There was no significant difference in functional independence at 3 months between the treatment groups (mean change from baseline, −1.5 points for SRS alone vs −4.2 points for SRS plus WBRT; mean difference, 2.7 points; 95% CI, −2.0 to 7.4 points; P = .26). Median overall survival was 10.4 months for SRS alone and 7.4 months for SRS plus WBRT (hazard ratio, 1.02; 95% CI, 0.75–1.38; P = .92). For long-term survivors, the incidence of cognitive deterioration was less after SRS alone at 3 months (5/11 [45.5%] vs 16/17 [94.1%]; difference, −48.7%; 95% CI, −87.6% to −9.7%; P = .007) and at 12 months (6/10 [60%] vs 17/18 [94.4%]; difference, −34.4%; 95% CI, −74.4% to 5.5%; P = .04). CONCLUSIONS AND RELEVANCE Among patients with 1 to 3 brain metastases, the use of SRS alone, compared with SRS combined with WBRT, resulted in less cognitive deterioration at 3 months. In the absence of a difference in overall survival, these findings suggest that for patients with 1 to 3 brain metastases amenable to radiosurgery, SRS alone may be a preferred strategy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00377156 PMID:27458945

Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial.

PubMed

Brown, Paul D; Jaeckle, Kurt; Ballman, Karla V; Farace, Elana; Cerhan, Jane H; Anderson, S Keith; Carrero, Xiomara W; Barker, Fred G; Deming, Richard; Burri, Stuart H; Ménard, Cynthia; Chung, Caroline; Stieber, Volker W; Pollock, Bruce E; Galanis, Evanthia; Buckner, Jan C; Asher, Anthony L

2016-07-26

Whole brain radiotherapy (WBRT) significantly improves tumor control in the brain after stereotactic radiosurgery (SRS), yet because of its association with cognitive decline, its role in the treatment of patients with brain metastases remains controversial. To determine whether there is less cognitive deterioration at 3 months after SRS alone vs SRS plus WBRT. At 34 institutions in North America, patients with 1 to 3 brain metastases were randomized to receive SRS or SRS plus WBRT between February 2002 and December 2013. The WBRT dose schedule was 30 Gy in 12 fractions; the SRS dose was 18 to 22 Gy in the SRS plus WBRT group and 20 to 24 Gy for SRS alone. The primary end point was cognitive deterioration (decline >1 SD from baseline on at least 1 cognitive test at 3 months) in participants who completed the baseline and 3-month assessments. Secondary end points included time to intracranial failure, quality of life, functional independence, long-term cognitive status, and overall survival. There were 213 randomized participants (SRS alone, n = 111; SRS plus WBRT, n = 102) with a mean age of 60.6 years (SD, 10.5 years); 103 (48%) were women. There was less cognitive deterioration at 3 months after SRS alone (40/63 patients [63.5%]) than when combined with WBRT (44/48 patients [91.7%]; difference, -28.2%; 90% CI, -41.9% to -14.4%; P < .001). Quality of life was higher at 3 months with SRS alone, including overall quality of life (mean change from baseline, -0.1 vs -12.0 points; mean difference, 11.9; 95% CI, 4.8-19.0 points; P = .001). Time to intracranial failure was significantly shorter for SRS alone compared with SRS plus WBRT (hazard ratio, 3.6; 95% CI, 2.2-5.9; P < .001). There was no significant difference in functional independence at 3 months between the treatment groups (mean change from baseline, -1.5 points for SRS alone vs -4.2 points for SRS plus WBRT; mean difference, 2.7 points; 95% CI, -2.0 to 7.4 points; P = .26). Median overall survival was 10.4 months for SRS alone and 7.4 months for SRS plus WBRT (hazard ratio, 1.02; 95% CI, 0.75-1.38; P = .92). For long-term survivors, the incidence of cognitive deterioration was less after SRS alone at 3 months (5/11 [45.5%] vs 16/17 [94.1%]; difference, -48.7%; 95% CI, -87.6% to -9.7%; P = .007) and at 12 months (6/10 [60%] vs 17/18 [94.4%]; difference, -34.4%; 95% CI, -74.4% to 5.5%; P = .04). Among patients with 1 to 3 brain metastases, the use of SRS alone, compared with SRS combined with WBRT, resulted in less cognitive deterioration at 3 months. In the absence of a difference in overall survival, these findings suggest that for patients with 1 to 3 brain metastases amenable to radiosurgery, SRS alone may be a preferred strategy. clinicaltrials.gov Identifier: NCT00377156.

Geospatial Distribution and Clustering of Chlamydia trachomatis in Communities Undergoing Mass Azithromycin Treatment

PubMed Central

Yohannan, Jithin; He, Bing; Wang, Jiangxia; Greene, Gregory; Schein, Yvette; Mkocha, Harran; Munoz, Beatriz; Quinn, Thomas C.; Gaydos, Charlotte; West, Sheila K.

2014-01-01

Purpose. We detected spatial clustering of households with Chlamydia trachomatis infection (CI) and active trachoma (AT) in villages undergoing mass treatment with azithromycin (MDA) over time. Methods. We obtained global positioning system (GPS) coordinates for all households in four villages in Kongwa District, Tanzania. Every 6 months for a period of 42 months, our team examined all children under 10 for AT, and tested for CI with ocular swabbing and Amplicor. Villages underwent four rounds of annual MDA. We classified households as having ≥1 child with CI (or AT) or having 0 children with CI (or AT). We calculated the difference in the K function between households with and without CI or AT to detect clustering at each time point. Results. Between 918 and 991 households were included over the 42 months of this analysis. At baseline, 306 households (32.59%) had ≥1 child with CI, which declined to 73 households (7.50%) at 42 months. We observed borderline clustering of households with CI at 12 months after one round of MDA and statistically significant clustering with growing cluster sizes between 18 and 24 months after two rounds of MDA. Clusters diminished in size at 30 months after 3 rounds of MDA. Active trachoma did not cluster at any time point. Conclusions. This study demonstrates that CI clusters after multiple rounds of MDA. Clusters of infection may increase in size if the annual antibiotic pressure is removed. The absence of growth after the three rounds suggests the start of control of transmission. PMID:24906862

Coping strategies among patients with newly diagnosed amyotrophic lateral sclerosis.

PubMed

Jakobsson Larsson, Birgitta; Nordin, Karin; Askmark, Håkan; Nygren, Ingela

2014-11-01

To prospectively identify different coping strategies among newly diagnosed amyotrophic lateral sclerosis patients and whether they change over time and to determine whether physical function, psychological well-being, age and gender correlated with the use of different coping strategies. Amyotrophic lateral sclerosis is a fatal disease with impact on both physical function and psychological well-being. Different coping strategies are used to manage symptoms and disease progression, but knowledge about coping in newly diagnosed amyotrophic lateral sclerosis patients is scarce. This was a prospective study with a longitudinal and descriptive design. A total of 33 patients were included and evaluation was made at two time points, one to three months and six months after diagnosis. Patients were asked to complete the Motor Neuron Disease Coping Scale and the Hospital Anxiety and Depression Scale. Physical function was estimated using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale. The most commonly used strategies were support and independence. Avoidance/venting and information seeking were seldom used at both time points. The use of information seeking decreased between the two time points. Men did not differ from women, but patients ≤64 years used positive action more often than older patients. Amyotrophic Lateral Sclerosis Functional Rating Scale was positively correlated with positive action at time point 1, but not at time point 2. Patients' psychological well-being was correlated with the use of different coping strategies. Support and independence were the most used coping strategies, and the use of different strategies changed over time. Psychological well-being was correlated with different coping strategies in newly diagnosed amyotrophic lateral sclerosis patients. The knowledge about coping strategies in early stage of the disease may help the nurses to improve and develop the care and support for these patients. © 2014 John Wiley & Sons Ltd.

Gender differences in cardiac patients: a longitudinal investigation of exercise, autonomic anxiety, negative affect and depression.

PubMed

Hunt-Shanks, Tiffany; Blanchard, Christopher; Reid, Robert D

2009-05-01

Female cardiac patients frequently experience greater anxiety and depression and engage in less exercise when compared with their male counterparts. This study considered whether exercise had similar effects on male and female cardiac patients' autonomic anxiety, negative affect and depression, and whether exercise behavior explained the gender difference in their affective functioning (e.g. autonomic anxiety, negative affect and depression). Eight hundred one participants completed the Hospital and Anxiety Depression Scale (HADS) and the leisure score index (LSI) of the Godin Leisure-Time Exercise Questionnaire at baseline, 6 months, 12 months, and 24 months. Female cardiac patients had greater autonomic anxiety, negative affect and depression and reduced exercise when compared with male cardiac patients at all time points. Although exercise was significantly related to affective outcomes at various time points for both men and women, gender did not moderate any of the exercise/affective relationships, and exercise did not mediate any of the gender/affective relationships. Further research is needed to clarify the complex relationships between gender, exercise, and the affective functioning of cardiac patients.

Applications of multiscale change point detections to monthly stream flow and rainfall in Xijiang River in southern China, part I: correlation and variance

NASA Astrophysics Data System (ADS)

Zhu, Yuxiang; Jiang, Jianmin; Huang, Changxing; Chen, Yongqin David; Zhang, Qiang

2018-04-01

This article, as part I, introduces three algorithms and applies them to both series of the monthly stream flow and rainfall in Xijiang River, southern China. The three algorithms include (1) normalization of probability distribution, (2) scanning U test for change points in correlation between two time series, and (3) scanning F-test for change points in variances. The normalization algorithm adopts the quantile method to normalize data from a non-normal into the normal probability distribution. The scanning U test and F-test have three common features: grafting the classical statistics onto the wavelet algorithm, adding corrections for independence into each statistic criteria at given confidence respectively, and being almost objective and automatic detection on multiscale time scales. In addition, the coherency analyses between two series are also carried out for changes in variance. The application results show that the changes of the monthly discharge are still controlled by natural precipitation variations in Xijiang's fluvial system. Human activities disturbed the ecological balance perhaps in certain content and in shorter spells but did not violate the natural relationships of correlation and variance changes so far.

Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.

PubMed

Shanafelt, Tait D; Mungo, Michelle; Schmitgen, Jaime; Storz, Kristin A; Reeves, David; Hayes, Sharonne N; Sloan, Jeff A; Swensen, Stephen J; Buskirk, Steven J

2016-04-01

To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort. Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction. Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months. Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

HABIT, a Randomized Feasibility Trial to Increase Hydroxyurea Adherence, Suggests Improved Health-Related Quality of Life in Youths with Sickle Cell Disease.

PubMed

Smaldone, Arlene; Findley, Sally; Manwani, Deepa; Jia, Haomiao; Green, Nancy S

2018-06-01

To examine the effect of a community health worker (CHW) intervention, augmented by tailored text messages, on adherence to hydroxyurea therapy in youths with sickle cell disease, as well as on generic and disease-specific health-related quality of life (HrQL) and youth-parent self-management responsibility concordance. We conducted a 2-site randomized controlled feasibility study (Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment [HABIT]) with 2:1 intervention allocation. Youths and parents participated as dyads. Intervention dyads received CHW visits and text message reminders. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and growth models adjusting for group assignment, time, and multiple comparisons. Changes in outcomes from 0 to 6 months were compared with their respective minimal clinically important differences. A total of 28 dyads (mean age of youths, 14.3 ± 2.6 years; 50% Hispanic) participated (18 in the intervention group, 10 in the control group), with 10.7% attrition. Accounting for group assignment, time, and multiple comparisons, at 6 months intervention youths reported improved generic HrQL total score (9.8 points; 95% CI, 0.4-19.2) and Emotions subscale score (15.0 points; 95% CI, 1.6-28.4); improved disease-specific subscale scores for Worry I (30.0 points; 95% CI, 8.5-51.5), Emotions (37.0 points, 95% CI, 9.4-64.5), and Communication I (17.8 points; 95% CI, 0.5-35.1); and 3-month dyad self-management responsibility concordance (3.5 points; 95% CI, -0.2 to 7.1). There were no differences in parent proxy-reported HrQL measures at 6 months. These findings add to research examining effects of behavioral interventions on HrQL outcomes in youths with sickle cell disease. ClinicalTrials.gov: NCT02029742. Copyright © 2018 Elsevier Inc. All rights reserved.

Longitudinal Care Improves Cessation in Smokers Who Do Not Initially Respond to Treatment by Increasing Cessation Self-Efficacy, Satisfaction, and Readiness to Quit: A Mediated Moderation Analysis

PubMed Central

Burns, Rachel J.; Rothman, Alexander J.; Fu, Steven S.; Lindgren, Bruce; Vock, David M.; Joseph, Anne M.

2015-01-01

Background The Tobacco Longitudinal Care study was a randomized controlled trial for smoking cessation. It demonstrated that longitudinal care for smoking cessation, in which telephone-based counseling and nicotine replacement therapy was offered for 12 months, was more effective than standard 8-week treatment. Purpose To identify for whom and how longitudinal care increased the likelihood of abstinence. Methods Mediated moderation analyses across three time points. Results There was a trend towards smokers who did not respond to treatment (i.e., were still smoking) by 21 days being more likely to be abstinent at 6 months if they received longitudinal care rather than usual care. Similarly, those who did not respond to treatment by 3 months were more likely to be abstinent at 12 months if they received longitudinal care. At both time points, the likelihood of abstinence did not differ across treatment conditions among participants who responded to treatment (i.e., quit smoking). The effect on 6-month outcomes was mediated by satisfaction and readiness to quit. Cessation self-efficacy, satisfaction, and readiness to quit mediated the effect on 12-month outcomes. The effect of treatment condition on the likelihood of abstinence at 18 months was not moderated by response to treatment at 6 months. Conclusions Smokers who did not respond to initial treatment benefited from longitudinal care. Differential effects of treatment condition were not observed among those who responded to early treatment. Conditional assignment to longitudinal care may be useful. Determining for whom and how interventions work over time will advance theory and practice. PMID:26373657

Longitudinal Care Improves Cessation in Smokers Who Do Not Initially Respond to Treatment by Increasing Cessation Self-Efficacy, Satisfaction, and Readiness to Quit: A Mediated Moderation Analysis.

PubMed

Burns, Rachel J; Rothman, Alexander J; Fu, Steven S; Lindgren, Bruce; Vock, David M; Joseph, Anne M

2016-02-01

The Tobacco Longitudinal Care study was a randomized controlled trial for smoking cessation. It demonstrated that longitudinal care for smoking cessation, in which telephone-based counseling and nicotine replacement therapy were offered for 12 months, was more effective than the standard 8-week treatment. This study aims to identify for whom and how longitudinal care increased the likelihood of abstinence. Mediated moderation analyses were utilized across three time points. There was a trend towards smokers who did not respond to treatment (i.e., were still smoking) by 21 days being more likely to be abstinent at 6 months if they received longitudinal care rather than usual care. Similarly, those who did not respond to treatment by 3 months were more likely to be abstinent at 12 months if they received longitudinal care. At both time points, the likelihood of abstinence did not differ across treatment conditions among participants who responded to treatment (i.e., quit smoking). The effect on 6-month outcomes was mediated by satisfaction and readiness to quit. Cessation self-efficacy, satisfaction, and readiness to quit mediated the effect on 12-month outcomes. The effect of treatment condition on the likelihood of abstinence at 18 months was not moderated by response to treatment at 6 months. Smokers who did not respond to initial treatment benefited from longitudinal care. Differential effects of treatment condition were not observed among those who responded to early treatment. Conditional assignment to longitudinal care may be useful. Determining for whom and how interventions work over time will advance theory and practice.

Mindfulness Meditation and CBT for Insomnia: A Naturalistic 12-Month Follow-up

PubMed Central

Ong, Jason C.; Shapiro, Shauna L.; Manber, Rachel

2016-01-01

A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at post-treatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome. Analyses were conducted on 21 participants who provided follow-up data at 6 and 12 months post treatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale (PSAS), Glasgow Sleep Effort Scale (GSES), Kentucky Inventory of Mindfulness Skills (KIMS), and the Insomnia Episode Questionnaire. Analyses examining the pattern of change across time (baseline, end-of-treatment, 6 month, and 12 month) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (≥ 1 month) during the follow-up period had higher scores on the PSAS (p < .05) and GSES (p < .05) at end-of-treatment compared to those with no insomnia episodes. Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (p < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia. These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period with indications that higher pre-sleep arousal and sleep effort at end-of-treatment constitute a risk for occurrence of insomnia during the 12 months following treatment. PMID:19114261

Immunisation coverage annual report, 2014.

PubMed

Hull, Brynley P; Hendry, Alexandra J; Dey, Aditi; Beard, Frank H; Brotherton, Julia M; McIntyre, Peter B

2017-03-31

This 8th annual immunisation coverage report shows data for 2014 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus Vaccination Program Register. This report includes coverage data for 'fully immunised' and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, 'fully immunised' coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, it has increased by more than 10 percentage points since 2009. As in previous years, coverage for 'fully immunised' at 12 months of age among Indigenous children was 3.7% lower than for non-Indigenous children overall, varying from 6.9 percentage points in Western Australia to 0.3 of a percentage point in the Australian Capital Territory. In 2014, 73.4% of Australian females aged 15 years had 3 documented doses of human papillomavirus vaccine (jurisdictional range 67.7% to 77.4%), and 82.7% had at least 1 dose, compared with 71.4% and 81.5%, respectively, in 2013. The disparity in on-time vaccination between Indigenous and non-Indigenous children in 2014 diminished progressively from 20.2% for vaccines due by 12 months to 11.5% for those due by 24 months and 3.0% at 60 months of age.

Expression analysis of selected classes of circulating exosomal miRNAs in soccer players as an indicator of adaptation to physical activity

PubMed Central

Jastrzębski, Zbigniew; Kiszałkiewicz, Justyna; Brzeziański, Michał; Pastuszak-Lewandoska, Dorota; Radzimińki, Łukasz; Brzeziańska-Lasota, Ewa; Jegier, Anna

2017-01-01

Recently studies have shown that, depending on the type of training and its duration, the expression levels of selected circulating myomiRNAs (c-miR-27a,b, c-miR-29a,b,c, c-miR-133a) differ and correlate with the physiological indicators of adaptation to physical activity. To analyse the expression of selected classes of miRNAs in soccer players during different periods of their training cycle. The study involved 22 soccer players aged 17-18 years. The multi-stage 20-m shuttle run test was used to estimate VO2 max among the soccer players. Samples serum were collected at baseline (time point I), after one week (time point II), and after 2 months of training (time point III). The analysis of the relative quantification (RQ) level of three exosomal myomiRNAs, c-miRNA-27b, c-miR-29a, and c-miR-133, was performed by quantitative polymerase chain reaction (qPCR) at three time points – before the training, after 1 week of training and after the completion of two months of competition season training. The expression analysis showed low expression levels (according to references) of all evaluated myomiRNAs before the training cycle. Analysis performed after a week of the training cycle and after completion of the entire training cycle showed elevated expression of all tested myomiRNAs. Statistical analysis revealed significant differences between the first and the second time point in soccer players for c-miR-27b and c-miR-29a; between the first and the third time point for c-miR-27b and c-miR-29a; and between the second and the third time point for c-miR-27b. Statistical analysis showed a positive correlation between the levels of c-miR-29a and VO2 max. Two months of training affected the expression of c-miR-27b and miR-29a in soccer players. The increased expression of c-miR-27b and c-miR-29 with training could indicate their probable role in the adaptation process that takes place in the muscular system. Possibly, the expression of c-miR-29a will be found to be involved in cardiorespiratory fitness in future research. PMID:29472735

Latanoprostene Bunod 0.024% versus Timolol Maleate 0.5% in Subjects with Open-Angle Glaucoma or Ocular Hypertension: The APOLLO Study.

PubMed

Weinreb, Robert N; Scassellati Sforzolini, Baldo; Vittitow, Jason; Liebmann, Jeffrey

2016-05-01

To compare the diurnal intraocular pressure (IOP)-lowering effect of latanoprostene bunod (LBN) ophthalmic solution 0.024% every evening (qpm) with timolol maleate 0.5% twice daily (BID) in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Phase 3, randomized, controlled, multicenter, double-masked, parallel-group clinical study. Subjects aged ≥18 years with a diagnosis of OAG or OHT in 1 or both eyes. Subjects were randomized (2:1) to a 3-month regimen of LBN 0.024% qpm or timolol 0.5% 1 drop BID. Intraocular pressure was measured at 8 am, 12 pm, and 4 pm of each postrandomization visit (week 2, week 6, and month 3). Adverse events were recorded throughout the study. The primary efficacy end point was IOP in the study eye measured at each of the 9 assessment time points. Secondary efficacy end points included the proportion of subjects with IOP ≤18 mmHg consistently at all 9 time points and the proportion of subjects with IOP reduction ≥25% consistently at all 9 time points. Of 420 subjects randomized, 387 completed the study (LBN 0.024%, n = 264; timolol 0.5%, n = 123). At all 9 time points, the mean IOP in the study eye was significantly lower in the LBN 0.024% group than in the timolol 0.5% group (P ≤ 0.002). At all 9 time points, the percentage of subjects with mean IOP ≤18 mmHg and the percentage with IOP reduction ≥25% were significantly higher in the LBN 0.024% group versus the timolol 0.5% group (mean IOP ≤18 mmHg: 22.9% vs. 11.3%, P = 0.005; IOP reduction ≥25%: 34.9% vs. 19.5%, P = 0.001). Adverse events were similar in both treatment groups. In this phase 3 study, LBN 0.024% qpm demonstrated significantly greater IOP lowering than timolol 0.5% BID throughout the day over 3 months of treatment. Latanoprostene bunod 0.024% was effective and safe in these adults with OAG or OHT. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Effect of group counseling on depression, compliance and blood sugar level in diabetic patients.

PubMed

Long, Feiyan; Yan, Jin; Hu, Ping'an; Xia, Miaojuan; Liu, Hua; Gu, Can

2015-08-01

To establish an interference mode of group counseling for diabetic patients with depression and to evaluate the effectiveness of this mode on depression, treatment compliance and blood sugar level in the patients.
 One hundred diabetic patients with depression were randomly divided into a counseling group and a control group (n=50 per group). Self-Rating Depression Scale (SDS) was applied to all the patients. The interference mode of group counseling was established through literature review, expert consultation or interview. The counseling group received counseling for 8 times within 2 months.
 There was a significant difference in the SDS scores at 0, 3, 6 or 12 months after the intervention between the 2 groups (P<0.001). For the counseling group, there was a significant difference in the SDS scores between pre-intervention and 3, 6 or 12 months after intervention (P<0.001). However, there was no significant difference in the SDS scores between any two time points after the intervention (P>0.05). There was a significant difference in the compliance between any two time points after the intervention (P<0.05). Fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG) or glycosylated hemoglobin (HbA1c) was significantly different at any two time points after the intervention (P<0.05).
 Group counseling can improve depression, compliance and blood sugar control in the diabetic patients.

Comparison of two methods for estimating base flow in selected reaches of the South Platte River, Colorado

USGS Publications Warehouse

Capesius, Joseph P.; Arnold, L. Rick

2012-01-01

The Mass Balance results were quite variable over time such that they appeared suspect with respect to the concept of groundwater flow as being gradual and slow. The large degree of variability in the day-to-day and month-to-month Mass Balance results is likely the result of many factors. These factors could include ungaged stream inflows or outflows, short-term streamflow losses to and gains from temporary bank storage, and any lag in streamflow accounting owing to streamflow lag time of flow within a reach. The Pilot Point time series results were much less variable than the Mass Balance results and extreme values were effectively constrained. Less day-to-day variability, smaller magnitude extreme values, and smoother transitions in base-flow estimates provided by the Pilot Point method are more consistent with a conceptual model of groundwater flow being gradual and slow. The Pilot Point method provided a better fit to the conceptual model of groundwater flow and appeared to provide reasonable estimates of base flow.

New clinical insights for transiently evoked otoacoustic emission protocols.

PubMed

Hatzopoulos, Stavros; Grzanka, Antoni; Martini, Alessandro; Konopka, Wieslaw

2009-08-01

The objective of the study was to optimize the area of a time-frequency analysis and then investigate any stable patterns in the time-frequency structure of otoacoustic emissions in a population of 152 healthy adults sampled over one year. TEOAE recordings were collected from 302 ears in subjects presenting normal hearing and normal impedance values. The responses were analyzed by the Wigner-Ville distribution (WVD). The TF region of analysis was optimized by examining the energy content of various rectangular and triangular TF regions. The TEOAE components from the initial and recordings 12 months later were compared in the optimized TF region. The best region for TF analysis was identified with base point 1 at 2.24 ms and 2466 Hz, base point 2 at 6.72 ms and 2466 Hz, and the top point at 2.24 ms and 5250 Hz. Correlation indices from the TF optimized region were higher, and were statistically significant, than the traditional indices in the selected time window. An analysis of the TF data within a 12-month period indicated a 85% TEOAE component similarity in 90% of the tested subjects.

Standard Samples and Reference Standards Issued by the National Bureau of Standards

DTIC Science & Technology

1954-08-31

precision and accuracy of control testing in the melting - point , density, index of refraction, heat rubber industry. of combustion, color, and gloss...pH (approx.) 1.7 65 2.50 Melting - Point Standards 44d Aluminum ---------------------------- 659.70 C...calculating the best frequencies for communication between any two points in the world at any time during the given month. The data are important to all

A work-family conflict/subjective well-being process model: a test of competing theories of longitudinal effects.

PubMed

Matthews, Russell A; Wayne, Julie Holliday; Ford, Michael T

2014-11-01

In the present study, we examine competing predictions of stress reaction models and adaptation theories regarding the longitudinal relationship between work-family conflict and subjective well-being. Based on data from 432 participants over 3 time points with 2 lags of varying lengths (i.e., 1 month, 6 months), our findings suggest that in the short term, consistent with prior theory and research, work-family conflict is associated with poorer subjective well-being. Counter to traditional work-family predictions but consistent with adaptation theories, after accounting for concurrent levels of work-family conflict as well as past levels of subjective well-being, past exposure to work-family conflict was associated with higher levels of subjective well-being over time. Moreover, evidence was found for reverse causation in that greater subjective well-being at 1 point in time was associated with reduced work-family conflict at a subsequent point in time. Finally, the pattern of results did not vary as a function of using different temporal lags. We discuss the theoretical, research, and practical implications of our findings. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Age-related changes in the function and structure of the peripheral sensory pathway in mice.

PubMed

Canta, Annalisa; Chiorazzi, Alessia; Carozzi, Valentina Alda; Meregalli, Cristina; Oggioni, Norberto; Bossi, Mario; Rodriguez-Menendez, Virginia; Avezza, Federica; Crippa, Luca; Lombardi, Raffaella; de Vito, Giuseppe; Piazza, Vincenzo; Cavaletti, Guido; Marmiroli, Paola

2016-09-01

This study is aimed at describing the changes occurring in the entire peripheral nervous system sensory pathway along a 2-year observation period in a cohort of C57BL/6 mice. The neurophysiological studies evidenced significant differences in the selected time points corresponding to childhood, young adulthood, adulthood, and aging (i.e., 1, 7, 15, and 25 months of age), with a parabolic course as function of time. The pathological assessment allowed to demonstrate signs of age-related changes since the age of 7 months, with a remarkable increase in both peripheral nerves and dorsal root ganglia at the subsequent time points. These changes were mainly in the myelin sheaths, as also confirmed by the Rotating-Polarization Coherent-Anti-stokes-Raman-scattering microscopy analysis. Evident changes were also present at the morphometric analysis performed on the peripheral nerves, dorsal root ganglia neurons, and skin biopsies. This extensive, multimodal characterization of the peripheral nervous system changes in aging provides the background for future mechanistic studies allowing the selection of the most appropriate time points and readouts according to the investigation aims. Copyright © 2016 Elsevier Inc. All rights reserved.

Intervening to reduce workplace sitting: mediating role of social-cognitive constructs during a cluster randomised controlled trial.

PubMed

Hadgraft, Nyssa T; Winkler, Elisabeth A H; Healy, Genevieve N; Lynch, Brigid M; Neuhaus, Maike; Eakin, Elizabeth G; Dunstan, David W; Owen, Neville; Fjeldsoe, Brianna S

2017-03-06

The Stand Up Victoria multi-component intervention successfully reduced workplace sitting time in both the short (three months) and long (12 months) term. To further understand how this intervention worked, we aimed to assess the impact of the intervention on four social-cognitive constructs, and examined whether these constructs mediated intervention effects on workplace sitting time at 3 and 12 months post-baseline. Two hundred and thirty one office-based workers (14 worksites, single government employer) were randomised to intervention or control conditions by worksite. The intervention comprised organisational, environmental, and individual level elements. Participant characteristics and social-cognitive constructs (perceived behavioural control, barrier self-efficacy, perceived organisational norms and knowledge) were measured through a self-administered online survey at baseline, 3 months and 12 months. Workplace sitting time (min/8 h day) was measured with the activPAL3 device. Single multi-level mediation models were performed for each construct at both time points. There were significant intervention effects at 3 months on perceived behavioural control, barrier self-efficacy and perceived organisational norms. Effects on perceived organisational norms were not significant at 12 months. Perceived behavioural control significantly mediated intervention effects at 3 months, accounting for a small portion of the total effect (indirect effect: -8.6 min/8 h day, 95% CI: -18.5, -3.6 min; 7.5% of total effect). At 12 months, barrier self-efficacy significantly mediated the intervention effects on workplace sitting time (indirect effect: -10.3 min/8 h day, 95% CI: -27.3, -2.2; 13.9% of total effect). No significant effects were observed for knowledge at either time point. Strategies that aim to increase workers' perceived control and self-efficacy over their sitting time may be helpful components of sedentary behaviour interventions in the workplace. However, social-cognitive factors only partially explain variation in workplace sitting reduction. Understanding the importance of other levels of influence (particularly interpersonal and environmental) for initiating and maintaining workplace sedentary behaviour change will be informative for intervention development and refinement. This study was prospectively registered with the Australian New Zealand Clinical Trials register ( ACTRN12611000742976 ) on 15 July 2011.

Abiraterone and increased survival in metastatic prostate cancer.

PubMed

de Bono, Johann S; Logothetis, Christopher J; Molina, Arturo; Fizazi, Karim; North, Scott; Chu, Luis; Chi, Kim N; Jones, Robert J; Goodman, Oscar B; Saad, Fred; Staffurth, John N; Mainwaring, Paul; Harland, Stephen; Flaig, Thomas W; Hutson, Thomas E; Cheng, Tina; Patterson, Helen; Hainsworth, John D; Ryan, Charles J; Sternberg, Cora N; Ellard, Susan L; Fléchon, Aude; Saleh, Mansoor; Scholz, Mark; Efstathiou, Eleni; Zivi, Andrea; Bianchini, Diletta; Loriot, Yohann; Chieffo, Nicole; Kheoh, Thian; Haqq, Christopher M; Scher, Howard I

2011-05-26

Biosynthesis of extragonadal androgen may contribute to the progression of castration-resistant prostate cancer. We evaluated whether abiraterone acetate, an inhibitor of androgen biosynthesis, prolongs overall survival among patients with metastatic castration-resistant prostate cancer who have received chemotherapy. We randomly assigned, in a 2:1 ratio, 1195 patients who had previously received docetaxel to receive 5 mg of prednisone twice daily with either 1000 mg of abiraterone acetate (797 patients) or placebo (398 patients). The primary end point was overall survival. The secondary end points included time to prostate-specific antigen (PSA) progression (elevation in the PSA level according to prespecified criteria), progression-free survival according to radiologic findings based on prespecified criteria, and the PSA response rate. After a median follow-up of 12.8 months, overall survival was longer in the abiraterone acetate-prednisone group than in the placebo-prednisone group (14.8 months vs. 10.9 months; hazard ratio, 0.65; 95% confidence interval, 0.54 to 0.77; P<0.001). Data were unblinded at the interim analysis, since these results exceeded the preplanned criteria for study termination. All secondary end points, including time to PSA progression (10.2 vs. 6.6 months; P<0.001), progression-free survival (5.6 months vs. 3.6 months; P<0.001), and PSA response rate (29% vs. 6%, P<0.001), favored the treatment group. Mineralocorticoid-related adverse events, including fluid retention, hypertension, and hypokalemia, were more frequently reported in the abiraterone acetate-prednisone group than in the placebo-prednisone group. The inhibition of androgen biosynthesis by abiraterone acetate prolonged overall survival among patients with metastatic castration-resistant prostate cancer who previously received chemotherapy. (Funded by Cougar Biotechnology; COU-AA-301 ClinicalTrials.gov number, NCT00638690.).

Head and neck cancer patients' perceptions of swallowing following chemoradiotherapy.

PubMed

Patterson, Joanne M; McColl, Elaine; Wilson, Janet; Carding, Paul; Rapley, Tim

2015-12-01

The study aims to describe patients' experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time. A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data. Patients' reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0-3 months) and late (6-18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle. Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.

Prevalence of suspected developmental delays in early infancy: results from a regional population-based longitudinal study.

PubMed

Valla, Lisbeth; Wentzel-Larsen, Tore; Hofoss, Dag; Slinning, Kari

2015-12-17

Prevalence estimates on suspected developmental delays (SDD) in young infants are scarce and a necessary first step for planning an early intervention. We investigated the prevalence of SDD at 4, 6 and 12 months, in addition to associations of SDD with gender, prematurity and maternal education. This study is based on a Norwegian longitudinal sample of 1555 infants and their parents attending well-baby clinics for regular health check-ups. Moreover, parents completed the Norwegian translation of the Ages and Stages Questionnaires (ASQ) prior to the check-up, with a corrected gestational age being used to determine the time of administration for preterm infants. Scores ≤ the established cut-offs in one or more of the five development areas: communication, gross motor, fine motor, problem solving and personal-social, which defined SDD for an infant were reported. Chi-square tests were performed for associations between the selected factors and SDD. According to established Norwegian cut-off points, the overall prevalence of SDD in one or more areas was 7.0 % (10.3 % US cut-off) at 4 months, 5.7 % (12.3 % US cut-off) at 6 months and 6.1 % (10.3 % US cut-off) at 12 months. The highest prevalence of SDD was in the gross motor area at all three time points. A gestational age of < 37 weeks revealed a significant association with the communication SDD at 4 months, and with the fine motor and personal social SDD at 6 months. Gender was significantly associated with the fine motor and problem solving SDD at 4 months and personal- social SDD at 6 months: as more boys than girls were delayed. No significant associations were found between maternal education and the five developmental areas of the ASQ. Our findings indicate prevalence rates of SDD between 5.7 and 7.0 % in Norwegian infants between 4 and 12 months of age based on the Norwegian ASQ cut-off points (10.3-12.3 %, US cut-off points). During the first year of life, delay is most frequent within the gross motor area. Special attention should be paid to infants born prematurely, as well as to boys. Separate norms for boys and girls should be considered for the ASQ.

Longitudinal Cognitive Profiles in Diabetes: Results From the National Alzheimer's Coordinating Center's Uniform Data.

PubMed

Sano, Mary; Zhu, Carolyn W; Grossman, Hillel; Schimming, Corbett

2017-10-01

Diabetes is a risk factor for the development of cognitive impairment and possibly for accelerated progression to Alzheimer disease (AD) and other dementias, though the trajectory of cognitive decline in general and in specfic cognitive domains by diabetes is unclear. Using the National Alzheimer's Coordinating Center's Uniform Data Det (NACC-UDS) to identify cohorts of elders with normal cognition (N = 7,663) and mild cognitive impairment (MCI, N = 4,114), we compared overall cognitive composite and domain specific sub-scores and their progression over time between diabetic and non-diabetic subjects. Diabetes was more common among those with MCI (14.7%) than among subjects who were cognitively normal (11.7%). In subjects who were cognitively normal, baseline cognitive composite scores, attention, and executive function sub-scores were lower in diabetics than non-diabetics (by 0.098, 0.066, and 0.015 points, respectively). Over time, cognitive composite score showed subtle worsening in non-diabetics (0.025 points every 6 months), with an additional worsening of 0.01 points every 6 months in diabetics compared to non-diabetics. In the MCI groups, baseline cognitive composite as well as attention and executive domain sub-scores were lower in diabetics than non-diabetics (by 0.078, 0.092, and 0.032 points, respectively). Over time, cognitive composite (by 0.103 points every 6 months) and all domain specific sub-scores showed subtle worsening in non-diabetics, but diabetics had significantly slower worsening than non-diabetics on both cognitive composite (by 0.028 points) and domain specific sub-scores. Among elders, diabetes may be associated with lower cognitive performance, primarily in non-memory domains. However it is not associated with continued worsening, suggesting a static deficit with minimal memory involvement. This data suggest that diabetes may contribute more to a vascular profile of cognitive impairment than a profile more typical of AD. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Long-Term Nightly Treatment with Indiplon in Adults with Primary Insomnia: Results of a Double-Blind, Placebo-Controlled, 3-Month Study

PubMed Central

Scharf, Martin B.; Black, Jed; Hull, Steven; Landin, Rick; Farber, Robert

2007-01-01

Objectives: To evaluate the efficacy and safety of indiplon in primary insomnia. Design: Randomized, double-blind, placebo-controlled, 3-month study. Setting: Multi-center outpatient setting. Patients: N=702 (61% female; mean age 46 years) who met DSM-IV criteria for primary insomnia of at least 3 months' duration. Interventions: Indiplon 10 mg (n=236), indiplon 20 mg (n=233), or placebo (n=233). Measurements: Subjective assessment of each of the following: latency to sleep onset (sLSO), total sleep time (sTST), number of awakenings after sleep onset (sNAASO), wake time after sleep onset (sWASO), sleep quality, Insomnia Severity Index (ISI), and global improvement. Results: Treatment with indiplon resulted in significant improvement relative to placebo at all time points for the primary endpoint, sLSO. Mean sLSO at Month 1 for each treatment group was: 10 mg (34.0 ± 1.3 mins), 20 mg (33.0 ± 1.3 mins), and placebo (48.7 ± 1.9 mins; P <0.0001 for both comparisons); efficacy was sustained through Month 3. Both doses of indiplon resulted in significant improvement in sleep maintenance and duration endpoints, sTST and sWASO, as well as sleep quality, ISI, and global improvement at all assessment time points. Conclusions: In patients with chronic insomnia, long-term nightly treatment with 10 mg and 20 mg doses of indiplon resulted in significant and sustained efficacy in sleep onset, maintenance, and duration, and significant associated improvement in both daytime functioning and quality of life. Citation: Scharf MB; Black J; Hull S et al. Long-term nightly treatment with indiplon in adults with primary insomnia: Results of a double-blind, placebo-controlled, 3-month study. SLEEP 2007;30(6):743-752. PMID:17580596

Boric acid irrigation as an adjunct to mechanical periodontal therapy in patients with chronic periodontitis: a randomized clinical trial.

PubMed

Sağlam, Mehmet; Arslan, Uğur; Buket Bozkurt, Şerife; Hakki, Sema S

2013-09-01

The purpose of this single-masked, randomized, controlled clinical trial was to evaluate the effects of boric acid irrigation as an adjunct to scaling and root planing (SRP) on clinical and microbiologic parameters and compare this method with chlorhexidine irrigation and SRP alone in patients with chronic periodontitis (CP). Forty-five systemically healthy patients with CP are included in this study. They were divided into three groups: 1) SRP + saline irrigation (C); 2) SRP + chlorhexidine irrigation (CHX); and 3) SRP + boric acid irrigation (B). To determine an ideal concentration of boric acid, a preclinical analysis was conducted. At baseline, 1 month, and 3 months after treatment, clinical measurements, including plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), were performed, and subgingival plaque samples were taken. Quantitative analysis of Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Treponema denticola (Td) was performed using real-time polymerase chain reaction (PCR) procedures. The concentration of boric acid is 0.75% in this study. All clinical parameters showed statistically significant reduction at all time points compared to baseline in all groups (P <0.001). Whole-mouth PD and CAL reduction was similar in all groups at all time points after treatment (P >0.05). The PD and CAL reductions for moderately deep pockets (PD ≥5 and <7) were greater in the B group compared to other groups between baseline and 1 month (P <0.05). For deep pockets (PD ≥7), reductions were similar in the B and CHX groups (P >0.05). BOP (percentage) was significantly lower in the B group compared with the CHX and C groups in the first month after treatment (P <0.001). GI and PI scores were significantly lower in the B and CHX groups compared with the C group at all time points after treatment (P <0.05). The amounts of Pg, Tf, and Td were significantly reduced in all treatment groups after 1 month (P <0.05). No statistically significant differences were detected among the groups for microbiologic parameters at any time points after treatment (P >0.05). The results of this study suggest that boric acid could be an alternative to chlorhexidine, and it might be more favorable because boric acid was superior in whole-mouth BOP as well as PD and CAL reduction for moderate pockets in early time periods.

Grandmothers and Caregiving to Grandchildren: Continuity, Change, and Outcomes over 24 Months

ERIC Educational Resources Information Center

Musil, Carol M.; Gordon, Nahida L.; Warner, Camille B.; Zauszniewski, Jaclene A.; Standing, Theresa; Wykle, May

2011-01-01

Purpose: Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. Design and Methods: This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the…

Predicting Deliberate Self-Harm in Adolescents: A Six Month Prospective Study

ERIC Educational Resources Information Center

O'Connor, Rory C.; Rasmussen, Susan; Hawton, Keith

2009-01-01

Few studies have investigated the extent to which psychosocial/psychological factors are associated with the prediction of deliberate self-harm (DSH) among adolescents. In this study, 737 pupils aged 15-16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents…

How has the presidential election affected young Americans?

PubMed

DeJonckheere, Melissa; Fisher, Andre; Chang, Tammy

2018-01-01

The 2016 presidential election season and subsequent political events have had physical and emotional impacts on youth. We collected qualitative insights from 14 to 24 year olds across the US related to these events over time. Open-ended probes were sent via text message at three time points before and after the 2016 presidential election. The majority of youth reported emotional stress during all three time points, and female participants were significantly more likely to experience emotional responses. White participants were more likely to report negative symptoms than their peers both pre-election and at 4-months post-election. While preliminary, the results indicate that feelings of stress, anxiety, and fear have persisted in the months following the election, particularly for young women. Additional research is needed to examine the long-term effects of political events on the emotional and physical health of youth.

Quantitative evaluation of multi-parametric MR imaging marker changes post-laser interstitial ablation therapy (LITT) for epilepsy

NASA Astrophysics Data System (ADS)

Tiwari, Pallavi; Danish, Shabbar; Wong, Stephen; Madabhushi, Anant

2013-03-01

Laser-induced interstitial thermal therapy (LITT) has recently emerged as a new, less invasive alternative to craniotomy for treating epilepsy; which allows for focussed delivery of laser energy monitored in real time by MRI, for precise removal of the epileptogenic foci. Despite being minimally invasive, the effects of laser ablation on the epileptogenic foci (reflected by changes in MR imaging markers post-LITT) are currently unknown. In this work, we present a quantitative framework for evaluating LITT-related changes by quantifying per-voxel changes in MR imaging markers which may be more reflective of local treatment related changes (TRC) that occur post-LITT, as compared to the standard volumetric analysis which involves monitoring a more global volume change across pre-, and post-LITT MRI. Our framework focuses on three objectives: (a) development of temporal MRI signatures that characterize TRC corresponding to patients with seizure freedom by comparing differences in MR imaging markers and monitoring them over time, (b) identification of the optimal time point when early LITT induced effects (such as edema and mass effect) subside by monitoring TRC at subsequent time-points post-LITT, and (c) identification of contributions of individual MRI protocols towards characterizing LITT-TRC for epilepsy by identifying MR markers that change most dramatically over time and employ individual contributions to create a more optimal weighted MP-MRI temporal profile that can better characterize TRC compared to any individual imaging marker. A cohort of patients were monitored at different time points post-LITT via MP-MRI involving T1-w, T2-w, T2-GRE, T2-FLAIR, and apparent diffusion coefficient (ADC) protocols. Post affine registration of individual MRI protocols to a reference MRI protocol pre-LITT, differences in individual MR markers are computed on a per-voxel basis, at different time-points with respect to baseline (pre-LITT) MRI as well as across subsequent time-points. A time-dependent MRI profile corresponding to successful (seizure-free) is then created that captures changes in individual MR imaging markers over time. Our preliminary analysis on two patient studies suggests that (a) LITT related changes (attributed to swelling and edema) appear to subside within 4-weeks post-LITT, (b) ADC may be more sensitive for evaluating early TRC (up to 3-months), and T1-w may be more sensitive in evaluating early delayed TRC (1-month, 3-months), while T2-w and T2-FLAIR appeared to be more sensitive in identifying late TRC (around 6-months post-LITT) compared to the other MRI protocols under evaluation. T2-GRE was found to be only nominally sensitive in identifying TRC at any follow-up time-point post-LITT. The framework presented in this work thus serves as an important precursor to a comprehensive treatment evaluation framework that can be used to identify sensitive MR markers corresponding to patient response (seizure-freedom or seizure recurrence), with an ultimate objective of making prognostic predictions about patient outcome post-LITT.

Insulin resistance, secretion and breakdown are increased 9 months following severe burn injury

PubMed Central

Cree, Melanie G.; Fram, Ricki Y.; Barr, David; Chinkes, David; Wolfe, Robert R.; Herndon, David N.

2012-01-01

Insulin resistance in the acute burn period has been well described, however, it is unknown if alterations in glucose metabolism persist beyond discharge from the acute injury. To measure the duration of insulin resistance following recovery from the acute burn injury, we performed a prospective cross-sectional study with a standard two hour oral glucose tolerance test in 46 severely burned children at 6, 9 or 12 months following initial injury. Glucose uptake and insulin secretion were assessed following the glucose load. Results were compared to those previously published in healthy children. At 6 months post-burn, the 2 hour glucose concentration was significantly (P<0.001) greater than controls, and the area under the curve (AUC) of glucose was significantly higher compared to 12 months and to healthy children (P=0.027 and P<0.001, respectively). The 9 month AUC glucose was higher than controls (P<0.01). The 6 month 2 hour insulin in was significantly higher than controls, as was the AUC of insulin in all time points post-burn. The AUC of C-peptide was significantly greater at 6 months post-injury compared to 9 and 12 months (P<0.01 for both). Increased 2 hour and AUC glucose and insulin indicate that glucose metabolism is still altered at 6 and 9 months post-injury, and coincides with previously documented defects in bone and muscle metabolism at these time points. Insulin breakdown is also still increased in this population. Further study of this population is warranted to determine if specific treatment is needed. PMID:18672331

Early palliative care in advanced lung cancer: a qualitative study.

PubMed

Yoong, Jaclyn; Park, Elyse R; Greer, Joseph A; Jackson, Vicki A; Gallagher, Emily R; Pirl, William F; Back, Anthony L; Temel, Jennifer S

2013-02-25

BACKGROUND Early ambulatory palliative care (PC) is an emerging practice, and its key elements have not been defined. We conducted a qualitative analysis of data from a randomized controlled trial that demonstrated improved quality of life, mood, and survival in patients with newly diagnosed metastatic non-small cell lung cancer who received early PC integrated with standard oncologic care vs standard oncologic care alone. Our objectives were to (1) identify key elements of early PC clinic visits, (2) explore the timing of key elements, and (3) compare the content of PC and oncologic visit notes at the critical time points of clinical deterioration and radiographic disease progression. METHODS We randomly selected 20 patients who received early PC and survived within 4 periods: less than 3 months (n = 5), 3 to 6 months (n = 5), 6 to 12 months (n = 5), and 12 to 24 months (n = 5). We performed content analysis on PC and oncologic visit notes from the electronic health records of these patients. RESULTS Addressing symptoms and coping were the most prevalent components of the PC clinic visits. Initial visits focused on building relationships and rapport with patients and their families and on illness understanding, including prognostic awareness. Discussions about resuscitation preferences and hospice predominantly occurred during later visits. Comparing PC and oncologic care visits around critical time points, both included discussions about symptoms and illness status; however, PC visits emphasized psychosocial elements, such as coping, whereas oncologic care visits focused on cancer treatment and management of medical complications. CONCLUSIONS Early PC clinic visits emphasize managing symptoms, strengthening coping, and cultivating illness understanding and prognostic awareness in a responsive and time-sensitive model. During critical clinical time points, PC and oncologic care visits have distinct features that suggest a key role for PC involvement and enable oncologists to focus on cancer treatment and managing medical complications.

Optimising seasonal streamflow forecast lead time for operational decision making in Australia

NASA Astrophysics Data System (ADS)

Schepen, Andrew; Zhao, Tongtiegang; Wang, Q. J.; Zhou, Senlin; Feikema, Paul

2016-10-01

Statistical seasonal forecasts of 3-month streamflow totals are released in Australia by the Bureau of Meteorology and updated on a monthly basis. The forecasts are often released in the second week of the forecast period, due to the onerous forecast production process. The current service relies on models built using data for complete calendar months, meaning the forecast production process cannot begin until the first day of the forecast period. Somehow, the bureau needs to transition to a service that provides forecasts before the beginning of the forecast period; timelier forecast release will become critical as sub-seasonal (monthly) forecasts are developed. Increasing the forecast lead time to one month ahead is not considered a viable option for Australian catchments that typically lack any predictability associated with snowmelt. The bureau's forecasts are built around Bayesian joint probability models that have antecedent streamflow, rainfall and climate indices as predictors. In this study, we adapt the modelling approach so that forecasts have any number of days of lead time. Daily streamflow and sea surface temperatures are used to develop predictors based on 28-day sliding windows. Forecasts are produced for 23 forecast locations with 0-14- and 21-day lead time. The forecasts are assessed in terms of continuous ranked probability score (CRPS) skill score and reliability metrics. CRPS skill scores, on average, reduce monotonically with increase in days of lead time, although both positive and negative differences are observed. Considering only skilful forecast locations, CRPS skill scores at 7-day lead time are reduced on average by 4 percentage points, with differences largely contained within +5 to -15 percentage points. A flexible forecasting system that allows for any number of days of lead time could benefit Australian seasonal streamflow forecast users by allowing more time for forecasts to be disseminated, comprehended and made use of prior to the commencement of a forecast season. The system would allow for forecasts to be updated if necessary.

Variability of Stimulant Levels in Nine Sports Supplements Over a 9-Month Period.

PubMed

Attipoe, Selasi; Cohen, Pieter A; Eichner, Amy; Deuster, Patricia A

2016-10-01

Many studies have found that some dietary supplement product labels do not accurately reflect the actual ingredients. However, studies have not been performed to determine if ingredients in the same dietary supplement product vary over time. The objective of this study was to assess the consistency of stimulant ingredients in popular sports supplements sold in the United States over a 9-month period. Three samples of nine popular sports supplements were purchased over the 9-month period. The 27 samples were analyzed for caffeine and several other stimulants (including adulterants). The identity and quantity of stimulants were compared with stimulants listed on the label and stimulants found at earlier time points to determine the variability in individual products over the 9-month period. The primary outcome measure was the variability of stimulant amounts in the products examined. Many supplements did not contain the same number and quantity of stimulants at all time points over the 9-month period. Caffeine content varied widely in five of the six caffeinated supplements compared with the initial measurement (-7% to +266%). In addition, the stimulants-synephrine, octopamine, cathine, ephedrine, pseudoephedrine, strychnine, and methylephedrine-occurred in variable amounts in eight of the nine products. The significance of these findings is uncertain: the sample size was insufficient to support statistical analysis. In our sample of nine popular sports supplements, the presence and quantity of stimulants varied over a 9-month period. However, future studies are warranted to determine if the variability found is significant and generalizable to other supplements.

Pretreatment rate of decay in forced vital capacity predicts long-term response to pirfenidone in patients with idiopathic pulmonary fibrosis.

PubMed

Biondini, Davide; Balestro, Elisabetta; Lacedonia, Donato; Cerri, Stefania; Milaneschi, Rosanna; Luppi, Fabrizio; Cocconcelli, Elisabetta; Bazzan, Erica; Clini, Enrico; Foschino Barbaro, Maria Pia; Gregori, Dario; Cosio, Manuel G; Saetta, Marina; Spagnolo, Paolo

2018-04-13

Pirfenidone reduces functional decline in patients with Idiopathic Pulmonary Fibrosis (IPF). However, response to treatment is highly heterogeneous. We sought to evaluate whether response to pirfenidone is influenced by the pretreatment rate of forced vital capacity (FVC) decline. Fifty-six IPF patients were categorized as rapid (RP) or slow progressors (SP) based on whether their FVC decline in the year preceding pirfenidone treatment was > or ≤ 10% predicted. Following pirfenidone treatment patients were followed-up every 6 months and up to 24 months. In the entire population, pirfenidone reduced significantly FVC decline from 231 to 49 ml/year at 6 months (T6) (p = 0.003) and this effect was maintained at the 12-, 18- and 24-month time points (p value for trend n.s.). In RP, the reduction of FVC decline was evident at 6 months (36 vs 706 ml/year pretreatment; p = 0.002) and maintained, though to a lesser degree, at 12 (106 ml/year), 18 (176 ml/year) and 24 months (162 ml/year; p value for trend n.s). Among SP, the reduction in FVC decline was not significant at any of the time points analyzed. In conclusion, pirfenidone reduces FVC decline in IPF patients. However, its beneficial effect is more pronounced in patients with rapidly progressive disease.

The effect of exemestane and tamoxifen on bone health within the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial: a meta-analysis of the US, German, Netherlands, and Belgium sub-studies.

PubMed

Hadji, Peyman; Asmar, Lina; van Nes, Johanna G H; Menschik, Thomas; Hasenburg, Annette; Kuck, Joachim; Nortier, Johan W R; van de Velde, Cornelis J H; Jones, Stephen E; Ziller, May

2011-06-01

We performed a meta-analysis of three sub-studies of the randomized Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial to determine the effects of exemestane and tamoxifen on bone health. Patients received exemestane or tamoxifen as adjuvant therapy for hormone receptor-positive breast cancer. Bone mineral density (BMD) was assessed at baseline and after 12 and 24 months of treatment. Bone turnover markers were also measured. Patients receiving tamoxifen showed a mean increase from baseline in lumbar spine BMD of 1.2% at month 12 and 0.2% at month 24. Patients receiving exemestane showed a mean decrease from baseline of 2.6% after 12 months and 3.5% after 24 months. There were significant differences in the changes in lumbar spine BMD between treatment groups (P < 0.0001 at both time points). Changes in BMD from baseline at the total hip were also significantly different between exemestane and tamoxifen (P < 0.05 at both time points). Bone turnover markers decreased from baseline with tamoxifen and increased with exemestane. Exemestane resulted in decreases in BMD and increases in bone turnover markers. BMD increased and bone turnover markers decreased with tamoxifen.

Twelve-Month Estrogen Levels in Premenopausal Women With Hormone Receptor–Positive Breast Cancer Receiving Adjuvant Triptorelin Plus Exemestane or Tamoxifen in the Suppression of Ovarian Function Trial (SOFT): The SOFT-EST Substudy

PubMed Central

Gray, Kathryn P.; Francis, Prudence A.; Láng, István; Ciruelos, Eva; Lluch, Ana; Climent, Miguel Angel; Catalán, Gustavo; Avella, Antoni; Bohn, Uriel; González-Martin, Antonio; Ferrer, Roser; Catalán, Roberto; Azaro, Analía; Rajasekaran, Agnita; Morales, Josefa; Vázquez, Josep; Fleming, Gini F.; Price, Karen N.; Regan, Meredith M.

2016-01-01

Purpose To describe estradiol (E2), estrone (E1), and estrone sulfate (E1S) levels during the first year of monthly triptorelin plus exemestane or tamoxifen and to assess possible suboptimal suppression while receiving exemestane plus triptorelin. Patients and Methods Premenopausal patients with early breast cancer on the Suppression of Ovarian Function Trial who selected triptorelin as the ovarian suppression method and were randomly assigned to exemestane plus triptorelin or tamoxifen plus triptorelin were enrolled until the target population of 120 patients was reached. Blood sampling time points were 0, 3, 6, 12, 18, 24, 36, and 48 months. Serum estrogens were measured with a highly sensitive and specific assay. This preplanned 12-month analysis evaluated E2, E1, E1S, follicle-stimulating hormone, and luteinizing hormone levels in all patients and the proportion of patients with E2 levels greater than 2.72 pg/mL at any time point during treatment with exemestane plus triptorelin. Results One hundred sixteen patients (exemestane, n = 86; tamoxifen, n = 30; median age, 44 years; median E2, 51 pg/mL; 55% prior chemotherapy) started triptorelin and had one or more samples drawn. With exemestane plus triptorelin, median reductions from baseline E2, E1, and E1S levels were consistently ≥ 95%, resulting in significantly lower levels than with tamoxifen plus triptorelin at all time points. Among patients on exemestane plus triptorelin, 25%, 24%, and 17% had an E2 level greater than 2.72 pg/mL at 3, 6, and 12 months, respectively. Baseline factors related to on-treatment E2 level greater than 2.72 pg/mL were no prior chemotherapy (P = .06), higher body mass index (P = .05), and lower follicle-stimulating hormone and luteinizing hormone (each P < .01). Conclusion During the first year, most patients on exemestane plus triptorelin had E2 levels below the defined threshold of 2.72 pg/mL, consistent with levels reported in postmenopausal patients on aromatase inhibitors, but at each time point, at least 17% of patients had levels greater than the threshold. PMID:26729437

Twelve-Month Estrogen Levels in Premenopausal Women With Hormone Receptor-Positive Breast Cancer Receiving Adjuvant Triptorelin Plus Exemestane or Tamoxifen in the Suppression of Ovarian Function Trial (SOFT): The SOFT-EST Substudy.

PubMed

Bellet, Meritxell; Gray, Kathryn P; Francis, Prudence A; Láng, István; Ciruelos, Eva; Lluch, Ana; Climent, Miguel Angel; Catalán, Gustavo; Avella, Antoni; Bohn, Uriel; González-Martin, Antonio; Ferrer, Roser; Catalán, Roberto; Azaro, Analía; Rajasekaran, Agnita; Morales, Josefa; Vázquez, Josep; Fleming, Gini F; Price, Karen N; Regan, Meredith M

2016-05-10

To describe estradiol (E2), estrone (E1), and estrone sulfate (E1S) levels during the first year of monthly triptorelin plus exemestane or tamoxifen and to assess possible suboptimal suppression while receiving exemestane plus triptorelin. Premenopausal patients with early breast cancer on the Suppression of Ovarian Function Trial who selected triptorelin as the ovarian suppression method and were randomly assigned to exemestane plus triptorelin or tamoxifen plus triptorelin were enrolled until the target population of 120 patients was reached. Blood sampling time points were 0, 3, 6, 12, 18, 24, 36, and 48 months. Serum estrogens were measured with a highly sensitive and specific assay. This preplanned 12-month analysis evaluated E2, E1, E1S, follicle-stimulating hormone, and luteinizing hormone levels in all patients and the proportion of patients with E2 levels greater than 2.72 pg/mL at any time point during treatment with exemestane plus triptorelin. One hundred sixteen patients (exemestane, n = 86; tamoxifen, n = 30; median age, 44 years; median E2, 51 pg/mL; 55% prior chemotherapy) started triptorelin and had one or more samples drawn. With exemestane plus triptorelin, median reductions from baseline E2, E1, and E1S levels were consistently ≥ 95%, resulting in significantly lower levels than with tamoxifen plus triptorelin at all time points. Among patients on exemestane plus triptorelin, 25%, 24%, and 17% had an E2 level greater than 2.72 pg/mL at 3, 6, and 12 months, respectively. Baseline factors related to on-treatment E2 level greater than 2.72 pg/mL were no prior chemotherapy (P = .06), higher body mass index (P = .05), and lower follicle-stimulating hormone and luteinizing hormone (each P < .01). During the first year, most patients on exemestane plus triptorelin had E2 levels below the defined threshold of 2.72 pg/mL, consistent with levels reported in postmenopausal patients on aromatase inhibitors, but at each time point, at least 17% of patients had levels greater than the threshold. © 2016 by American Society of Clinical Oncology.

Fetal gender prediction based on maternal plasma testosterone and insulin-like peptide 3 concentrations at midgestation and late gestation in cattle.

PubMed

Kibushi, M; Kawate, N; Kaminogo, Y; Hannan, M A; Weerakoon, W W P N; Sakase, M; Fukushima, M; Seyama, T; Inaba, T; Tamada, H

2016-10-15

We compared maternal plasma testosterone and insulin-like peptide 3 (INSL3) concentrations between dams carrying a male versus female fetus from early to late gestation and examined the application of maternal hormonal concentrations to fetal gender prediction in dairy and beef cattle. Blood samples were collected from Holstein cows or heifers (N = 31) and Japanese Black beef cows (N = 33) at 1-month intervals at 2 to 8 months of gestation. Fetal gender was confirmed by visual observation of external genitalia of calves just after birth. Plasma testosterone and INSL3 concentrations were determined by enzyme-immunoassay. Fetal genders were judged based on cutoff values of maternal testosterone and INSL3 concentrations (male, if it was ≥ cutoff value; female, if < cutoff value), which we set for each hormone at each gestational month using receiver operating characteristic curves. Plasma testosterone concentrations were higher for dams with a male fetus than those with a female at 4, 5, 7, and 8 months for the dairy cattle (P < 0.05) and at 4, 5, 6, and 8 months for the beef cows (P < 0.05). Plasma INSL3 concentrations were higher for dams with a male fetus than those with a female at 2 and 6 months for the dairy cattle (P < 0.05) and at 4 to 8 months for the beef cows (P < 0.05). The predictive values and detection rates for fetal gender prediction based on maternal testosterone concentrations were 75.8% to 79.3% for dairy cattle at 5 and 7 months and for beef cows at 5 and 6 months, whereas those values by maternal INSL3 concentrations were 71.0% to 72.4% for the dairy cattle at 6 months and beef cows at 4 and 8 months. When multiple time points of testosterone and INSL3 concentrations at several midgestation and late gestation months were considered for fetal gender prediction, predictive values were 89.3% (5-7 months) and 85.7% to 88.0% (4-6, 8 months) for the dairy and beef breeds, respectively. Maternal testosterone and INSL3 concentrations in dams carrying a male fetus were higher than those carrying a female at midgestation and/or late gestation in Holstein and Japanese Black beef cattle. Nearly, 80% accuracy was obtained for fetal gender prediction by a single time point of maternal plasma testosterone concentrations at midgestation. Nearly 90% accuracy for the prediction was obtained when multiple time points of testosterone and INSL3 concentrations from midgestation to late gestation were considered. Copyright © 2016 Elsevier Inc. All rights reserved.

Behavioral Effects of a Locomotor-Based Physical Activity Intervention in Preschoolers.

PubMed

Burkart, Sarah; Roberts, Jasmin; Davidson, Matthew C; Alhassan, Sofiya

2018-01-01

Poor adaptive learning behaviors (ie, distractibility, inattention, and disruption) are associated with behavior problems and underachievement in school, as well as indicating potential attention-deficit hyperactivity disorder. Strategies are needed to limit these behaviors. Physical activity (PA) has been suggested to improve behavior in school-aged children, but little is known about this relationship in preschoolers. This study examined the effects of a PA intervention on classroom behaviors in preschool-aged children. Eight preschool classrooms (n = 71 children; age = 3.8 ± 0.7 y) with children from low socioeconomic environments were randomized to a locomotor-based PA (LB-PA) or unstructured free playtime (UF-PA) group. Both interventions were implemented by classroom teachers and delivered for 30 minutes per day, 5 days per week for 6 months. Classroom behavior was measured in both groups at 3 time points, whereas PA was assessed at 2 time points over a 6-month period and analyzed with hierarchical linear modeling. Linear growth models showed significant decreases in hyperactivity (LB-PA: -2.58 points, P = .001; UF-PA: 2.33 points, P = .03), aggression (LB-PA: -2.87 points, P = .01; UF-PA: 0.97 points, P = .38) and inattention (LB-PA: 1.59 points, P < .001; UF-PA: 3.91 points, P < .001). This research provides promising evidence for the efficacy of LB-PA as a strategy to improve classroom behavior in preschoolers.

Sequential imaging of asymptomatic carotid atheroma using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging: a feasibility study.

PubMed

Sadat, Umar; Howarth, Simon P S; Usman, Ammara; Tang, Tjun Y; Graves, Martin J; Gillard, Jonathan H

2013-11-01

Inflammation within atheromatous plaques is a known risk factor for plaque vulnerability. This can be detected in vivo on high-resolution magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) contrast medium. The purpose of this study was to assess the feasibility of performing sequential USPIO studies over a 1-year period. Ten patients with moderate asymptomatic carotid stenosis underwent carotid MRI imaging both before and 36 hours after USPIO infusion at 0, 6, and 12 months. Images were manually segmented into quadrants, and the signal change per quadrant was calculated at these time points. A mixed repeated measures statistical model was used to determine signal change attributable to USPIO uptake over time. All patients remained asymptomatic during the study. The mixed model revealed no statistical difference in USPIO uptake between the 3 time points. Intraclass correlation coefficients revealed a good agreement of quadrant signal pre-USPIO infusion between 0 and 6 months (0.70) and 0 and 12 months (0.70). Good agreement of quadrant signal after USPIO infusion was shown between 0 and 6 months (0.68) and moderate agreement was shown between 0 and 12 months (0.33). USPIO-enhanced sequential MRI of atheromatous carotid plaques is clinically feasible. This may have important implications for future longitudinal studies involving pharmacologic intervention in large patient cohorts. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Methods for estimating selected flow-duration and flood-frequency characteristics at ungaged sites in Central Idaho

USGS Publications Warehouse

Kjelstrom, L.C.

1998-01-01

Methods for estimating daily mean discharges for selected flow durations and flood discharge for selected recurrence intervals at ungaged sites in central Idaho were applied using data collected at streamflow-gaging stations in the area. The areal and seasonal variability of discharge from ungaged drainage basins may be described by estimating daily mean discharges that are exceeded 20, 50, and 80 percent of the time each month. At 73 gaging stations, mean monthly discharge was regressed with discharge at three points—20, 50, and 80—from daily mean flow-duration curves for each month. Regression results were improved by dividing the study area into six regions. Previously determined estimates of mean monthly discharge from about 1,200 ungaged drainage basins provided the basis for applying the developed techniques to the ungaged basins. Estimates of daily mean discharges that are exceeded 20, 50, and 80 percent of the time each month at ungaged drainage basins can be made by multiplying mean monthly discharges estimated at ungaged sites by a regression factor for the appropriate region. In general, the flow-duration data were less accurately estimated at discharges exceeded 80 percent of the time than at discharges exceeded 20 percent of the time. Curves drawn through the three points for each of the six regions were most similar in July and most different from December through March. Coefficients of determination of the regressions indicate that differences in mean monthly discharge largely explain differences in discharge at points on the daily mean flow-duration curve. Inherent in the method are errors in the technique used to estimate mean monthly discharge. Flood discharge estimates for selected recurrence intervals at ungaged sites upstream or downstream from gaging stations can be determined by a transfer technique. A weighted ratio of drainage area times flood discharge for selected recurrence intervals at the gaging station can be used to estimate flood discharge at the ungaged site. Best results likely are obtained when the difference between gaged and ungaged drainage areas is small.

Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial.

PubMed

Blaya, Joaquín A; Shin, Sonya; Contreras, Carmen; Yale, Gloria; Suarez, Carmen; Asencios, Luis; Kim, Jihoon; Rodriguez, Pablo; Cegielski, Peter; Fraser, Hamish S F

2011-01-01

To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system. Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs. For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of 'late' DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of 'late' DSTs (p=0.57) compared with the control. Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting.

Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial

PubMed Central

Shin, Sonya; Contreras, Carmen; Yale, Gloria; Suarez, Carmen; Asencios, Luis; Kim, Jihoon; Rodriguez, Pablo; Cegielski, Peter; Fraser, Hamish S F

2010-01-01

Objective To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system. Methods Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs. Results For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of ‘late’ DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of ‘late’ DSTs (p=0.57) compared with the control. Conclusions Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting. PMID:21113076

Talking about Twisters: Relations between Mothers' and Children's Contributions to Conversations about a Devastating Tornado

ERIC Educational Resources Information Center

Bauer, Patricia J.; Burch, Melissa M.; Van Abbema, Dana L.; Ackil, Jennifer K.

2007-01-01

Mother-child dyads who experienced a devastating tornado talked about the storm and about two affectively more positive or neutral events at each of two time points: 4 months and 10 months after the storm. The conversations were analyzed to determine whether mothers and/or children's contributions differed as a function of event type and whether…

Monthly leaf area index estimates from point-in-time measurements and needle phenology for Pinus taeda

Treesearch

D.A. Sampson; T.J. Albaugh; Kurt H. Johnsen; H.L. Allen; Stanley J. Zarnoch

2003-01-01

Abstract: Leaf area index (LAI) of loblolly pine (Pinus taeda L.) trees of the southern United States varies almost twofold interannually; loblolly pine, essentially, carries two foliage cohorts at peak LAI (September) and one at minimum (March–April). Herein, we present an approach that may be site invariant to estimate monthly...

Early Maternal Language Use during Book Sharing in Families from Low-Income Environments

ERIC Educational Resources Information Center

Abraham, Linzy M.; Crais, Elizabeth; Vernon-Feagans, Lynne; Cox, Martha; Blair, Clancy; Burchinal, Peg; Crnic, Keith; Crouter, Ann; Garrett-Peters, Patricia; Greenberg, Mark; Lanza, Stephanie; Mills-Koonce, Roger; Werner, Emily; Willoughby, Michael

2013-01-01

Purpose: The authors examined the language used by mothers from low-income and rural environments with their infants at ages 6 and 15 months to identify predictors of maternal language use at the 15-month time point. Method: Maternal language use by 82 mothers with their children was documented during book-sharing interactions within the home in a…

The Effects of Early Experience on Face Recognition: An Event-Related Potential Study of Institutionalized Children in Romania

ERIC Educational Resources Information Center

Moulson, Margaret C.; Westerlund, Alissa; Fox, Nathan A.; Zeanah, Charles H.; Nelson, Charles A.

2009-01-01

Data are reported from 3 groups of children residing in Bucharest, Romania. Face recognition in currently institutionalized, previously institutionalized, and never-institutionalized children was assessed at 3 time points: preintervention (n = 121), 30 months of age (n = 99), and 42 months of age (n = 77). Children watched photographs of caregiver…

Predictors of early person reference development: maternal language input, attachment and neurodevelopmental markers.

PubMed

Lemche, Erwin; Joraschky, Peter; Klann-Delius, Gisela

2013-12-01

In a longitudinal natural language development study in Germany, the acquisition of verbal symbols for present persons, absent persons, inanimate things and the mother-toddler dyad was investigated. Following the notion that verbal referent use is more developed in ostensive contexts, symbolic play situations were coded for verbal person reference by means of noun and pronoun use. Depending on attachment classifications at twelve months of age, effects of attachment classification and maternal language input were studied up to 36 months in four time points. Hierarchical regression analyses revealed that, except for mother absence, maternal verbal referent input rates at 17 and 36 months were stronger predictors for all referent types than any of the attachment organizations, or any other social or biological predictor variable. Attachment effects accounted for up to 9.8% of unique variance proportions in the person reference variables. Perinatal and familial measures predicted person references dependent on reference type. The results of this investigation indicate that mother-reference, self-reference and thing-reference develop in similar quantities measured from the 17-month time point, but are dependent of attachment quality. Copyright © 2013 Elsevier Inc. All rights reserved.

Women With Breast Cancer: Self-Reported Distress in Early Survivorship

PubMed Central

Lester, Joanne; Crosthwaite, Kara; Stout, Robin; Jones, Rachel N.; Holloman, Christopher; Shapiro, Charles; Andersen, Barbara L.

2015-01-01

Purpose/Objectives To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. Design Descriptive, cross-sectional. Setting A National Cancer Institute–designated comprehensive cancer center. Sample 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. Methods Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. Main Research Variables Distress scores, problem reports, and time groups. Findings Participants scored in range of the cutoff of more than 4 (range = 4.1–5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). Conclusions Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. Implications for Nursing Interventions to reduce or prevent distress may improve outcomes in early survivorship. PMID:25542330

Quarterly repeat cycles of onabotulinumtoxinA in chronic migraine patients: the benefits of the prolonged treatment on the continuous responders and quality-of-life conversion rate in a real-life setting.

PubMed

Santoro, Antonio; Fontana, Andrea; Miscio, Anna M; Zarrelli, Michele M; Copetti, Massimiliano; Leone, Maurizio A

2017-10-01

OnabotulinumtoxinA was approved for treatment of chronic migraine (CM) after publication of Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. However, the PREEMPT trials lasted only up to 1 year. The main aim of our retrospective study was to evaluate whether a prolonged treatment of onabotulinumtoxinA (18 months, six quarterly cycles) will sustain or further improve the efficacy results and the quality of life achieved at 6 and 12 months. Patients were adults with CM with or without overuse of drugs, with at least six regularly repeat onabotulinumtoxinA treatments, administered according to the PREEMPT protocol. The outcomes were investigated after 6, 12, and 18 months of treatment with respect to baseline and with respect to each previous study time point. Headache days and hours, and dosage of headache medication taken with latency period, were collected from the patients daily. Quality of life was evaluated by means of the Migraine Disability Assessment (MIDAS) questionnaire. At each study time point, the proportion of responder patients with respect to baseline was evaluated. For all measures, the baseline data were referred to the previous month before starting. Forty-seven patients were evaluated. Our data show a decrease in the monthly headache days and hours, at each study evaluation, with respect to the previous one. They showed that beyond the first year, a statistically significant difference in the monthly days of headache compared at 18 vs. 12 months is observed. A significantly higher proportion of patients (with a response greater than 75% decrease from baseline in the frequency of headache days and hours) was observed at month 18 compared to month 12. The proportion of patients in MIDAS grade I increased over time, and a statistically significant improvement in MIDAS I score was obtained from month 12 to month 18. A positive modification in the consumption of analgesics over time was observed (p for trend <0.001). The mean acute drug latency strongly decreased over time. Our study confirmed that onabotulinumtoxinA is an effective treatment to reduce headache-related disability and improve patients' quality of life, highlighting that upon repeated administration, the therapy efficacy increases significantly and a progressive trend of "first-time response" is observed for the entire period under consideration.

Current validity of diagnosis of permanent vegetative state: A longitudinal study in a sample of patients with altered states of consciousness.

PubMed

Noé, E; Olaya, J; Colomer, C; Moliner, B; Ugart, P; Rodriguez, C; Llorens, R; Ferri, J

2017-07-13

Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P<.01), chronicity (P=.01), and CRS-R scores at admission (P<.001) correctly predicted emergence from MCS in 77.5% of the cases. UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up.

PubMed

Kubaisi, Buraa; Maleki, Arash; Ahmed, Aseef; Lamba, Neel; Sahawneh, Haitham; Stephenson, Andrew; Montieth, Alyssa; Topgi, Shobha; Foster, C Stephen

2018-01-01

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma. This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015. Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found. AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years.

Developmental Programming: Impact of Prenatal Testosterone Excess on Steroidal Machinery and Cell Differentiation Markers in Visceral Adipocytes of Female Sheep.

PubMed

Puttabyatappa, Muraly; Lu, Chunxia; Martin, Jacob D; Chazenbalk, Gregorio; Dumesic, Daniel; Padmanabhan, Vasantha

2017-01-01

Prenatal testosterone (T)-treated female sheep manifest reduced adipocyte size and peripheral insulin resistance. The small adipocyte phenotype may reflect defects in adipogenesis and its steroidal machinery. To test whether prenatal T treatment from gestational days 30 to 90 alters the visceral adipose tissue (VAT) steroidal machinery and reduces adipocyte differentiation, we examined expression of the steroidogenic enzymes, steroid receptors, and adipocyte differentiation markers at fetal day 90 and postnatal ages 10 and 21 months. Because gestational T treatment increases fetal T and maternal insulin, the contributions of these were assessed by androgen receptor antagonist or insulin sensitizer cotreatment, either separately (at fetal day 90 and 21 months of age time points) or together (10 months of age). The effects on adipogenesis were assessed in the VAT-derived mesenchymal stem cells (AT-MSCs) from pre- and postpubertal time points to evaluate the effects of pubertal steroidal changes on adipogenesis. Our results show that VAT manifests potentially a predominant estrogenic intracrine milieu (increased aromatase and estrogen receptor α) and reduced differentiation markers at fetal day 90 and postnatal 21 months of age. These changes appear to involve both androgenic and metabolic pathways. Preliminary findings suggest that prenatal T treatment reduces adipogenesis, decreases expression of differentiation, and increases expression of commitment markers at both pre- and postpubertal time points. Together, these findings suggest that (1) increased commitment of AT-MSCs to adipocyte lineage and decreased differentiation to adipocytes may underlie the small adipocyte phenotype of prenatal T-treated females and (2) excess T-induced changes in steroidal machinery in the VAT likely participate in the programming/maintenance of this defect.

Ahmed glaucoma valve in uveitic patients with fluocinolone acetonide implant-induced glaucoma: 3-year follow-up

PubMed Central

Kubaisi, Buraa; Maleki, Arash; Ahmed, Aseef; Lamba, Neel; Sahawneh, Haitham; Stephenson, Andrew; Montieth, Alyssa; Topgi, Shobha; Foster, C Stephen

2018-01-01

Purpose To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma. Methods This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015. Results Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10 eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found. Conclusion AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years. PMID:29750012

Return to activity after concussion affects dual-task gait balance control recovery.

PubMed

Howell, David R; Osternig, Louis R; Chou, Li-Shan

2015-04-01

Recent work has identified deficits in dual-task gait balance control for up to 2 months after adolescent concussion; however, how resumption of preinjury physical activities affects recovery is unknown. The objective of this study is to examine how return to activity (RTA) affects recovery from concussion on measures of symptom severity, cognition, and balance control during single-task and dual-task walking. Nineteen adolescents with concussion who returned to preinjury activity within 2 months after injury and 19 uninjured, matched controls completed symptom inventories, computerized cognitive testing, and single-task and dual-task gait analyses. Concussion participants were assessed at five time points: within 72 h, 1 wk, 2 wk, 1 month, and 2 months postinjury. Control participants were assessed at the same time points as their matched concussion counterparts. RTA day was documented as the postinjury day in which physical activity participation was allowed. The effect of returning to physical activity was assessed by examining the percent change on each dependent variable across time before and directly after the RTA. Data were analyzed by two-way mixed effects ANOVAs. After the RTA day, concussion participants significantly increased their total center-of-mass medial/lateral displacement (P = 0.009, ηp = .175) and peak velocity (P = 0.048, ηp = 0.104) during dual-task walking when compared with pre-RTA data, whereas no changes for the concussion group or between groups were detected on measures of single-task walking, forward movement, or cognition. Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA, suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery.

Effect of Energy Drinks on Discoloration of Silorane and Dimethacrylate-Based Composite Resins.

PubMed

Ahmadizenouz, Ghazaleh; Esmaeili, Behnaz; Ahangari, Zohreh; Khafri, Soraya; Rahmani, Aghil

2016-08-01

This study aimed to assess the effects of two energy drinks on color change (ΔE) of two methacrylate-based and a silorane-based composite resin after one week and one month. Thirty cubic samples were fabricated from Filtek P90, Filtek Z250 and Filtek Z350XT composite resins. All the specimens were stored in distilled water at 37°C for 24 hours. Baseline color values (L*a*b*) of each specimen were measured using a spectrophotometer according to the CIEL*a*b* color system. Ten randomly selected specimens from each composite were then immersed in the two energy drinks (Hype, Red Bull) and artificial saliva (control) for one week and one month. Color was re-assessed after each storage period and ΔE values were calculated. The data were analyzed using the Kruskal Wallis and Mann-Whitney U tests. Filtek Z250 composite showed the highest ΔE irrespective of the solutions at both time points. After seven days and one month, the lowest ΔE values were observed in Filtek Z350XT and Filtek P90 composites immersed in artificial saliva, respectively. The ΔE values of Filtek Z250 and Z350XT composites induced by Red Bull and Hype energy drinks were not significantly different. Discoloration of Filtek P90 was higher in Red Bull energy drink at both time points. Prolonged immersion time in all three solutions increased ΔE values of all composites. However, the ΔE values were within the clinically acceptable range (<3.3) at both time points.

Altered autophagy and sympathetic innervation in salivary glands from high-fat diet mice.

PubMed

de Carvalho, Polliane Morais; Gavião, Maria Beatriz Duarte; Carpenter, Guy Howard

2017-03-01

to investigate the effects of a high fat diet (HFD) on salivary glands in vivo, in a mouse model. In particular, whether it will induce the appearance of fat cells in salivary glands, alterations related to autophagy, mTOR pathway and sympathetic innervation. 27 adult female ICR mice were separated in six groups. Three groups fed with (HFD) containing 55% fat, for one, two and three month and another three groups fed with normal diet (2.7% of fat), for the same time periods. The submandibular glands and liver were dissected and part homogenized for protein analyses and part fixed in formalin for histological analyses. After three months the HFD fed mice total body weight fold change increased compared to controls. The Oil Red O staining showed no fat cells deposit in salivary gland however a large increase was observed in liver after three months of HFD. Adiponectin levels were significantly decreased in the HFD group after three months. The group fed with HFD for three months showed increased conversion of the LC3 autophagy marker in salivary gland. mTOR showed no activation regarding the time point studied. Tyrosine hydroxylase significantly decreased after two and three month of HFD. HFD caused several changes after three months however the earliest change was noticed after two months regarding sympathetic innervation. This suggests neural alteration may drive other diet induced changes in salivary glands. These early changes may be the starting point for longer term alterations of salivary glands with alterations in diet. Copyright © 2016 Elsevier Ltd. All rights reserved.

Remote kinematic training for patients with chronic neck pain: a randomised controlled trial.

PubMed

Sarig Bahat, Hilla; Croft, Kate; Carter, Courtney; Hoddinott, Anna; Sprecher, Elliot; Treleaven, Julia

2018-06-01

To evaluate short- and intermediate-term effects of kinematic training (KT) using virtual reality (VR) or laser in patients with chronic neck pain. A randomised controlled trial with three arms (laser, VR, control) to post-intervention (N = 90), and two arms (laser or VR) continuing to 3 months follow-up. Home training intervention was provided during 4 weeks to VR and laser groups while control group waited. Primary outcome measures included neck disability index (NDI), global perceived effect (GPE), and cervical motion velocity (mean and peak). Secondary outcome measures included pain intensity (VAS), health status (EQ5D), kinesiophobia (TSK), range, smoothness, and accuracy of neck motion as measured by the neck VR system. Measures were taken at baseline, immediately post-training, and 3 months later. Ninety patients with neck pain were randomised to the trial, of which 76 completed 1 month follow-up, and 56 the 3 months follow-up. Significant improvements were demonstrated in NDI and velocity with good effect sizes in intervention groups compared to control. No within-group changes were presented in the control group, compared to global improvements in intervention groups. Velocity significantly improved at both time points in both groups. NDI, VAS, EQ5D, TSK and accuracy significantly improved at both time points in VR and in laser at 3 months evaluation in all but TSK. GPE scores showed 74-84% of participants perceived improvement and/or were satisfied. Significant advantages to the VR group compared to laser were found in velocity, pain intensity, health status and accuracy at both time points. The results support home kinematic training using VR or laser for improving disability, neck pain and kinematics in the short and intermediate term with an advantage to the VR group. The results provide directions for future research, use and development. ACTRN12615000231549.

The impact of maternal post-partum depression on the language development of children at 12 months.

PubMed

Quevedo, L A; Silva, R A; Godoy, R; Jansen, K; Matos, M B; Tavares Pinheiro, K A; Pinheiro, R T

2012-05-01

Language is one of the most important acquisitions made during childhood. Before verbal language, a child develops a range of skills and behaviours that allow the child to acquire all communication skills. Factors such as environmental factors, socio-economic status and interaction with parents can affect the acquisition of vocabulary in children. Post-partum depression can negatively affect the first interactions with the child and, consequently, the emotional, social and cognitive development of the child. To analyse the effect of the duration of the mother's depression on the language development of children at 12 months old. This was a longitudinal study. The participants of this study were mothers who had received prenatal care from the Brazilian National System of Public Health in Pelotas city, State of Rio Grande do Sul, Brazil. The mothers were interviewed at two different time points: from 30 to 90 days after delivery and at 12 months after delivery; the children were also evaluated at this later time point. To diagnose maternal depression, we used the Mini International Neuropsychiatric Interview, and to assess child development, we used the language scale of the Bayley Scales of Infant Development III. We followed 296 dyads. Maternal depression at both time points (post partum and at 12 months) was significantly associated with the language development of infants at 12 months of age. This impact was accentuated when related to the duration of the disorder. Older women and women with more than two children were more likely to have children with poorer language development, while women who were the primary caregiver had children with higher scores on the language test. The findings indicate that maternal age, parity, primary caregiver status and duration of post-partum depression are associated with the language development of the child. © 2011 Blackwell Publishing Ltd.

Siblings, theory of mind, and executive functioning in children aged 3-6 years: new longitudinal evidence.

PubMed

McAlister, Anna R; Peterson, Candida C

2013-01-01

Longitudinal data were obtained from 157 children aged 3 years 3 months to 5 years 6 months at Time 1. At Time 2 these children had aged an average of 12 months. Theory of mind (ToM) and executive functioning (EF) were measured at both time points. Results suggest that Time 1 ToM scores predict Time 2 EF scores. Detailed examination of sibling influences suggests that benefits-in terms of advanced ToM development-accrue to children with siblings versus without, and to those with a larger number of child-aged siblings. Any advance in either area (ToM or EF) is likely to benefit the other, and early sibling interaction appears to act as a catalyst. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Beach response dynamics of a littoral cell using a 17-year single-point time series of sand thickness

USGS Publications Warehouse

Barnard, P.L.; Hubbard, D.M.; Dugan, J.E.

2012-01-01

A 17-year time series of near-daily sand thickness measurements at a single intertidal location was compared with 5. years of semi-annual 3-dimensional beach surveys at the same beach, and at two other beaches within the same littoral cell. The daily single point measurements correlated extremely well with the mean beach elevation and shoreline position of ten high-spatial resolution beach surveys. Correlations were statistically significant at all spatial scales, even for beach surveys 10s of kilometers downcoast, and therefore variability at the single point monitoring site was representative of regional coastal behavior, allowing us to examine nearly two decades of continuous coastal evolution. The annual cycle of beach oscillations dominated the signal, typical of this region, with additional, less intense spectral peaks associated with seasonal wave energy fluctuations (~. 45 to 90. days), as well as full lunar (~. 29. days) and semi-lunar (~. 13. days; spring-neap cycle) tidal cycles. Sand thickness variability was statistically linked to wave energy with a 2. month peak lag, as well as the average of the previous 7-8. months of wave energy. Longer term anomalies in sand thickness were also apparent on time scales up to 15. months. Our analyses suggest that spatially-limited morphological data sets can be extremely valuable (with robust validation) for understanding the details of beach response to wave energy over timescales that are not resolved by typical survey intervals, as well as the regional behavior of coastal systems. ?? 2011.

A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury.

PubMed

Terré, R; Mearin, F

2015-04-01

To evaluate the effectiveness of neuromuscular electrical stimulation (NMES) treatment in patients with oropharyngeal dysphagia secondary to acquired brain injury. Twenty patients with neurological oropharyngeal dysphagia (14 stroke and six severe traumatic brain injury) were enrolled in a prospective randomized study, with patients and assessors blinded (to group allocation): 10 patients underwent NMES and conventional swallowing therapy and 10 patients underwent sham electrical stimulation (SES) and conventional swallowing therapy. Both groups completed 20 sessions. At baseline, at the end of treatment (1 month) and at 3-month follow-up, clinical, videofluoroscopic and esophageal manometric analyses were done. Feeding swallowing capacity was evaluated using the functional oral intake scale (FOIS). Mean FOIS score before treatment was 1.9 for the NMES group and 2.1 for the SES group. After treatment, the NMES group increased by 2.6 points (4.5 points) compared with only 1 point (3.1 points) for the SES group (P = 0.005). At 3 months of follow-up, mean scores were 5.3 and 4.6 respectively; thus, both groups improved similarly. At that time point (3 months), tracheal aspiration persisted in six patients in each group. However, a significant improvement in relation to the bolus viscosity at which aspiration appeared was found in the NMES group versus the SES group (P = 0.015). Also, a significant increase (P = 0.04) in pharyngeal amplitude contraction was observed at the end of treatment (1 month) in the NMES group compared with the SES group. Neuromuscular electrical stimulation significantly accelerated swallowing function improvement in patients with oropharyngeal dysphagia secondary to acquired brain injury. © 2015 EAN.

Recovery of rat muscle size but not function more than 1 year after a single botulinum toxin injection.

PubMed

Ward, Samuel R; Minamoto, Viviane B; Suzuki, Kentaro P; Hulst, Jonah B; Bremner, Shannon N; Lieber, Richard L

2018-03-01

Neurotoxin injection is used to treat a wide variety of neuromuscular disorders. The purpose of this study was to measure the functional and structural properties of botulinum toxin-injected adult rat skeletal muscle over nearly the entire lifespan. Ten groups of animals were subjected to either neurotoxin injection [Botox, Type A (BT-A); Allergan, Irvine, California] or saline solution injection. Neurotoxin-injected animals (n = 90) were analyzed at different time-points: 1 week; 1 month; 3 months; 6 months; 12 months; or 18 months. In spite of the recovery of structural features, such as muscle mass and fiber area, dorsiflexion torque production remained significantly depressed by 25%, even at 12 months after neurotoxin injection. The data demonstrate that, after a single BT-A injection, although gross muscle morphology recovered over a 12-month time period, loss of contractile function did not recover. Muscle Nerve 57: 435-441, 2018. © 2017 Wiley Periodicals, Inc.

A longitudinal study of parental discipline of young children.

PubMed

Socolar, Rebecca R S; Savage, Eric; Evans, Hughes

2007-05-01

To determine how discipline practices changed over time for young children. A cohort of parents with young children were interviewed in clinic about a broad array of disciplinary practices at two points in time. A total of 182 parents were interviewed at Time 1, and 94 were interviewed at Time 1 and 2. Mean age of the child was 16.2 months at Time 1 and 35.8 months at Time 2. Monitoring, verbal communication, and distracting were the most common types of discipline when the children were one year old. Corporal punishment (P < 0.05), verbal communication (P < 0.001), timeout (< 0.0001), removing privileges (< 0.0001), negative demeanor (< 0.0001), and sternness (< 0.0001) increased significantly from Time 1 to Time 2. Distracting (< 0.001) decreased significantly and positive demeanor also decreased. Most discipline practices increased in frequency over the 20 months of this study. The increase in parental negative demeanor seems particularly important and worthy of further study.

Gonioscopy-assisted Transluminal Trabeculotomy: An Ab Interno Circumferential Trabeculotomy: 24 Months Follow-up.

PubMed

Grover, Davinder S; Smith, Oluwatosin; Fellman, Ronald L; Godfrey, David G; Gupta, Aditi; Montes de Oca, Ildamaris; Feuer, William J

2018-05-01

The purpose of this study was to provide 24-month follow-up on surgical success and safety of an ab interno circumferential 360-degree trabeculotomy. Chart review of patients who underwent a gonioscopy-assisted transluminal trabeculotomy (GATT) procedure was performed by 4 of the authors (D.S.G., O.S., R.L.F., and D.G.G.). The surgery was performed in adults with various types of open-angle glaucoma with preoperative intraocular pressures (IOPs) of ≥18 mm Hg. In total, 198 patients aged 24 to 89 years underwent the GATT procedure with at least 18 months follow-up. Patients with primary open-angle glaucoma had an average IOP decrease of 9.2 mm Hg at 24 months with an average decrease of 1.43 glaucoma medications. The mean percentage of IOP decrease in these primary open-angle glaucoma groups at 24 months was 37.3%. In secondary open-angle glaucoma, at 24 months there was an average decrease in IOP of 14.1 mm Hg on an average of 2.0 fewer medications. The mean percentage of IOP decrease in the secondary open-angle glaucoma groups at 24 months was 49.8%. The cumulative proportion of failure at 24 months ranged from 0.18 to 0.48, depending on the group. In all 6 study groups, at all 5 postoperative time points (3, 6, 12, 18, and 24 mo) the mean IOP and reduction in glaucoma medications was significantly reduced from baseline (P<0.001) with the exception of one time point. The 24-month results demonstrate that GATT is relatively safe and effective in treating various forms of open-angle glaucoma. The long-term results for GATT are relatively equivalent to those previously reported for GATT and ab externo trabeculotomy studies.

The Self-Regulation Model of Illness Applied to Smoking Behavior in Lung Cancer

PubMed Central

Browning, Kristine K.; Wewers, Mary Ellen; Ferketich, Amy K.; Otterson, Gregory A.; Reynolds, Nancy R.

2010-01-01

Thirteen to 20% of lung cancer patients continue to smoke after diagnosis. Guided by Self-Regulation theory, the purpose of this study was to examine illness perceptions over time in a sample of lung cancer patients. This prospective one-group descriptive longitudinal design study included participants 18 years or older, with a lung cancer diagnosis within the past 60 days who self-reported smoking within the past 7 days. At baseline patients completed a sociodemographics and tobacco use history questionnaire. The Illness Perception Questionnaire-Revised (IPQ-R) was repeated at 3 time points (baseline, 2–4 weeks, 6 months). Fifty-two participants provided data for the IPQ-R at baseline, 47 at 2–4 weeks, and 29 at 6 months. Differences between mean scores for each illness representation attribute of the IPQ-R at repeated time points were calculated by within-subject repeated measures analysis of variance and Wilcoxon Signed-Rank Tests. Identity (baseline vs. 2–4 weeks: p=0.026; baseline vs. 6 months: p=0.005) and acute/chronic timeline (p=0.018) mean scores significantly increased over time; personal and treatment control mean scores significantly decreased over time (p=0.007 and p=0.047, respectively). Understanding the context in which a patient perceives disease and smoking behavior may contribute to developing interventions that influence behavior change. PMID:19444080

A multicenter randomized trial indicates initial prednisolone treatment for childhood nephrotic syndrome for two months is not inferior to six-month treatment.

PubMed

Yoshikawa, Norishige; Nakanishi, Koichi; Sako, Mayumi; Oba, Mari S; Mori, Rintaro; Ota, Erika; Ishikura, Kenji; Hataya, Hiroshi; Honda, Masataka; Ito, Shuichi; Shima, Yuko; Kaito, Hiroshi; Nozu, Kandai; Nakamura, Hidefumi; Igarashi, Takashi; Ohashi, Yasuo; Iijima, Kazumoto

2015-01-01

In this multicenter, open-label, randomized controlled trial, we determined whether 2-month prednisolone therapy for steroid-sensitive nephrotic syndrome was inferior or not to 6-month therapy despite significantly less steroid exposure. The primary end point was time from start of initial treatment to start of frequently relapsing nephrotic syndrome. The pre-specified non-inferiority margin was a hazard ratio of 1.3 with one-sided significance of 5%. We randomly assigned 255 children with an initial episode of steroid-sensitive nephrotic syndrome to either 2 - or 6-month treatment of which 246 were eligible for final analysis. The total prednisolone exposure counted both initial and relapse prednisolone treatment administered over 24 months. Median follow-up in months was 36.7 in the 2-month and 38.2 in the 6-month treatment group. Time to frequent relaps was similar in both groups; however, the median was reached only in the 6-month group (799 days). The hazard ratio was 0.86 (90% confidence interval, 0.64-1.16) and met the non-inferior margin. Time to first relapse was also similar in both groups: median day 242 (2-month) and 243 (6-month). Frequency and severity of adverse events were similar in both groups. Most adverse events were transient and occurred during initial or relapse therapy. Thus, 2 months of initial prednisolone therapy for steroid-sensitive nephrotic syndrome, despite less prednisolone exposure, is not inferior to 6 months of initial therapy in terms of time to onset of frequently relapsing nephrotic syndrome.

Early mortality in multiple myeloma: the time-dependent impact of comorbidity: A population-based study in 621 real-life patients.

PubMed

Ríos-Tamayo, Rafael; Sáinz, Juan; Martínez-López, Joaquín; Puerta, José Manuel; Chang, Daysi-Yoe-Ling; Rodríguez, Teresa; Garrido, Pilar; de Veas, José Luís García; Romero, Antonio; Moratalla, Lucía; López-Fernández, Elisa; González, Pedro Antonio; Sánchez, María José; Jiménez-Moleón, José Juan; Jurado, Manuel; Lahuerta, Juan José

2016-07-01

Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large population-based cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality. Am. J. Hematol. 91:700-704, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Chronologic Evaluation of Cerebral Hemodynamics by Dynamic Susceptibility Contrast Magnetic Resonance Imaging After Indirect Bypass Surgery for Moyamoya Disease.

PubMed

Ishii, Yosuke; Tanaka, Yoji; Momose, Toshiya; Yamashina, Motoshige; Sato, Akihito; Wakabayashi, Shinichi; Maehara, Taketoshi; Nariai, Tadashi

2017-12-01

Although indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI). We retrospectively analyzed the cases of 25 patients with MMD (37 sides; mean age, 14.7 years; range, 3-36 years) who underwent indirect bypass surgery and repeated DSC-MRI measurement within 6 months after the operation. The difference in the mean transit time (MTT) between the target regions and the control region (cerebellum) was termed the MTT delay, and we measured the MTT delay's chronologic changes after surgery. The postoperative MTT delay was 1.81 ± 1.16 seconds within 1 week after surgery, 1.57 ± 1.01 at weeks 1-2, 1.55 ± 0.68 at weeks 2-4, 1.32 ± 0.68 at months 1-2, 0.95 ± 0.32 at months 2-3, and 0.77 ± 0.33 at months 3-6. Compared with the preoperative value (2.11 ± 0.98 seconds), the MTT delay decreased significantly from 2 to 4 weeks after surgery (P < 0.05). The amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period. Copyright © 2017. Published by Elsevier Inc.

Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial.

PubMed

Krohn-Dale, Ivar; Bøe, Olav E; Enersen, Morten; Leknes, Knut N

2012-08-01

The objective of this randomized, controlled clinical trial was to compare the clinical and microbiological effects of pocket debridement using erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser with conventional debridement in maintenance patients. Fifteen patients, all smokers, having at least four teeth with residual probing depth (PD) ≥ 5 mm were recruited. Two pockets in two jaw quadrants were randomly assigned to subgingival debridement using an Er:YAG laser (test) or ultrasonic scaler/curette (control) at 3-month intervals. Relative attachment level (RAL), PD, bleeding on probing and dental plaque were recorded at baseline and at 6 and 12 months. Microbiological subgingival samples were taken at the same time points and analysed using a checkerboard DNA-DNA hybridization technique. A significant decrease in PD took place in both treatments from baseline to 12 months (p < 0.01). In the control, the mean initial PD decreased from 5.4 to 4.0 mm at 12 months. For the test, a similar decrease occurred. No significant between-treatment differences were shown at any time point. The mean RAL showed no overall significant inter- or intra-treatment differences (p > 0.05). No significant between-treatment differences were observed in subgingival microbiological composition or total pathogens. The results failed to support that an Er:YAG laser may be superior to conventional debridement in the treatment of smokers with recurring chronic inflammation. This appears to be the first time that repeated Er-YAG laser instrumentation has been compared with mechanical instrumentation of periodontal sites with recurring chronic inflammation over a clinically relevant time period. © 2012 John Wiley & Sons A/S.

Preclinical animal study and human clinical trial data of co-electrospun poly(l-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

PubMed Central

Wu, Xujun; Wang, Yuru; Zhu, Cancan; Tong, Xiaowen; Yang, Ming; Yang, Li; Liu, Zhang; Huang, Weihong; Wu, Feng; Zong, Honghai; Li, Huaifang; He, Hongbing

2016-01-01

Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly(l-lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement (P<0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more (P<0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement. PMID:26893556

In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'.

PubMed

Llewellyn-Thomas, H; Thiel, E; Paterson, M; Naylor, D

1999-04-01

To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001). Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

Longitudinal Monitoring of Patients With Chronic Low Back Pain During Physical Therapy Treatment Using the STarT Back Screening Tool.

PubMed

Medeiros, Flávia Cordeiro; Costa, Leonardo Oliveira Pena; Added, Marco Aurélio Nemitalla; Salomão, Evelyn Cassia; Costa, Lucíola da Cunha Menezes

2017-05-01

Study Design Preplanned secondary analysis of a randomized clinical trial. Background The STarT Back Screening Tool (SBST) was developed to screen and to classify patients with low back pain into subgroups for the risk of having a poor prognosis. However, this classification at baseline does not take into account variables that can influence the prognosis during treatment or over time. Objectives (1) To investigate the changes in risk subgroup measured by the SBST over a period of 6 months, and (2) to assess the long-term predictive ability of the SBST when administered at different time points. Methods Patients with chronic nonspecific low back pain (n = 148) receiving physical therapy care as part of a randomized trial were analyzed. Pain intensity, disability, global perceived effect, and the SBST were collected at baseline, 5 weeks, 3 months, and 6 months. Changes in SBST risk classification were calculated. Hierarchical linear regression models adjusted for potential confounders were built to analyze the predictive capabilities of the SBST when administered at different time points. Results A large proportion of patients (60.8%) changed their risk subgroup after receiving physical therapy care. The SBST improved the prediction for all 6-month outcomes when using the 5-week risk subgroup and the difference between baseline and 5-week subgroup, after controlling for potential confounders. The SBST at baseline did not improve the predictive ability of the models after adjusting for confounders. Conclusion This study shows that many patients change SBST risk subgroup after receiving physical therapy care, and that the predictive ability of the SBST in patients with chronic low back pain increases when administered at different time points. Level of Evidence Prognosis, 2b. J Orthop Sports Phys Ther 2017;47(5):314-323. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7199.

The association between body mass index, weight loss and physical function in the year following a hip fracture.

PubMed

Reider, L; Hawkes, W; Hebel, J R; D'Adamo, C; Magaziner, J; Miller, R; Orwig, D; Alley, D E

2013-01-01

To determine whether body mass index (BMI) at the time of hospitalization or weight change in the period immediately following hospitalization predict physical function in the year after hip fracture. Prospective observational study. Two hospitals in Baltimore, Maryland. Female hip fracture patients age 65 years or older (N=136 for BMI analysis, N=41 for analysis of weight change). Body mass index was calculated based on weight and height from the medical chart. Weight change was based on DXA scans at 3 and 10 days post fracture. Physical function was assessed at 2, 6 and 12 months following fracture using the lower extremity gain scale (LEGS), walking speed and grip strength. LEGS score and walking speed did not differ across BMI tertiles. However, grip strength differed significantly across BMI tertiles (p=0.029), with underweight women having lower grip strength than normal weight women at all time points. Women experiencing the most weight loss (>4.8%) had significantly lower LEGS scores at all time points, slower walking speed at 6 months, and weaker grip strength at 12 months post-fracture relative to women with more modest weight loss. In adjusted models, overall differences in function and functional change across all time points were not significant. However, at 12 months post fracture,women with the most weight loss had an average grip strength 7.0 kg lower than women with modest weight loss (p=0.030). Adjustment for confounders accounts for much of the relationships between BMI and function and weight change and function in the year after fracture. However, weight loss is associated with weakness during hip fracture recovery. Weight loss during and immediately after hospitalization appears to identify women at risk of poor function and may represent an important target for future interventions.

Accuracy of Two Motor Assessments during the First Year of Life in Preterm Infants for Predicting Motor Outcome at Preschool Age.

PubMed

Spittle, Alicia J; Lee, Katherine J; Spencer-Smith, Megan; Lorefice, Lucy E; Anderson, Peter J; Doyle, Lex W

2015-01-01

The primary aim of this study was to investigate the accuracy of the Alberta Infant Motor Scale (AIMS) and Neuro-Sensory Motor Developmental Assessment (NSMDA) over the first year of life for predicting motor impairment at 4 years in preterm children. The secondary aims were to assess the predictive value of serial assessments over the first year and when using a combination of these two assessment tools in follow-up. Children born <30 weeks' gestation were prospectively recruited and assessed at 4, 8 and 12 months' corrected age using the AIMS and NSMDA. At 4 years' corrected age children were assessed for cerebral palsy (CP) and motor impairment using the Movement Assessment Battery for Children 2nd-edition (MABC-2). We calculated accuracy of the AIMS and NSMDA for predicting CP and MABC-2 scores ≤15th (at-risk of motor difficulty) and ≤5th centile (significant motor difficulty) for each test (AIMS and NSMDA) at 4, 8 and 12 months, for delay on one, two or all three of the time points over the first year, and finally for delay on both tests at each time point. Accuracy for predicting motor impairment was good for each test at each age, although false positives were common. Motor impairment on the MABC-2 (scores ≤5th and ≤15th) was most accurately predicted by the AIMS at 4 months, whereas CP was most accurately predicted by the NSMDA at 12 months. In regards to serial assessments, the likelihood ratio for motor impairment increased with the number of delayed assessments. When combining both the NSMDA and AIMS the best accuracy was achieved at 4 months, although results were similar at 8 and 12 months. Motor development during the first year of life in preterm infants assessed with the AIMS and NSMDA is predictive of later motor impairment at preschool age. However, false positives are common and therefore it is beneficial to follow-up children at high risk of motor impairment at more than one time point, or to use a combination of assessment tools. ACTR.org.au ACTRN12606000252516.

[Clinical study on patellar replacement in total knee arthroplasty].

PubMed

Bao, Liang; Gao, Zhihui; Shi, Xiaoqiang; Fang, Xiaomin; Jin, Qunhua

2013-01-01

To evaluate the influence of patellar replacement on total knee arthroplasty by comparing with non patellar replacement. Between September 2010 and November 2010, 63 patients (63 knees) with osteoarthritis who met the selection criteria and underwent total knee arthroplasty, were randomly divided into 2 groups: patellar replacement in 32 cases (replacement group), non patellar replacement in 31 cases (non patellar replacement group). There was no significant difference in gender, age, disease duration, osteoarthritis grading, the clinical and functional scores of American Knee Society Score (KSS), the patellar tilt angle, tibiofemoral angle, and patellar ligament ratio between 2 groups (P > 0.05), they were comparable. After 6 weeks, 3, 6, and 12 months of operation, clinical and imaging evaluation methods were used to assessment the effectiveness. Primary healing of incision was obtained in all patients of 2 groups. Deep venous thrombosis occurred in 6 cases of replacement group and in 8 cases of non patellar replacement group. All patients were followed up 12 months. The postoperative incidence of anterior knee pain in replacement group was significantly lower than that in non patellar replacement group (P < 0.05) at 3, 6, and 12 months after operation. No significant difference was found in the postoperative KSS clinical score between 2 groups at each time point (P > 0.05). The joint function score of the replacement group was significantly higher than that of the non patellar replacement group at the other time point (P < 0.05) except the score at 6 weeks and 3 months. Significant difference was found in the patella score between 2 groups at 12 months (P < 0.05), but no significant difference at the other time points (P > 0.05). X-ray film showed no patellar fracture and dislocation, or loosening and breakage of internal fixation. At 12 months after operation, the tibiofemoral angle, the patellar ligament ratio, and the patellar tilt angle showed no significant difference between 2 groups (P > 0.05). Patella replacement can improve knee function score and the patella score, and reduce the incidence of postoperative anterior knee pain.

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial.

PubMed

Sackley, Catherine M; Walker, Marion F; Burton, Christopher R; Watkins, Caroline L; Mant, Jonathan; Roalfe, Andrea K; Wheatley, Keith; Sheehan, Bart; Sharp, Leslie; Stant, Katie E; Fletcher-Smith, Joanna; Steel, Kerry; Wilde, Kate; Irvine, Lisa; Peryer, Guy

2015-02-05

To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Pragmatic, parallel group, cluster randomised controlled trial. 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval -0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies.Trial registration Current Controlled Trials ISRCTN00757750. © Sackley et al 2015.

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

PubMed Central

Sackley, Catherine M; Walker, Marion F; Burton, Christopher R; Watkins, Caroline L; Mant, Jonathan; Roalfe, Andrea K; Wheatley, Keith; Sheehan, Bart; Sharp, Leslie; Stant, Katie E; Fletcher-Smith, Joanna; Steel, Kerry; Wilde, Kate; Irvine, Lisa

2015-01-01

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies. Trial registration Current Controlled Trials ISRCTN00757750. PMID:25657106

Health-related quality of life, cognitive screening, and functional status in a randomized phase III trial (EF-14) of tumor treating fields with temozolomide compared to temozolomide alone in newly diagnosed glioblastoma.

PubMed

Zhu, Jay-Jiguang; Demireva, Petya; Kanner, Andrew A; Pannullo, Susan; Mehdorn, Maximilian; Avgeropoulos, Nicholas; Salmaggi, Andrea; Silvani, Antonio; Goldlust, Samuel; David, Carlos; Benouaich-Amiel, Alexandra

2017-12-01

We characterized health-related quality of life (HRQoL), cognitive, and functional status in newly diagnosed glioblastoma (GBM) patients receiving Tumor treating fields (TTFields) with temozolomide (TMZ) versus TMZ alone in a planned interim analysis of a randomized phase III trial [NCT00916409], which showed significant improvement in progression-free and overall survival with TTFields/TMZ. After radiotherapy with concomitant TMZ, newly diagnosed GBM patients were randomized (2:1) to TTFields/TMZ (n = 210) or TMZ (n = 105). Interim analysis was performed in 315 patients with ≥18 months of follow-up. HRQoL, a secondary endpoint, was evaluated in per-protocol patient population and expressed as change from baseline (CFB) at 3, 6, and 9 months for each subscale in the EORTC QLQ-C30/BN20. Karnofsky performance scores (KPS) and Mini-Mental State Examination scores (MMSE) were assessed. CFB in HRQoL was balanced in treatment groups at the 12-month time point. Initially, HRQoL improved in patients treated with TTFields/TMZ (CFB3: 24% and CFB6: 13%) versus TMZ (CFB3: -7% and CFB6: -17%), though this difference was no longer evident at the 9-month point. General scales, including physical and social functioning, showed no difference at 9 and 12 months. TTFields/TMZ group reported higher concerns of "itchy skin". KPS over 12 months was just below 90 in both groups. Cognitive status (MMSE) was stable over time. HRQoL, KPS, and MMSE were balanced in both groups over time. There was no preliminary evidence that HRQoL, cognitive, and functional status is adversely affected by the continuous use of TTFields.

Phase II trial of bevacizumab and erlotinib as a second-line therapy for advanced hepatocellular carcinoma.

PubMed

Kaseb, Ahmed O; Morris, Jeffrey S; Iwasaki, Michiko; Al-Shamsi, Humaid O; Raghav, Kanwal Pratap Singh; Girard, Lauren; Cheung, Sheree; Nguyen, Van; Elsayes, Khaled M; Xiao, Lianchun; Abdel-Wahab, Reham; Shalaby, Ahmed S; Hassan, Manal; Hassabo, Hesham M; Wolff, Robert A; Yao, James C

2016-01-01

Clinicaltrials.gov #NCT01180959. Early clinical studies of bevacizumab and erlotinib in advanced hepatocellular carcinoma (HCC) have a tolerable toxicity and a promising clinical outcome. We evaluated the efficacy and tolerability of this combination as a second-line therapy for HCC refractory to sorafenib. For this single-arm, Phase II study, we recruited patients with Child-Pugh class A or B liver disease, Eastern Cooperative Oncology Group performance status 0-2, and advanced HCC that was not amenable to surgical or regional therapies and treatment with sorafenib had failed (disease progressed or patient could not tolerate sorafenib). Patients received 10 mg/kg intravenous bevacizumab every 14 days and 150 mg oral erlotinib daily for 28-day cycles until progression. Tumor response was evaluated every two cycles using Response Evaluation Criteria in Solid Tumors. The primary end point was the 16-week progression-free survival rate. Secondary end points included time to progression and overall survival. A total of 44 patients were enrolled and had a median follow-up time of 33.8 months (95% confidence interval [CI]: 23.5 months - not defined). The 16-week progression-free survival rate was 43% (95% CI: 28%-59%), median time to progression was 3.9 months (95% CI: 2.0-8.3 months), and median overall survival duration was 9.9 months (95% CI: 8.3-15.5 months). Grade 3-4 adverse events included fatigue (13%), acne (11%), diarrhea (9%), anemia (7%), and upper gastrointestinal hemorrhage (7%). Bevacizumab plus erlotinib was tolerable and showed a signal of survival benefit in the second-line setting for patients with advanced HCC. Because standard-of-care options are lacking in this setting, further studies to identify predictors of response to this regimen are warranted.

Resource Use and Cost of Alzheimer's Disease in France: 18-Month Results from the GERAS Observational Study.

PubMed

Rapp, Thomas; Andrieu, Sandrine; Chartier, Florence; Deberdt, Walter; Reed, Catherine; Belger, Mark; Vellas, Bruno

2018-03-01

There is little longitudinal data on resource use and costs associated with Alzheimer's disease (AD) in France. To evaluate resource use and societal costs associated with AD in a French cohort of patients and their caregivers and the effect of patient cognitive decline on costs over an 18-month period. Community-dwelling patients with mild, moderate, or moderately severe/severe AD dementia (n = 419) were followed-up for 18 months. Total societal costs were estimated by applying 2010 unit costs to resource use, including outpatient visits, hospital days, institutionalization, and caregiver hours. Cognitive function was assessed by Mini-Mental State Examination scores. Mean cumulative total costs over the 18-month period were €24,140 for patients with mild AD dementia, €34,287 for those with moderate AD dementia, and €44,171 for those with moderately severe/severe AD dementia (P < 0.001; ANOVA comparison between severity groups). The biggest contributor to total societal costs was caregiver informal care (>50% of total costs at all stages of AD dementia). Cognitive decline (≥3-point decrease in Mini-Mental State Examination score or institutionalization) was associated with a 12.5% increase in total costs (P = 0.02). Significant differences were observed across severity groups for caregiver time (P < 0.001); mean monthly caregiver time increased at each time point over the 18 months in each severity group. Increasing severity of AD dementia in France is associated with increased use of resources as well as increased total societal and patient costs; informal care was the greatest cost contributor. Clinically meaningful cognitive decline is associated with significantly increased costs. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Community point distribution of insecticide-treated bed nets and community health worker hang-up visits in rural Zambia: a decision-focused evaluation.

PubMed

Wang, Paul; Connor, Alison L; Joudeh, Ammar S; Steinberg, Jeffrey; Ndhlovu, Ketty; Siyolwe, Musanda; Ntebeka, Bristol; Chibuye, Benjamin; Hamainza, Busiku

2016-03-03

In 2013, the Zambian Ministry of Health through its National Malaria Control Programme distributed over two million insecticide-treated bed nets (ITNs) in four provinces using a door-to-door distribution strategy, and more than 6 million ITNs were allocated to be distributed in 2014. This study was commissioned to measure attendance rates at a community point distribution and to examine the impact of follow-up community health worker (CHW) hang-up visits on short and medium-term ITN retention and usage with a view of informing optimal ITN distribution strategy in Zambia. Households received ITNs at community point distributions conducted in three rural communities in Rufunsa District, Zambia. Households were then randomly allocated into five groups to receive CHW visits to hang any unhung ITNs at different intervals: 1-3, 5-7, 10-12, 15-17 days, and no hang-up visit. Follow-up surveys were conducted among all households at 7-11 weeks after distribution and at 5-6 months after distribution to measure short- and medium-term household retention and usage of ITNs. Of the 560 pre-registered households, 540 (96.4 %) attended the community point distribution. Self-installation of ITNs by households increased over the first 10 days after the community point distribution. Retention levels remained high over time with 90.2 % of distributed ITNs still in the household at 7-11 weeks and 85.7 % at 5-6 months. Retention did not differ between households that received a CHW visit and those that did not. At 7-11 weeks, households had an average of 73.8 % of sleeping spaces covered compared to 80.3 % at 5-6 months. On average, 65.6 % of distributed ITNs were hanging at 7-11 weeks compared to 63.1 % at 5-6 months. While a CHW hang-up visit was associated with increased usage at 7-11 weeks, this difference was no longer apparent at 5-6 months. This evaluation revealed that (1) the community point distributions achieved high attendance rates followed by acceptable rates of short-term and medium-term ITN retention and usage, as compared to reported rates achieved by door-to-door distributions in the recent past, (2) CHW hang-up visits had a modest short-term impact on ITN usage but no medium-term effect, and (3) community point distributions can yield sizeable time savings compared to door-to-door distributions.

A Scenario-Based Virtual Patient Program to Support Substance Misuse Education.

PubMed

Zlotos, Leon; Power, Ailsa; Hill, Duncan; Chapman, Paul

2016-04-25

Objective. To evaluate virtual patient (VP) programs for injecting equipment provision (IEP) and opiate substitution therapy (OST) services with respect to confidence and knowledge among preregistration pharmacist trainees. Methods. Preregistration trainee pharmacists pilot-tested the VP programs and were invited to complete pre/post and 6-month assessments of knowledge and perceived confidence. Results. One hundred six trainees participated and completed the pre/postassessments. Forty-six (43.4%) participants repeated the assessments at six months. Scores in perceived confidence increased in all domains at both time points postprogram. Knowledge scores were greater posteducation than preeducation. Knowledge scores were also greater six months after education than preeducation. Knowledge scores at six months were lower than posteducation for both programs. Conclusion. Virtual patients programs increased preregistration pharmacists' knowledge and confidence with regard to IEP and OST immediately after use and at six months postprogram. There was a loss of clinical knowledge over time but confidence change was sustained.

Permissive Attitude Towards Drug Use, Life Satisfaction, and Continuous Drug Use Among Psychoactive Drug Users in Hong Kong.

PubMed

Cheung, N Wt; Cheung, Y W; Chen, X

2016-06-01

To examine the effects of a permissive attitude towards regular and occasional drug use, life satisfaction, self-esteem, depression, and other psychosocial variables in the drug use of psychoactive drug users. Psychosocial factors that might affect a permissive attitude towards regular / occasional drug use and life satisfaction were further explored. We analysed data of a sample of psychoactive drug users from a longitudinal survey of psychoactive drug abusers in Hong Kong who were interviewed at 6 time points at 6-month intervals between January 2009 and December 2011. Data of the second to the sixth time points were stacked into an individual time point structure. Random-effects probit regression analysis was performed to estimate the relative contribution of the independent variables to the binary dependent variable of drug use in the last 30 days. A permissive attitude towards drug use, life satisfaction, and depression at the concurrent time point, and self-esteem at the previous time point had direct effects on drug use in the last 30 days. Interestingly, permissiveness to occasional drug use was a stronger predictor of drug use than permissiveness to regular drug use. These 2 permissive attitude variables were affected by the belief that doing extreme things shows the vitality of young people (at concurrent time point), life satisfaction (at concurrent time point), and self-esteem (at concurrent and previous time points). Life satisfaction was affected by sense of uncertainty about the future (at concurrent time point), self-esteem (at concurrent time point), depression (at both concurrent and previous time points), and being stricken by stressful events (at previous time point). A number of psychosocial factors could affect the continuation or discontinuation of drug use, as well as the permissive attitude towards regular and occasional drug use, and life satisfaction. Implications of the findings for prevention and intervention work targeted at psychoactive drug users are discussed.

[Counselling versus cognitive group therapy for tinnitus. A retrospective study of their efficacy].

PubMed

Schmidt, A; Lins, U; Wetscher, I; Welzl-Müller, K; Weichbold, V

2004-03-01

Both counselling and group therapy have been recommended for supporting patients with chronic tinnitus. It is unclear which of these treatments is superior. This retrospective study aimed at comparing relief from tinnitus distress following counselling with that following cognitive group therapy. Distress relief was also compared to the distress level of the waiting group patients. Tinnitus distress was assessed through the Tinnitus Questionnaire (TQ, Goebel and Hiller) at three different times: before treatment (in waiting list patients: at initial contact) and at 3 and 6 months after initial assessment. Data from 21 patients per group were included in the analysis. The initial tinnitus distress scores were similar in all groups (about 48 TQ points out of a maximum of 84). After 3 months, both counselling subjects and group therapy participants exhibited a significant distress reduction of 13 TQ points, which remained stable after 6 months. Patients on the waiting list experienced no distress relief over time. Results from our data demonstrate the need for a future prospective study on the comparison of efficacy of counselling vs cognitive group therapy.

Procedural discourse performance in adults with severe traumatic brain injury at 3 and 6 months post injury.

PubMed

Stubbs, Elin; Togher, Leanne; Kenny, Belinda; Fromm, Davida; Forbes, Margaret; MacWhinney, Brian; McDonald, Skye; Tate, Robyn; Turkstra, Lyn; Power, Emma

2018-01-01

There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults. In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed. No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery. Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase.

Methods of a large prospective, randomised, open-label, blinded end-point study comparing morning versus evening dosing in hypertensive patients: the Treatment In Morning versus Evening (TIME) study.

PubMed

Rorie, David A; Rogers, Amy; Mackenzie, Isla S; Ford, Ian; Webb, David J; Willams, Bryan; Brown, Morris; Poulter, Neil; Findlay, Evelyn; Saywood, Wendy; MacDonald, Thomas M

2016-02-09

Nocturnal blood pressure (BP) appears to be a better predictor of cardiovascular outcome than daytime BP. The BP lowering effects of most antihypertensive therapies are often greater in the first 12 h compared to the next 12 h. The Treatment In Morning versus Evening (TIME) study aims to establish whether evening dosing is more cardioprotective than morning dosing. The TIME study uses the prospective, randomised, open-label, blinded end-point (PROBE) design. TIME recruits participants by advertising in the community, from primary and secondary care, and from databases of consented patients in the UK. Participants must be aged over 18 years, prescribed at least one antihypertensive drug taken once a day, and have a valid email address. After the participants have self-enrolled and consented on the secure TIME website (http://www.timestudy.co.uk) they are randomised to take their antihypertensive medication in the morning or the evening. Participant follow-ups are conducted after 1 month and then every 3 months by automated email. The trial is expected to run for 5 years, randomising 10,269 participants, with average participant follow-up being 4 years. The primary end point is hospitalisation for the composite end point of non-fatal myocardial infarction (MI), non-fatal stroke (cerebrovascular accident; CVA) or any vascular death determined by record-linkage. Secondary end points are: each component of the primary end point, hospitalisation for non-fatal stroke, hospitalisation for non-fatal MI, cardiovascular death, all-cause mortality, hospitalisation or death from congestive heart failure. The primary outcome will be a comparison of time to first event comparing morning versus evening dosing using an intention-to-treat analysis. The sample size is calculated for a two-sided test to detect 20% superiority at 80% power. TIME has ethical approval in the UK, and results will be published in a peer-reviewed journal. UKCRN17071; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Validation of accelerometer cut points in toddlers with and without cerebral palsy.

PubMed

Oftedal, Stina; Bell, Kristie L; Davies, Peter S W; Ware, Robert S; Boyd, Roslyn N

2014-09-01

The purpose of this study was to validate uni- and triaxial ActiGraph cut points for sedentary time in toddlers with cerebral palsy (CP) and typically developing children (TDC). Children (n = 103, 61 boys, mean age = 2 yr, SD = 6 months, range = 1 yr 6 months-3 yr) were divided into calibration (n = 65) and validation (n = 38) samples with separate analyses for TDC (n = 28) and ambulant (Gross Motor Function Classification System I-III, n = 51) and nonambulant (Gross Motor Function Classification System IV-V, n = 25) children with CP. An ActiGraph was worn during a videotaped assessment. Behavior was coded as sedentary or nonsedentary. Receiver operating characteristic-area under the curve analysis determined the classification accuracy of accelerometer data. Predictive validity was determined using the Bland-Altman analysis. Classification accuracy for uniaxial data was fair for the ambulatory CP and TDC group but poor for the nonambulatory CP group. Triaxial data showed good classification accuracy for all groups. The uniaxial ambulatory CP and TDC cut points significantly overestimated sedentary time (bias = -10.5%, 95% limits of agreement [LoA] = -30.2% to 9.1%; bias = -17.3%, 95% LoA = -44.3% to 8.3%). The triaxial ambulatory and nonambulatory CP and TDC cut points provided accurate group-level measures of sedentary time (bias = -1.5%, 95% LoA = -20% to 16.8%; bias = 2.1%, 95% LoA = -17.3% to 21.5%; bias = -5.1%, 95% LoA = -27.5% to 16.1%). Triaxial accelerometers provide useful group-level measures of sedentary time in children with CP across the spectrum of functional abilities and TDC. Uniaxial cut points are not recommended.

Statistical properties of solar Hα flare activity

NASA Astrophysics Data System (ADS)

Deng, Linhua; Zhang, Xiaojuan; An, Jianmei; Cai, Yunfang

2017-12-01

Magnetic field structures on the solar atmosphere are not symmetric distribution in the northern and southern hemispheres, which is an important aspect of quasi-cyclical evolution of magnetic activity indicators that are related to solar dynamo theories. Three standard analysis techniques are applied to analyze the hemispheric coupling (north-south asymmetry and phase asynchrony) of monthly averaged values of solar Hα flare activity over the past 49 years (from 1966 January to 2014 December). The prominent results are as follows: (1) from a global point of view, solar Hα flare activity on both hemispheres are strongly correlated with each other, but the northern hemisphere precedes the southern one with a phase shift of 7 months; (2) the long-range persistence indeed exists in solar Hα flare activity, but the dynamical complexities in the two hemispheres are not identical; (3) the prominent periodicities of Hα flare activity are 17 years full-disk activity cycle and 11 years Schwabe solar cycle, but the short- and mid-term periodicities cannot determined by monthly time series; (4) by comparing the non-parametric rescaling behavior on a point-by-point basis, the hemispheric asynchrony of solar Hα flare activity are estimated to be ranging from several months to tens of months with an average value of 8.7 months. The analysis results could promote our knowledge on the long-range persistence, the quasi-periodic variation, and the hemispheric asynchrony of solar Hα flare activity on both hemispheres, and possibly provide valuable information for the hemispheric interrelation of solar magnetic activity.

A Randomized Trial Comparing Part-time Patching with Observation for Intermittent Exotropia in Children 12 to 35 Months of Age.

PubMed

Mohney, Brian G; Cotter, Susan A; Chandler, Danielle L; Holmes, Jonathan M; Chen, Angela M; Melia, Michele; Donahue, Sean P; Wallace, David K; Kraker, Raymond T; Christian, Melanie L; Suh, Donny W

2015-08-01

To determine the effectiveness of part-time patching for treating intermittent exotropia (IXT) in young children. Multicenter, randomized clinical trial. Two hundred one children 12 to 35 months of age with untreated IXT meeting the following criteria: (1) IXT at distance OR constant exotropia at distance and either IXT or exophoria at near, and (2) 15-prism diopter (Δ) or more exodeviation at distance or near by prism and alternate cover test (PACT) but at least 10 Δ exodeviation at distance by PACT. Participants were assigned randomly to either observation (no treatment for 6 months) or patching prescribed for 3 hours daily for 5 months, followed by 1 month of no patching. The primary outcome was deterioration, defined as constant exotropia measuring at least 10 Δ at distance and near or receipt of nonprotocol treatment for IXT. Of the 177 participants (88%) completing the 6-month primary outcome examination, deterioration occurred in 4.6% (4 of 87) of the participants in the observation group and in 2.2% (2 of 90) of the participants in the patching group (difference, 2.4%; P = 0.27; 95% confidence interval, -3.8% to +9.4%). Motor deterioration occurred in 2.3% (2 of 87) of the observation group and in 2.2% (2 of 90) of the patching group (difference, 0.08%; P = 0.55; 95% confidence interval, -5.8% to +6.1%). For the observation and patching groups, respectively, 6-month mean PACT measurements were 27.9 Δ versus 24.9 Δ at distance (P = 0.02) and 19.3 Δ versus 17.0 Δ at near (P = 0.10); 6-month mean exotropia control scores were 2.8 versus 2.3 points at distance (P = 0.02) and 1.4 versus 1.1 points at near (P = 0.26). Among children 12 to 35 months of age with previously untreated IXT, deterioration over 6 months was uncommon, with or without patching treatment. There was insufficient evidence to recommend part-time patching for the treatment of IXT in children in this age group. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemotheraphy, Neurotoxicity, and Cognitive Decline: Developing a Mouse Model and Potential Interventions

DTIC Science & Technology

2011-09-01

dUTP nick-end labeling (TUNEL) as a function of pre & co-treatment with 1) N-acetyl cysteine (NAC) 2) Melatonin & 3) Fluoxetine . Saline Group...4 time points for a total of 20 C57BL/6J mice) 5-FU + Melatonin Group: (n=5 x 4 time points for a total of 20 C57BL/6J mice) 5-FU + Fluoxetine ...56 days, and 6 months after 5-FU treatment using Ki-67 as a function of pre & co-treatment with 1) NAC 2) Melatonin & 3) Fluoxetine . 1c

The Relationship Between Function and Disease Activity as Measured by the HAQ and DAS28 Varies Over Time and by Rheumatoid Factor Status in Early Inflammatory Arthritis (EIA). Results from the CATCH Cohort.

PubMed

Boyd, Tristan A; Bonner, A; Thorne, C; Boire, G; Hitchon, C; Haraoui, B P; Keystone, E C; Bykerk, V P; Pope, J E

2013-01-01

To investigate the relationship between function and disease activity in early inflammatory arthritis (EIA). Canadian Early Arthritis Cohort (CATCH) (n=1143) is a multi-site EIA cohort. Correlations between the Health Assessment Questionnaire Disability Index (HAQ) and DAS28 were done at every 3 months for the first year and then at 18 and 24 months. We also investigated the relationship between HAQ and DAS28 by age (<65 versus ≥65) and RF (positive vs negative). Mean HAQ and DAS28 scores were highest at the initial visit with HAQ decreasing over 24 months from a baseline of 0.94 to 0.40 and DAS28 scores decreasing from 4.54 to 2.29. All correlations between HAQ and DAS28 were significant at all time points (p<0.01). The correlations between HAQ and DAS28 were variable over time. The strongest correlation between HAQ and DAS28 occurred at initial visit (most DMARD naive) (n=1,143) and 18 months (r=0.57, n=321) and 24 months (r=0.59, n=214). The baseline correlation between HAQ and DAS28 was significantly different than correlations obtained at 3, 6, and 12 months (p=0.02, 0.01, and 0.01, respectively). Age did not change the association between HAQ and DAS28 {<65 years old (r=0.50, n=868) versus ≥65 (r=0.48, n=254), p=0.49}. The correlation between HAQ and DAS28 was stronger with RF+ patients (r=0.63, n=636) vs RF negative (r=0.47, n=477), p=0.0043. Over 2 years in EIA, HAQ and DAS both improved; correlations at time points were different over 2 years and RF status affected the correlations.

Effect of Energy Drinks on Discoloration of Silorane and Dimethacrylate-Based Composite Resins

PubMed Central

Ahmadizenouz, Ghazaleh; Esmaeili, Behnaz; Ahangari, Zohreh; Khafri, Soraya; Rahmani, Aghil

2016-01-01

Objectives: This study aimed to assess the effects of two energy drinks on color change (ΔE) of two methacrylate-based and a silorane-based composite resin after one week and one month. Materials and Methods: Thirty cubic samples were fabricated from Filtek P90, Filtek Z250 and Filtek Z350XT composite resins. All the specimens were stored in distilled water at 37°C for 24 hours. Baseline color values (L*a*b*) of each specimen were measured using a spectrophotometer according to the CIEL*a*b* color system. Ten randomly selected specimens from each composite were then immersed in the two energy drinks (Hype, Red Bull) and artificial saliva (control) for one week and one month. Color was re-assessed after each storage period and ΔE values were calculated. The data were analyzed using the Kruskal Wallis and Mann–Whitney U tests. Results: Filtek Z250 composite showed the highest ΔE irrespective of the solutions at both time points. After seven days and one month, the lowest ΔE values were observed in Filtek Z350XT and Filtek P90 composites immersed in artificial saliva, respectively. The ΔE values of Filtek Z250 and Z350XT composites induced by Red Bull and Hype energy drinks were not significantly different. Discoloration of Filtek P90 was higher in Red Bull energy drink at both time points. Conclusions: Prolonged immersion time in all three solutions increased ΔE values of all composites. However, the ΔE values were within the clinically acceptable range (<3.3) at both time points. PMID:28127318

Predictors of exclusive breastfeeding across three time points in Bangladesh: an examination of the 2007, 2011 and 2014 Demographic and Health Survey.

PubMed

Blackstone, Sarah R; Sanghvi, Tina

2018-05-01

The objective of this study was to explore predictors of exclusive breastfeeding (EBF) in Bangladesh using data from 2007, 2011 and 2014, specifically focusing on potential reasons why rates of EBF changed over those time periods. Data on mother/infant pairs with infants <6 months of age were examined at the three time points using the Bangladesh Demographic and Health Survey. The EBF prevalence, changes in EBF since the previous survey and determinants of EBF at each time period were examined using t-tests, χ2 and multilevel logistic regression. The prevalence of EBF was 42.5, 65 and 59.4% in 2007, 2011 and 2014, respectively. The age of the child was significantly associated with EBF across all time points. The largest changes in EBF occurred in the 3- to 5-month age group. Predictors of EBF in this specific age group were similar to overall predictors (e.g. age of the child and region). Participation of the mother in household decisions was a significant predictor in 2014. EBF prevalence in Bangladesh increased between 2007 and 2011 and then decreased between 2011 and 2014. The increase in 2011 may have been the result of widespread initiatives to promote EBF in that time frame. Due to the unexplained decrease in EBF between 2011 and 2014, there is still a need for interventions such as peer counselling, antenatal education and community awareness to promote EBF.

Heart rate variability associated with posttraumatic stress disorder in victims' families of sewol ferry disaster.

PubMed

Lee, Sang Min; Han, Hyesung; Jang, Kuk-In; Huh, Seung; Huh, Hyu Jung; Joo, Ji-Young; Chae, Jeong-Ho

2018-01-01

Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure. Copyright © 2017. Published by Elsevier B.V.

Pulmonary Vein Doppler Patterns in Infants with Single Right Ventricle Anomalies After Initial Staged Palliations.

PubMed

Kirkpatrick, Edward C; Steltzer, Jessica; Simpson, Pippa; Pan, Amy; Dragulescu, Andrea; Falkensammer, Christine B; Gelehrter, Sarah; Lai, Wyman W; Levine, Jami; Miller, Stephen; Miller, Thomas A; Pruetz, Jay; Sachdeva, Ritu; Thacker, Deepika; Frommelt, Peter

2017-08-01

The aim of this study was to describe serial changes in echocardiographic Doppler pulmonary vein flow (PVF) patterns in infants with single right ventricle (RV) anomalies enrolled in the Single Ventricle Reconstruction trial. Measurement of PVF peak systolic (S) and diastolic (D) velocities, velocity time integrals (VTI), S/D peak velocity and VTI ratios, and frequency of atrial reversal (Ar) waves were made at three postoperative time points in 261 infants: early post-Norwood, pre-stage II surgery, and 14 months. Indices were compared over time, between initial shunt type [modified Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery shunt (RVPAS)] and in relation to clinical outcomes. S velocities and VTI increased over time while D wave was stable, resulting in increasing S/D peak velocity and VTI ratios, with a median post-Norwood S/D VTI ratio of 1.14 versus 1.38 at pre-stage II and 1.89 at 14 months (P < 0.0001 between intervals). MBTS subjects had significantly higher S/D peak velocity and VTI ratios compared to RVPAS at the post-Norwood and pre-stage II time points (P < 0.0001) but not by 14 months. PVF patterns did not correlate with survival or hospitalization course at 1 year. PVF patterns after Norwood palliation differ from normal infants by having a dominant systolic pattern throughout infancy. PVF differences based upon shunt type resolve by 14 months and did not correlate with clinical outcomes. This study describes normative values and variations in PVF for infants with a single RV from shunt-dependent pulmonary blood flow to cavopulmonary blood flow.

Estimating the Time to Benefit for Preventive Drugs with the Statistical Process Control Method: An Example with Alendronate.

PubMed

van de Glind, Esther M M; Willems, Hanna C; Eslami, Saeid; Abu-Hanna, Ameen; Lems, Willem F; Hooft, Lotty; de Rooij, Sophia E; Black, Dennis M; van Munster, Barbara C

2016-05-01

For physicians dealing with patients with a limited life expectancy, knowing the time to benefit (TTB) of preventive medication is essential to support treatment decisions. The aim of this study was to investigate the usefulness of statistical process control (SPC) for determining the TTB in relation to fracture risk with alendronate versus placebo in postmenopausal women. We performed a post hoc analysis of the Fracture Intervention Trial (FIT), a randomized, controlled trial that investigated the effect of alendronate versus placebo on fracture risk in postmenopausal women. We used SPC, a statistical method used for monitoring processes for quality control, to determine if and when the intervention group benefited significantly more than the control group. SPC discriminated between the normal variations over time in the numbers of fractures in both groups and the variations that were attributable to alendronate. The TTB was defined as the time point from which the cumulative difference in the number of clinical fractures remained greater than the upper control limit on the SPC chart. For the total group, the TTB was defined as 11 months. For patients aged ≥70 years, the TTB was 8 months [absolute risk reduction (ARR) = 1.4%]; for patients aged <70 years, it was 19 months (ARR = 0.7%). SPC is a clear and understandable graphical method to determine the TTB. Its main advantage is that there is no need to define a prespecified time point, as is the case in traditional survival analyses. Prescribing alendronate to patients who are aged ≥70 years is useful because the TTB shows that they will benefit after 8 months. Investigators should report the TTB to simplify clinical decision making.

Mothers' Expectations for Shared Reading Following Delivery: Implications For Reading Activities at 6 Months

PubMed Central

Berkule, Samantha B.; Dreyer, Benard P.; Klass, Perri E.; Huberman, Harris S.; Yin, Hsiang S.; Mendelsohn, Alan L.

2008-01-01

Objective To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. Method This was a cohort study with enrollment post-partum and follow-up at 6 months in an urban public hospital. Predictors: mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes: mothers' shared reading activities and resources at 6 months (StimQ-READ). Results 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7 point increase in 6 month score; 95% CI: 0.3 – 3.0), plans to read in infancy (3.1 point increase; 95% CI: 1.6-4.6), and having baby books in the home (2.3 point increase; 95% CI: 0.9 – 3.6). In multiple logistic regression analysis, mothers with two or more attitudes and resources had an AOR of 6.2 (95% CI: 2.0-18.9) for having initiated reading at 6 months. Conclusions Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read. PMID:18501863

Field test of classical symmetric encryption with continuous variables quantum key distribution.

PubMed

Jouguet, Paul; Kunz-Jacques, Sébastien; Debuisschert, Thierry; Fossier, Simon; Diamanti, Eleni; Alléaume, Romain; Tualle-Brouri, Rosa; Grangier, Philippe; Leverrier, Anthony; Pache, Philippe; Painchault, Philippe

2012-06-18

We report on the design and performance of a point-to-point classical symmetric encryption link with fast key renewal provided by a Continuous Variable Quantum Key Distribution (CVQKD) system. Our system was operational and able to encrypt point-to-point communications during more than six months, from the end of July 2010 until the beginning of February 2011. This field test was the first demonstration of the reliability of a CVQKD system over a long period of time in a server room environment. This strengthens the potential of CVQKD for information technology security infrastructure deployments.

Longitudinal Course of Risk for Parental Post-Adoption Depression

PubMed Central

Foli, Karen J.; South, Susan C.; Lim, Eunjung; Hebdon, Megan

2016-01-01

Objective To determine whether the Postpartum Depression Predictors Inventory-Revised (PDPI-R) could be used to reveal distinct classes of adoptive parents across time. Design Longitudinal data were collected via online surveys at 4-6 weeks pre-placement, 4-6 weeks post-placement, and 5-6 months post-placement. Setting Participants were primarily clients of the largest adoption agency in the United States. Participants Participants included 127 adoptive parents (68 mothers and 59 fathers). Methods We applied a latent class growth analysis to the PDPI-R and conducted mixed effects modeling of class, time, and class×time interaction for the following categories of explanatory variables: parental expectations; interpersonal variables; psychological symptoms; and life orientation. Results Four latent trajectory classes were found. Class 1 (55% of sample) showed a stably low level of PDPI-R scores over time. Class 2 (32%) reported mean scores below the cut-off points at all three time points. Class 3 (8%) started at an intermediate level and increased after post-placement, but decreased at 5-6 months post-placement. Class 4 (5%) had high mean scores at all three time points. Significant main effects were found for almost all explanatory variables for class and for several variables for time. Significant interactions between class and time were found for expectations about the child and amount of love and ambivalence in parent's intimate relationship. Conclusion Findings may assist nurses to be alert to trajectories of risk for post-adoption depression. Additional factors, not included in the PDPI-R, to determine risk for post-adoption depression may be needed for adoptive parents. PMID:26874267

Treating Eyres type IV and V coracoid fracture using the acromion osteotomy approach.

PubMed

Wu, Jin; Fu, Xi-jin; Sha, Mo; Liu, Hui; Chen, Zhi-da; Kang, Liang-qi

2016-02-01

To introduce a surgical method of treating Eyres type IV and V coracoid fracture using the acromion osteotomy approach and to further analyse the clinical effectiveness of this surgical procedure. Nine patients were included in this study with a mean follow-up time of 23.3 months (range, 14.0-34.0 months). Patients were evaluated with use of the Constant score, the Simple Shoulder Test (SST) score and a visual analogue scale (VAS) pain score. Moreover, the shoulder range of motion was also observed. The mean operation time was 91.6 min with a blood loss volume ranging from 310 to 530 ml. The fractures of eight patients had recovered between 10 and 12 weeks post operation with no signs of infection, screw loosening, plate breaking or other internal fixation failures, while one case had non-union at 34 months' follow-up. The mean Constant score increased from 75.6 points preoperatively to 91.0 points at follow-up. The mean VAS score decreased from 5.3 preoperatively to 1.0 at follow-up, while the average SST score increased from 7.1 points preoperatively to 10.0 points at follow-up. The mean abduction, forward flexion, external rotation, internal rotation and backward extension angles were 162°, 159° 50°, 55° and 47°. Five cases were classified as excellent, three cases were marked as good and one case was classified as fair. Treating coracoid fracture through the approach of acromion osteotomy could be an effective treatment option with minimise damages.

Stability of BDNF in Human Samples Stored Up to 6 Months and Correlations of Serum and EDTA-Plasma Concentrations.

PubMed

Polyakova, Maryna; Schlögl, Haiko; Sacher, Julia; Schmidt-Kassow, Maren; Kaiser, Jochen; Stumvoll, Michael; Kratzsch, Jürgen; Schroeter, Matthias L

2017-06-03

Brain-derived neurotrophic factor (BDNF), an important neural growth factor, has gained growing interest in neuroscience, but many influencing physiological and analytical aspects still remain unclear. In this study we assessed the impact of storage time at room temperature, repeated freeze/thaw cycles, and storage at -80 °C up to 6 months on serum and ethylenediaminetetraacetic acid (EDTA)-plasma BDNF. Furthermore, we assessed correlations of serum and plasma BDNF concentrations in two independent sets of samples. Coefficients of variations (CVs) for serum BDNF concentrations were significantly lower than CVs of plasma concentrations ( n = 245, p = 0.006). Mean serum and plasma concentrations at all analyzed time points remained within the acceptable change limit of the inter-assay precision as declared by the manufacturer. Serum and plasma BDNF concentrations correlated positively in both sets of samples and at all analyzed time points of the stability assessment ( r = 0.455 to r s = 0.596; p < 0.004). In summary, when considering the acceptable change limit, BDNF was stable in serum and in EDTA-plasma up to 6 months. Due to a higher reliability, we suggest favoring serum over EDTA-plasma for future experiments assessing peripheral BDNF concentrations.

Atrial septal pacing in small dogs: a pilot study.

PubMed

Jones, Ashley E; Estrada, Amara H; Pariaut, Romain; Sosa-Samper, Ivan; Shih, Andre C; Mincey, Brandy D; Moïse, N Sydney

2014-09-01

To determine the feasibility of atrial septal pacing via a delivery catheter-guided small non-retracting helix pacing lead. Six healthy beagles (8.3-12.9 kg). Using single plane fluoroscopic guidance, Medtronic(®) 3830 SelectSecure leads were connected to the atrial septum via Medtronic® Attain Select® II standard 90 Left Heart delivery catheter. Pacing threshold and lead impedance were measured at implantation. The Wenckebach point was tested via atrial pacing up to 220 paced pulses per minute (ppm). Thoracic radiographs were performed following implantation to identify the lead position, and repeated at 24 h, 1 month, and 3 months post-operatively. Macro-lead dislodgement occurred in two dogs at 24 h and in three dogs at one-month post-implantation. Lead impedance, measured at the time of implantation, ranged from 583 to 1421 Ω. The Wenckebach point was >220 ppm in four of the six dogs. The remaining two dogs had Wenckebach points of 120 and 190 ppm. This pilot study suggests the selected implantation technique and lead system were inadequate for secure placement in the atrial septum of these dogs. The possible reasons for inadequate stability include unsuitable lead design for this location, inadequate lead slack at the time of implantation and inadequate seating of the lead as evidenced by low impedance at the time of implantation. Other implantation techniques and/or pacing leads should be investigated to determine the optimal way of pacing the atria in small breed dogs that are prone to sinus node dysfunction. Copyright © 2014 Elsevier B.V. All rights reserved.

Overall Survival After Whole-Brain Radiation Therapy for Intracerebral Metastases from Testicular Cancer.

PubMed

Rades, Dirk; Dziggel, Liesa; Veninga, Theo; Bajrovic, Amira; Schild, Steven E

2016-09-01

To identify predictors and develop a score for overall survival of patients with intracerebral metastasis from testicular cancer. Whole-brain radiation therapy program, age, Karnofsky performance score (KPS), number of intracerebral metastases, number of other metastatic sites and time between testicular cancer diagnosis and radiation therapy were analyzed for their association with overall survival in eight patients. KPS of 80-90% was significantly associated with better overall survival (p=0.006), one or no other metastatic sites showed a trend for a better outcome (p=0.10). The following scores were assigned: KPS 60-70%=0 points, KPS 80-90%=1 point, ≥2 other metastatic sites=0 points, 0-1 other metastatic sites=1 point. Two groups, with 0 and with 1-2 points, were formed. Overall survival rates were 33% vs. 100% at 6 months and 0% vs. 100% at 12 months (p=0.006), respectively. A simple instrument enabling physicians to judge the overall survival of patients with intracerebral metastasis from testicular cancer is provided. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Comprehensive analysis and selection of anthrax vaccine adsorbed immune correlates of protection in rhesus macaques.

PubMed

Chen, Ligong; Schiffer, Jarad M; Dalton, Shannon; Sabourin, Carol L; Niemuth, Nancy A; Plikaytis, Brian D; Quinn, Conrad P

2014-11-01

Humoral and cell-mediated immune correlates of protection (COP) for inhalation anthrax in a rhesus macaque (Macaca mulatta) model were determined. The immunological and survival data were from 114 vaccinated and 23 control animals exposed to Bacillus anthracis spores at 12, 30, or 52 months after the first vaccination. The vaccinated animals received a 3-dose intramuscular priming series (3-i.m.) of anthrax vaccine adsorbed (AVA) (BioThrax) at 0, 1, and 6 months. The immune responses were modulated by administering a range of vaccine dilutions. Together with the vaccine dilution dose and interval between the first vaccination and challenge, each of 80 immune response variables to anthrax toxin protective antigen (PA) at every available study time point was analyzed as a potential COP by logistic regression penalized by least absolute shrinkage and selection operator (LASSO) or elastic net. The anti-PA IgG level at the last available time point before challenge (last) and lymphocyte stimulation index (SI) at months 2 and 6 were identified consistently as a COP. Anti-PA IgG levels and lethal toxin neutralization activity (TNA) at months 6 and 7 (peak) and the frequency of gamma interferon (IFN-γ)-secreting cells at month 6 also had statistically significant positive correlations with survival. The ratio of interleukin 4 (IL-4) mRNA to IFN-γ mRNA at month 6 also had a statistically significant negative correlation with survival. TNA had lower accuracy as a COP than did anti-PA IgG response. Following the 3-i.m. priming with AVA, the anti-PA IgG responses at the time of exposure or at month 7 were practicable and accurate metrics for correlating vaccine-induced immunity with protection against inhalation anthrax. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

A possible simplification for the estimation of area under the curve (AUC₀₋₁₂) of enteric-coated mycophenolate sodium in renal transplant patients receiving tacrolimus.

PubMed

Fleming, Denise H; Mathew, Binu S; Prasanna, Samuel; Annapandian, Vellaichamy M; John, George T

2011-04-01

Enteric-coated mycophenolate sodium (EC-MPS) is widely used in renal transplantation. With a delayed absorption profile, it has not been possible to develop limited sampling strategies to estimate area under the curve (mycophenolic acid [MPA] AUC₀₋₁₂), which have limited time points and are completed in 2 hours. We developed and validated simplified strategies to estimate MPA AUC₀₋₁₂ in an Indian renal transplant population prescribed EC-MPS together with prednisolone and tacrolimus. Intensive pharmacokinetic sampling (17 samples each) was performed in 18 patients to measure MPA AUC₀₋₁₂. The profiles at 1 month were used to develop the simplified strategies and those at 5.5 months used for validation. We followed two approaches. In one, the AUC was calculated using the trapezoidal rule with fewer time points followed by an extrapolation. In the second approach, by stepwise multiple regression analysis, models with different time points were identified and linear regression analysis performed. Using the trapezoidal rule, two equations were developed with six time points and sampling to 6 or 8 hours (8hrAUC[₀₋₁₂exp]) after the EC-MPS dose. On validation, the 8hrAUC(₀₋₁₂exp) compared with total measured AUC₀₋₁₂ had a coefficient of correlation (r²) of 0.872 with a bias and precision (95% confidence interval) of 0.54% (-6.07-7.15) and 9.73% (5.37-14.09), respectively. Second, limited sampling strategies were developed with four, five, six, seven, and eight time points and completion within 2 hours, 4 hours, 6 hours, and 8 hours after the EC-MPS dose. On validation, six, seven, and eight time point equations, all with sampling to 8 hours, had an acceptable r with the total measured MPA AUC₀₋₁₂ (0.817-0.927). In the six, seven, and eight time points, the bias (95% confidence interval) was 3.00% (-4.59 to 10.59), 0.29% (-5.4 to 5.97), and -0.72% (-5.34 to 3.89) and the precision (95% confidence interval) was 10.59% (5.06-16.13), 8.33% (4.55-12.1), and 6.92% (3.94-9.90), respectively. Of the eight simplified approaches, inclusion of seven or eight time points improved the accuracy of the predicted AUC compared with the actual and can be advocated based on the priority of the user.

Wait times for gastroenterology consultation in Canada: The patients’ perspective

PubMed Central

Paterson, WG; Barkun, AN; Hopman, WM; Leddin, DJ; Paré, P; Petrunia, DM; Sewitch, MJ; Switzer, C; van Zanten, S Veldhuyzen

2010-01-01

Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms. PMID:20186353

Association between patient-centered medical home rating and operating cost at federally funded health centers.

PubMed

Nocon, Robert S; Sharma, Ravi; Birnberg, Jonathan M; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H

2012-07-04

Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH). To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27,300; 95% CI, $3047-$57,804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32,731; 95% CI, $1571-$73,670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39,809; 95% CI, $1893-$63,169). According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.

Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: a 2-year longitudinal analysis.

PubMed

Reijnen, A; Rademaker, A R; Vermetten, E; Geuze, E

2015-02-01

Recent studies in troops deployed to Iraq and Afghanistan have shown that combat exposure and exposure to deployment-related stressors increase the risk for the development of mental health symptoms. The aim of this study is to assess the prevalence of mental health symptoms in a cohort of Dutch military personnel prior to and at multiple time-points after deployment. Military personnel (n=994) completed various questionnaires at 5 time-points; starting prior to deployment and following the same cohort at 1 and 6 months and 1 and 2 years after their return from Afghanistan. The prevalence of symptoms of fatigue, PTSD, hostility, depression and anxiety was found to significantly increase after deployment compared with pre-deployment rates. As opposed to depressive symptoms and fatigue, the prevalence of PTSD was found to decrease after the 6-month assessment. The prevalence of sleeping problems and hostility remained relatively stable. The prevalence of mental health symptoms in military personnel increases after deployment, however, symptoms progression over time appears to be specific for various mental health symptoms. Comprehensive screening and monitoring for a wide range of mental health symptoms at multiple time-points after deployment is essential for early detection and to provide opportunities for intervention. This project was funded by the Dutch Ministry of Defence. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Differential Effects of Teriparatide and Denosumab on Intact PTH and Bone Formation Indices: AVA Osteoporosis Study

PubMed Central

Zhou, Hua; Recker, Robert R.; Brown, Jacques P.; Recknor, Christopher P.; Lewiecki, E. Michael; Miller, Paul D.; Rao, Sudhaker D.; Kendler, David L.; Lindsay, Robert; Krege, John H.; Alam, Jahangir; Taylor, Kathleen A.; Janos, Boris; Ruff, Valerie A.

2016-01-01

Context: Denosumab-induced PTH elevation may stimulate early bone formation. Objective: Our objective was to evaluate whether denosumab-induced changes of intact PTH (iPTH) result in early anabolic effects according to histomorphometry and bone turnover markers (BTMs) compared with teriparatide, an established anabolic agent. Design: This open-label, randomized study used quadruple labeling to label bone before/after treatment, with a transiliac bone biopsy at 3 months. Setting: This study took both in both US and Canadian sites. Participants: Sixty-nine postmenopausal women with osteoporosis were included. Interventions: Teriparatide (20 μg/day) for 6 months and denosumab (60 mg once) were used in this study. Main Outcome Measure: Between-treatment comparison of change from baseline to month 3 in cancellous mineralizing surface/bone surface, histomorphometric indices in four bone envelopes, and BTM and iPTH at baseline, 1, 3, and 6 months was undertaken. Results: After denosumab, iPTH peaked at month 1 (P < .001), then declined, remaining above baseline through month 6 (P ≤ .01); after teriparatide, iPTH declined at all time points (P < .001). From baseline to month 3, cancellous mineralizing surface/bone surface increased with teriparatide and decreased with denosumab and at month 3, was higher with teriparatide. Similar results were observed in other bone envelopes. BTMs increased from baseline in teriparatide-treated subjects (procollagen type 1 N-terminal propeptide at month 1 and carboxyterminal cross-linking telopeptide of type 1 collagen at month 3); procollagen type 1 N-terminal propeptide and carboxyterminal cross-linking telopeptide of type 1 collagen decreased from baseline at all time points in denosumab-treated subjects. Conclusions: Denosumab treatment increased iPTH but inhibited bone formation indices. In contrast, teriparatide treatment decreased iPTH but stimulated bone formation indices. These findings are not consistent with the hypothesis of early indirect anabolic effect with denosumab. PMID:26859106

Early Childhood Development over Time for a Cohort of Australian Aboriginal Children Living in an Urban Environment

ERIC Educational Resources Information Center

Grace, Rebekah; Elcombe, Emma; Knight, Jennifer; McMahon, Catherine; McDonald, Jenny; Comino, Elizabeth

2017-01-01

Child development for a cohort of urban Aboriginal children was assessed at three time points: 12 months, 3 years and 4.5 years. This paper reports developmental findings and explores the impact of child, family, home and community variables over time. Overall, child development at 4.5 years was significantly below the standardised mean. Female…

Gulf War agent exposure causes impairment of long-term memory formation and neuropathological changes in a mouse model of Gulf War Illness.

PubMed

Zakirova, Zuchra; Tweed, Miles; Crynen, Gogce; Reed, Jon; Abdullah, Laila; Nissanka, Nadee; Mullan, Myles; Mullan, Michael J; Mathura, Venkatarajan; Crawford, Fiona; Ait-Ghezala, Ghania

2015-01-01

Gulf War Illness (GWI) is a chronic multisymptom illness with a central nervous system component such as memory deficits, neurological, and musculoskeletal problems. There are ample data that demonstrate that exposure to Gulf War (GW) agents, such as pyridostigmine bromide (PB) and pesticides such as permethrin (PER), were key contributors to the etiology of GWI post deployment to the Persian GW. In the current study, we examined the consequences of acute (10 days) exposure to PB and PER in C57BL6 mice. Learning and memory tests were performed at 18 days and at 5 months post-exposure. We investigated the relationship between the cognitive phenotype and neuropathological changes at short and long-term time points post-exposure. No cognitive deficits were observed at the short-term time point, and only minor neuropathological changes were detected. However, cognitive deficits emerged at the later time point and were associated with increased astrogliosis and reduction of synaptophysin staining in the hippocampi and cerebral cortices of exposed mice, 5 months post exposure. In summary, our findings in this mouse model of GW agent exposure are consistent with some GWI symptom manifestations, including delayed onset of symptoms and CNS disturbances observed in GWI veterans.

Gulf War Agent Exposure Causes Impairment of Long-Term Memory Formation and Neuropathological Changes in a Mouse Model of Gulf War Illness

PubMed Central

Zakirova, Zuchra; Tweed, Miles; Crynen, Gogce; Reed, Jon; Abdullah, Laila; Nissanka, Nadee; Mullan, Myles; Mullan, Michael J.; Mathura, Venkatarajan; Crawford, Fiona; Ait-Ghezala, Ghania

2015-01-01

Gulf War Illness (GWI) is a chronic multisymptom illness with a central nervous system component such as memory deficits, neurological, and musculoskeletal problems. There are ample data that demonstrate that exposure to Gulf War (GW) agents, such as pyridostigmine bromide (PB) and pesticides such as permethrin (PER), were key contributors to the etiology of GWI post deployment to the Persian GW. In the current study, we examined the consequences of acute (10 days) exposure to PB and PER in C57BL6 mice. Learning and memory tests were performed at 18 days and at 5 months post-exposure. We investigated the relationship between the cognitive phenotype and neuropathological changes at short and long-term time points post-exposure. No cognitive deficits were observed at the short-term time point, and only minor neuropathological changes were detected. However, cognitive deficits emerged at the later time point and were associated with increased astrogliosis and reduction of synaptophysin staining in the hippocampi and cerebral cortices of exposed mice, 5 months post exposure. In summary, our findings in this mouse model of GW agent exposure are consistent with some GWI symptom manifestations, including delayed onset of symptoms and CNS disturbances observed in GWI veterans. PMID:25785457

Arithmetic strategy development and its domain-specific and domain-general cognitive correlates: a longitudinal study in children with persistent mathematical learning difficulties.

PubMed

Vanbinst, Kiran; Ghesquière, Pol; De Smedt, Bert

2014-11-01

Deficits in arithmetic fact retrieval constitute the hallmark of children with mathematical learning difficulties (MLD). It remains, however, unclear which cognitive deficits underpin these difficulties in arithmetic fact retrieval. Many prior studies defined MLD by considering low achievement criteria and not by additionally taking the persistence of the MLD into account. Therefore, the present longitudinal study contrasted children with persistent MLD (MLD-p; mean age: 9 years 2 months) and typically developing (TD) children (mean age: 9 years 6 months) at three time points, to explore whether differences in arithmetic strategy development were associated with differences in numerical magnitude processing, working memory and phonological processing. Our longitudinal data revealed that children with MLD-p had persistent arithmetic fact retrieval deficits at each time point. Children with MLD-p showed persistent impairments in symbolic, but not in nonsymbolic, magnitude processing at each time point. The two groups differed in phonological processing, but not in working memory. Our data indicate that both domain-specific and domain-general cognitive abilities contribute to individual differences in children's arithmetic strategy development, and that the symbolic processing of numerical magnitudes might be a particular risk factor for children with MLD-p. Copyright © 2014 Elsevier Ltd. All rights reserved.

Time Series Analysis of Sexual Assault Case Characteristics and the 2007–2008 Period of Post-Election Violence in Kenya

PubMed Central

Anastario, Michael P.; Adhiambo Onyango, Monica; Nyanyuki, Joan; Naimer, Karen; Muthoga, Rachel; Sirkin, Susannah; Barrick, Kelle; van Hasselt, Martijn; Aruasa, Wilson; Kibet, Cynthia; Omollo, Grace

2014-01-01

Background Following the declaration that President Mwai Kibaki was the winner of the Kenyan presidential election held on December 27, 2007, a period of post-election violence (PEV) took place. In this study, we aimed to identify whether the period of PEV in Kenya was associated with systematic changes in sexual assault case characteristics. Methods and Findings Medical records of 1,615 patients diagnosed with sexual assault between 2007 and 2011 at healthcare facilities in Eldoret (n = 569), Naivasha (n = 534), and Nakuru (n = 512) were retrospectively reviewed to examine characteristics of sexual assault cases over time. Time series and linear regression were used to examine temporal variation in case characteristics relative to the period of post-election violence in Kenya. Key informant interviews with healthcare workers at the sites were employed to triangulate findings. The time series of sexual assault case characteristics at these facilities were examined, with a specific focus on the December 2007–February 2008 period of post-election violence. Prais-Winsten estimates indicated that the three-month period of post-election violence was associated with a 22 percentage-point increase in cases where survivors did not know the perpetrator, a 20 percentage-point increase in cases with more than one perpetrator, and a 4 percentage-point increase in cases that had evidence of abdominal injury. The post-election violence period was also associated with an 18 percentage-point increase in survivors waiting >1 month to report to a healthcare facility. Sensitivity analyses confirmed that these characteristics were specific to the post-election violence time period. Conclusion These results demonstrate systematic patterns in sexual assault characteristics during the PEV period in Kenya. PMID:25170917

Changes in academic adjustment and relational self-worth across the transition to middle school.

PubMed

Ryan, Allison M; Shim, Sungok Serena; Makara, Kara A

2013-09-01

Moving from elementary to middle school is a time of great transition for many early adolescents. The present study examined students' academic adjustment and relational self-worth at 6-month intervals for four time points spanning the transition from elementary school to middle school (N = 738 at time 1; 53 % girls; 54 % African American, 46 % European American). Grade point average (G.P.A.), intrinsic value for schoolwork, self-worth around teachers, and self-worth around friends were examined at every time point. The overall developmental trajectory indicated that G.P.A. and intrinsic value for schoolwork declined. The overall decline in G.P.A. was due to changes at the transition and across the first year in middle school. Intrinsic value declined across all time points. Self-worth around teachers was stable. The developmental trends were the same regardless of gender or ethnicity except for self-worth around friends, which was stable for European American students and increased for African American students due to an ascent at the transition into middle school. Implications for the education of early adolescents in middle schools are discussed.

Acceptability of Adaptations for Struggling Writers: A National Survey with Primary-Grade Teachers

ERIC Educational Resources Information Center

Graham, Steve; Harris, Karen R.; Bartlett, Brendan J.; Popadopoulou, Eleni; Santoro, Julia

2016-01-01

One hundred twenty-five primary-grade teachers randomly selected from across the United States indicated how frequently they made 20 instructional adaptations for the struggling writers in their classroom. The measure of frequency ranged from never, several times a year, monthly, weekly, several times a week, and daily. Using a 6-point Likert-type…

Depression Status Is Associated with Functional Decline Over 1-Year Following Acute Stroke.

PubMed

El Husseini, Nada; Goldstein, Larry B; Peterson, Eric D; Zhao, Xin; Olson, DaiWai M; Williams, John W; Bushnell, Cheryl; Laskowitz, Daniel T

2017-07-01

We investigated the independent association of depression status at 3 and 12 months after stroke and functional decline. Data were obtained as part of the multicenter Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry. Depression was assessed with the Patient Health Questionnaire-8 (depression, PHQ-8 ≥ 10), and functional status was assessed with the modified Rankin score (mRS) at 3 and 12 months following hospitalization for ischemic stroke. We used logistic regression analyses to evaluate the independent association between the change in depression rating and the change in mRS. Among 1444 patients, 75% did not have depression at either time point, 9.2% had persistent depression, 8.7% had resolving depression, and 7% had incident depression at 12 months. After covariate adjustment, depression status at 3 and 12 months remained associated with worsening mRS (P = .01). Compared with patients without depression, those with resolving depression were less likely to have a worsening mRS (odds ratio [OR] = .49, 95% confidence interval [CI]: .29-0.83). There was no difference in functional decline between those with no depression and those with persistent depression; however, those with persistent depression had worse mRS at both time points (median mRS: 2.5 [Q1-Q3: 2-3] at 3 months; 2 [2-3] at 12 months) than those with no depression (mRS: 1 [0-2] at both 3 and 12 months), P < .0001. Patients with resolving depression in the first year after stroke were less likely to have functional deterioration than those without depression. Greater functional impairment was present in the setting of depression. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Effects of laser in situ keratomileusis on mental health-related quality of life.

PubMed

Tounaka-Fujii, Kaoru; Yuki, Kenya; Negishi, Kazuno; Toda, Ikuko; Abe, Takayuki; Kouyama, Keisuke; Tsubota, Kazuo

2016-01-01

The aims of our study were to investigate whether laser in situ keratomileusis (LASIK) improves health-related quality of life (HRQoL) and to identify factors that affect postoperative HRQoL. A total of 213 Japanese patients who underwent primary LASIK were analyzed in this study. The average age of patients was 35.0±9.4 years. The subjects were asked to answer questions regarding subjective quality of vision, satisfaction, and quality of life (using the Japanese version of 36-Item Short Form Health Survey Version 2) at three time points: before LASIK, 1 month after LASIK, and 6 months after LASIK. Longitudinal changes over 6 months in the outputs of mental component summary (MCS) score and the physical component summary (PCS) score from the 36-Item Short Form Health Survey Version 2 questionnaire were compared between time points using a linear mixed-effects model. Delta MCS and PCS were calculated by subtracting the postoperative score (1 month after LASIK) from the preoperative score. Preoperative and postoperative factors associated with a change in the MCS score or PCS score were evaluated via a linear regression model. The preoperative MCS score was 51.0±9.4 and increased to 52.0±9.8 and 51.5±9.6 at 1 month and 6 months after LASIK, respectively, and the trend for the change from baseline in MCS through 6 months was significant ( P =0.03). PCS score did not change following LASIK. Delta MCS was significantly negatively associated with preoperative spherical equivalent, axial length, and postoperative quality of vision, after adjusting for potential confounding factors. Mental HRQoL is not lost with LASIK, and LASIK may improve mental HRQoL. Preoperative axial length may predict postoperative mental HRQoL.

Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results.

PubMed

Jiang, W-J; Xu, X-T; Jin, M; Du, B; Dong, K-H; Dai, J-P

2007-05-01

A recent trial shows an 8.3 per 100-patient-years' ischemic stroke rate in the territory of the intracranial stenotic artery, despite aspirin treatment. Our aim was to prospectively study the feasibility and outcome of a new intracranial balloon-expandable Apollo stent for symptomatic atherosclerotic intracranial stenosis (SAIS). Forty-six patients (41 men and 5 women; median, 54 years of age) with forty-eight >or=50% SAISs were enrolled. Procedural feasibility was evaluated by stent success (residual stenosis or=24 months), which varied from 1 month to 30.7 months (median, 23.9 months). After 30 days, 1 patient (2.2%, 1/46) developed minor stroke in the target-lesion artery territory at 6.7 months. Primary end point rate was 4.3 per 100 patient years. Angiographic follow-up was performed in 25 patients. Seven restenoses (28%, 7/25) were detected, 1 of which was symptomatic. Angioplasty with the Apollo stent for symptomatic atherosclerotic intracranial stenosis is feasible. Severe tortuosity is an independent predictor of stent failure. Our clinical outcome seems to compare favorably with results of aspirin therapy, but the restenotic rate was high.

Greater Pupil Size in Response to Emotional Faces as an Early Marker of Social-Communicative Difficulties in Infants at High Risk for Autism

PubMed Central

Wagner, Jennifer B.; Luyster, Rhiannon J.; Tager-Flusberg, Helen; Nelson, Charles A.

2016-01-01

When scanning faces, individuals with autism spectrum disorder (ASD) have shown reduced visual attention (e.g., less time on eyes) and atypical autonomic responses (e.g., heightened arousal). To understand how these differences might explain sub-clinical variability in social functioning, 9-month-olds, with or without a family history of ASD, viewed emotionally-expressive faces, and gaze and pupil diameter (a measure of autonomic activation) were recorded using eye-tracking. Infants at high-risk for ASD with no subsequent clinical diagnosis (HRA-) and low-risk controls (LRC) showed similar face scanning and attention to eyes and mouth. Attention was overall greater to eyes than mouth, but this varied as a function of the emotion presented. HRA- showed significantly larger pupil size than LRC. Correlations between scanning at 9 months, pupil size at 9 months, and 18-month social-communicative behavior, revealed positive associations between pupil size and attention to both face and eyes at 9 months in LRC, and a negative association between 9-month pupil size and 18-month social-communicative behavior in HRA-. The present findings point to heightened autonomic arousal in HRA-. Further, with greater arousal relating to worse social-communicative functioning at 18 months, this work points to a mechanism by which unaffected siblings might develop atypical social behavior. PMID:27616938

Greater Pupil Size in Response to Emotional Faces as an Early Marker of Social-Communicative Difficulties in Infants at High Risk for Autism.

PubMed

Wagner, Jennifer B; Luyster, Rhiannon J; Tager-Flusberg, Helen; Nelson, Charles A

2016-01-01

When scanning faces, individuals with autism spectrum disorder (ASD) have shown reduced visual attention (e.g., less time on eyes) and atypical autonomic responses (e.g., heightened arousal). To understand how these differences might explain sub-clinical variability in social functioning, 9-month-olds, with or without a family history of ASD, viewed emotionally-expressive faces, and gaze and pupil diameter (a measure of autonomic activation) were recorded using eye-tracking. Infants at high-risk for ASD with no subsequent clinical diagnosis (HRA-) and low-risk controls (LRC) showed similar face scanning and attention to eyes and mouth. Attention was overall greater to eyes than mouth, but this varied as a function of the emotion presented. HRA- showed significantly larger pupil size than LRC. Correlations between scanning at 9 months, pupil size at 9 months, and 18-month social-communicative behavior, revealed positive associations between pupil size and attention to both face and eyes at 9 months in LRC, and a negative association between 9-month pupil size and 18-month social-communicative behavior in HRA-. The present findings point to heightened autonomic arousal in HRA-. Further, with greater arousal relating to worse social-communicative functioning at 18 months, this work points to a mechanism by which unaffected siblings might develop atypical social behavior.

Descriptive and Prospective Analysis of Young Adult Alcohol Use and Romantic Relationships: Disentangling between- and within-Person Associations Using Monthly Assessments.

PubMed

Fleming, Charles B; Lee, Christine M; Rhew, Isaac C; Ramirez, Jason J; Abdallah, Devon Alisa; Fairlie, Anne M

2018-05-08

Prior research on romantic relationships and alcohol use among young adults has not distinguished between differences in patterns of relationship status over extended periods of time and within-person changes in status that only occur for some individuals. This study captured between-person differences in relationship patterns, assessed associations between relationship patterns and alcohol use, and examined within-person associations between alcohol use and relationship status changes. In addition, age and sex differences in between- and within-person associations were tested. We used multilevel modeling of monthly data collected over one year on alcohol use and romantic relationship status from a Seattle area community sample of 620 young adults (ages 18-24). Participants were coded into six relationship pattern groups: (1) single-not-dating (16%), (2) stable-in-a-relationship (30%), (3) single-dating (10%), (4) ended-a-relationship (14%), (5) started-a-relationship (13%), and (6) ended-and-started-a-relationship (18%). Single-not-dating and stable-in-a-relationship groups reported the least drinking across the entire year; the single-dating, ended-a-relationship, and ended-and-started-a-relationship groups reported higher levels of drinking. Examining within-person changes in groups 3-6 revealed increases in drinking associated with months of dating among the single-dating group, months postbreakup among the ended-a-relationship group, and months of breaking up and starting a new relationship among the ended-and-started-a-relationship group. Few differences by age or sex were found for between- or within-person associations. The findings point to heterogeneity in patterns of relationship status over time, differences in relationship patterns associated with variations in drinking, and particular time points of elevated risk for young adults who experience changes in status.

Emergency department information system implementation and process redesign result in rapid and sustained financial enhancement at a large academic center.

PubMed

Shapiro, Jason S; Baumlin, Kevin M; Chawla, Neal; Genes, Nicholas; Godbold, James; Ye, Fen; Richardson, Lynne D

2010-05-01

The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to "break even" on the initial investment. A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost. Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods. A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point. .

Intraocular methotrexate in the treatment of uveitis and uveitic cystoid macular edema.

PubMed

Taylor, Simon R J; Habot-Wilner, Zohar; Pacheco, Patricio; Lightman, Sue L

2009-04-01

A pilot study to evaluate the use of intravitreal methotrexate (MTX) for the treatment of uveitis and uveitic cystoid macular edema (CME). Prospective, consecutive, interventional case series. Fifteen eyes of 15 patients with a unilateral exacerbation of noninfectious intermediate, posterior uveitis, or panuveitis and/or CME such that visual acuity (VA) was 20/40 or worse, together with a history of increased intraocular pressure (IOP) in response to corticosteroid administration. Intravitreal injection of 400 microg in 0.1 ml MTX. The primary outcome measure was VA (using the Early Treatment Diabetic Retinopathy Study chart). Other outcome measures included ocular inflammation scores, time to relapse, levels of systemic corticosteroid and immunosuppressive therapy, and ocular coherence tomography. Potential complications of intravitreal MTX injection, including cataract progression, vitreous hemorrhage, retinal detachment, and corneal epitheliopathy, were assessed. VA improved at all time points and was statistically significant at the 3- and 6-month follow-up examinations. The mean visual improvement was 4 lines at 3 months and 4.5 lines at 6 months, with no statistical difference between the best VA obtained after MTX injection and after previous corticosteroid treatment, including intravitreal triamcinolone acetate injection. Five patients relapsed after a median of 4 months; a similar improvement was seen after re-injection. Ocular inflammation scores improved at all time points, and systemic immunosuppressive medication was reduced in 3 of 7 patients taking this at the start of the trial. In patients with uveitis and uveitic CME, intravitreal MTX can improve VA and reduce CME and, in some patients, allows the reduction of immunosuppressive therapy. Relapse occurs at a median of 4 months in some patients, but reinjection has similar efficacy.

Docosahexaenoic acid for the treatment of fatty liver: randomised controlled trial in children.

PubMed

Nobili, V; Alisi, A; Della Corte, C; Risé, P; Galli, C; Agostoni, C; Bedogni, G

2013-11-01

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children. We tested whether dietary supplementation with docosahexaenoic acid (DHA) can decrease liver fat content in children with NAFLD. We performed a randomized controlled trial of DHA supplementation (250 mg/day and 500 mg/day) vs. placebo in 60 children with NAFLD (20 children per group). The main outcome was the change in liver fat as detected by ultrasonography after 6, 12, 18 and 24 months of treatment. Secondary outcomes were changes in triglycerides, alanine transaminase (ALT), body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA). The odds of more severe versus less severe liver steatosis decreased to the same degree at 6 months in children treated with DHA 250 mg/day and DHA 500 mg/day vs. placebo and persisted virtually unmodified for 24 months (OR ≤ 0.02, p ≤ 0.05 for all time points). Triglycerides were lower in the DHA groups than in the placebo group at any time point and ALT was lower in these groups from month 12 onwards. HOMA was lower in the DHA 250 mg group vs. placebo at months 6 and 12. DHA supplementation improves liver steatosis in children with NAFLD. Doses of 250 mg/day and 500 mg/day of DHA appear to be equally effective in reducing liver fat content. Copyright © 2012 Elsevier B.V. All rights reserved.

Caregiver reports of common symptoms in children following a traumatic brain injury.

PubMed

Hooper, Stephen R; Alexander, Joshua; Moore, Daniel; Sasser, Howell C; Laurent, Sherry; King, Jennifer; Bartel, Sheri; Callahan, Beth

2004-01-01

This study describes the common symptoms in children and adolescents following a traumatic brain injury (TBI) as reported by their primary caregivers. Utilizing data from a large-scale state demonstration project, 681 children who had sustained a TBI were ascertained from both Hospital Emergency Departments (n = 409) and Pediatric Inpatient settings (n = 272). The sample ranged in age from infancy to 18 years, was largely male (59.7%), and had equal numbers of Caucasian and minority patients. Most of the participants experienced a mild TBI (83%), with about 5.1% being moderate and 12% severe. Caregivers described the presence of current symptoms (neurological, neurocognitive, behavioral, school problems) using a series of dichotomous questions regarding their child via a structured telephone interview at 1, 4, and 10 months post-injury. Inpatient children were described as manifesting more symptoms at each of the follow-up time points than their ED counterparts. At 1 month inpatients were described as having more symptoms across all 4 domains. At 4 and 10 months, the inpatients were described as having more neurocognitive symptoms and as not returning to school on a full-time basis, with behavior problems approaching significance at the 10-month point. A large number of individuals from both groups also reported persistent symptoms 10 months post-injury including headaches, attention and memory problems, low frustration tolerance, sleep problems, personality changes, and new school problems. Practical implications of these findings for the ongoing management of these children are discussed.

Botulinum toxin a in the treatment of chronic tension-type headache with cervical myofascial trigger points: a randomized, double-blind, placebo-controlled pilot study.

PubMed

Harden, R Norman; Cottrill, Jerod; Gagnon, Christine M; Smitherman, Todd A; Weinland, Stephan R; Tann, Beverley; Joseph, Petra; Lee, Thomas S; Houle, Timothy T

2009-05-01

To evaluate the efficacy of botulinum toxin A (BT-A) as a prophylactic treatment for chronic tension-type headache (CTTH) with myofascial trigger points (MTPs) producing referred head pain. Although BT-A has received mixed support for the treatment of TTH, deliberate injection directly into the cervical MTPs very often found in this population has not been formally evaluated. Patients with CTTH and specific MTPs producing referred head pain were assigned randomly to receive intramuscular injections of BT-A or isotonic saline (placebo) in a double-blind design. Daily headache diaries, pill counts, trigger point pressure algometry, range of motion assessment, and responses to standardized pain and psychological questionnaires were used as outcome measures; patients returned for follow-up assessment at 2 weeks, 1 month, 2 months, and 3 months post injection. After 3 months, all patients were offered participation in an open-label extension of the study. Effect sizes were calculated to index treatment effects among the intent-to-treat population; individual time series models were computed for average pain intensity. The 23 participants reported experiencing headache on a near-daily basis (average of 27 days/month). Compared with placebo, patients in the BT-A group reported greater reductions in headache frequency during the first part of the study (P = .013), but these effects dissipated by week 12. Reductions in headache intensity over time did not differ significantly between groups (P = .80; maximum d = 0.13), although a larger proportion of BT-A patients showed evidence of statistically significant improvements in headache intensity in the time series analyses (62.5% for BT-A vs 30% for placebo). There were no differences between the groups on any of the secondary outcome measures. The evidence for BT-A in headache is mixed, and even more so in CTTH. However, the putative technique of injecting BT-A directly into the ubiquitous MTPs in CTTH is partially supported in this pilot study. Definitive trials with larger samples are needed to test this hypothesis further.

Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.

PubMed

Przekop, Peter; Przekop, Allison; Haviland, Mark G

2016-10-01

Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p < .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p < .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quality of Life and Survival Outcome for Patients With Nasopharyngeal Carcinoma Receiving Three-Dimensional Conformal Radiotherapy vs. Intensity-Modulated Radiotherapy-A Longitudinal Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fang, F.-M.; Kaohsiung Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung Hsien, Taiwan; Chien, C.-Y.

2008-10-01

Purpose: To investigate the changes of quality of life (QoL) and survival outcomes for patients with nasopharyngeal carcinoma (NPC) treated by three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT). Methods and Materials: Two hundred and three newly diagnosed NPC patients, who were curatively treated by 3D-CRT (n = 93) or IMRT (n = 110) between March 2002 and July 2004, were analyzed. The distributions of clinical stage according to American Joint Committee on Cancer 1997 were I: 15 (7.4%), II: 78 (38.4%), III: 74 (36.5%), and IV: 36 (17.7%). QoL was longitudinally assessed by the European Organization for Research andmore » Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H and N35 questionnaires at the five time points: before RT, during RT (36 Gy), and 3 months, 12 months, and 24 months after RT. Results: The 3-year locoregional control, metastasis-free survival, and overall survival rates were 84.8%, 76.7%, and 81.7% for the 3D-CRT group, respectively, compared with 84.2%, 82.6%, and 85.4% for the IMRT group (p value > 0.05). A general trend of maximal deterioration in most QoL scales was observed during RT, followed by a gradual recovery thereafter. There was no significant difference in most scales between the two groups at each time point. The exception was that patients treated by IMRT had a both statistically and clinically significant improvement in global QoL, fatigue, taste/smell, dry mouth, and feeling ill at the time point of 3 months after RT. Conclusions: The potential advantage of IMRT over 3D-CRT in treating NPC patients might occur in QoL outcome during the recovery phase of acute toxicity.« less

Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors.

PubMed

Li, Xinning; Killie, Heather; Guerrero, Patrick; Busconi, Brian D

2009-03-01

Modification of the Bröstrom repair with suture anchors has been used to address chronic lateral ankle instability. However, there are few studies in the literature reporting the functional outcomes after this particular procedure in the high-demand athlete. Anatomical reconstruction of the lateral ankle ligaments for chronic instability will return the high-demand athlete functionally to his or her previous level of activity. Case series; Level of evidence, 4. Sixty-two patients who had grade III ankle sprain that failed at least a 6-month course of supervised conservative management with a preinjury Tegner score of > or = 6 underwent a variant of the Gould-modified Broström procedure with suture anchors for lateral ankle instability. Each patient was given the Tegner and Karlsson questionnaire at the 6-month, 1-year, and 2-year time points. Range of motion of the operative ankle was also assessed. The mean age was 19.6 years (range, 16-26 years), and 10 patients were lost to follow-up. The mean follow-up was 29 months (minimum, 24 months) in the remaining 52 patients (84%). Mean Tegner scores at the 1- and 2-year time points were 8.2 (range, 5-9) and 8.6 (range, 5-9), respectively. The mean Karlsson scores were 92 +/- 5.2 and 95 +/- 3.1 at the 1- and 2-year time points, respectively. Range of motion was equal to the contralateral ankle in all but 3 patients at the 2-year follow up. A 6% major complication rate included 3 reruptures. Anatomical ligament reconstruction for chronic lateral ankle instability using a variant of the Gould-modified Broström procedure with suture anchors was effective in returning high-demand athletes to their preinjury functional level.

The Relationship between OCT-measured Central Retinal Thickness and Visual Acuity in Diabetic Macular Edema

PubMed Central

2008-01-01

Objective To compare optical coherence tomography (OCT)-measured retinal thickness and visual acuity in eyes with diabetic macular edema (DME) both before and after macular laser photocoagulation. Design Cross-sectional and longitudinal study. Participants 210 subjects (251 eyes) with DME enrolled in a randomized clinical trial of laser techniques. Methods Retinal thickness was measured with OCT and visual acuity was measured with the electronic-ETDRS procedure. Main Outcome Measures OCT-measured center point thickness and visual acuity Results The correlation coefficients for visual acuity versus OCT center point thickness were 0.52 at baseline and 0.49, 0.36, and 0.38 at 3.5, 8, and 12 months post-laser photocoagulation. The slope of the best fit line to the baseline data was approximately 4.4 letters (95% C.I.: 3.5, 5.3) better visual acuity for every 100 microns decrease in center point thickness at baseline with no important difference at follow-up visits. Approximately one-third of the variation in visual acuity could be predicted by a linear regression model that incorporated OCT center point thickness, age, hemoglobin A1C, and severity of fluorescein leakage in the center and inner subfields. The correlation between change in visual acuity and change in OCT center point thickening 3.5 months after laser treatment was 0.44 with no important difference at the other follow-up times. A subset of eyes showed paradoxical improvements in visual acuity with increased center point thickening (7–17% at the three time points) or paradoxical worsening of visual acuity with a decrease in center point thickening (18%–26% at the three time points). Conclusions There is modest correlation between OCT-measured center point thickness and visual acuity, and modest correlation of changes in retinal thickening and visual acuity following focal laser treatment for DME. However, a wide range of visual acuity may be observed for a given degree of retinal edema and paradoxical increases in center point thickening with increases in visual acuity as well as paradoxical decreases in center point thickening with decreases in visual acuity were not uncommon. Thus, although OCT measurements of retinal thickness represent an important tool in clinical evaluation, they cannot reliably substitute as a surrogate for visual acuity at a given point in time. This study does not address whether short-term changes on OCT are predictive of long-term effects on visual acuity. PMID:17123615

A Score to Identify Patients with Brain Metastases from Colorectal Cancer Who May Benefit from Whole-brain Radiotherapy in Addition to Stereotactic Radiosurgery/Radiotherapy.

PubMed

Rades, Dirk; Dziggel, Liesa; Blanck, Oliver; Gebauer, Niklas; Bartscht, Tobias; Schild, Steven E

2018-05-01

To design a tool to predict the probability of new cerebral lesions after stereotactic radiosurgery/radiotherapy for patients with 1-3 brain metastases from colorectal cancer. In 21 patients, nine factors were evaluated for freedom from new brain metastases, namely age, gender, Karnofsky performance score (KPS), tumor type, number, maximum total diameter of all lesions and sites of cerebral lesions, extra-cranial metastases, and time from cancer diagnosis to irradiation. Freedom from new lesions was positively associated with KPS of 90-100 (p=0.013); maximum total diameter ≤15 mm showed a trend for positive association (p=0.09). Points were assigned as: KPS 70-80=1 point, KPS 90-100=2 points, maximum diameter ≤15 mm=2 points and maximum diameter >15 mm=1 point. Six-month rates of freedom from new lesions were 29%, 45% and 100% for those with total scores of 2, 3 and 4 points, respectively, with corresponding 12-month rates of 0%, 45% and 100% (p=0.027). This study identified three risk groups regarding new brain metastases after stereotactic irradiation. Patients with 2 points could benefit from additional whole-brain radiotherapy. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

A Scenario-Based Virtual Patient Program to Support Substance Misuse Education

PubMed Central

Power, Ailsa; Hill, Duncan; Chapman, Paul

2016-01-01

Objective. To evaluate virtual patient (VP) programs for injecting equipment provision (IEP) and opiate substitution therapy (OST) services with respect to confidence and knowledge among preregistration pharmacist trainees. Methods. Preregistration trainee pharmacists pilot-tested the VP programs and were invited to complete pre/post and 6-month assessments of knowledge and perceived confidence. Results. One hundred six trainees participated and completed the pre/postassessments. Forty-six (43.4%) participants repeated the assessments at six months. Scores in perceived confidence increased in all domains at both time points postprogram. Knowledge scores were greater posteducation than preeducation. Knowledge scores were also greater six months after education than preeducation. Knowledge scores at six months were lower than posteducation for both programs. Conclusion. Virtual patients programs increased preregistration pharmacists’ knowledge and confidence with regard to IEP and OST immediately after use and at six months postprogram. There was a loss of clinical knowledge over time but confidence change was sustained. PMID:27170819

A Longitudinal Study of Household Water, Sanitation, and Hygiene Characteristics and Environmental Enteropathy Markers in Children Less than 24 Months in Iquitos, Peru

PubMed Central

Exum, Natalie G.; Lee, Gwenyth O.; Olórtegui, Maribel Paredes; Yori, Pablo Peñataro; Salas, Mery Siguas; Trigoso, Dixner Rengifo; Colston, Josh M.; Schwab, Kellogg J.; McCormick, Benjamin J. J.; Kosek, Margaret N.

2018-01-01

Abstract. Poor child gut health, resulting from a lack of access to an improved toilet or clean water, has been proposed as a biological mechanism underlying child stunting and oral vaccine failure. Characteristics related to household sanitation, water use, and hygiene were measured among a birth cohort of 270 children from peri-urban Iquitos Peru. These children had monthly stool samples and urine samples at four time points and serum samples at (2–4) time points analyzed for biomarkers related to intestinal inflammation and permeability. We found that less storage of fecal matter near the household along with a reliable water connection were associated with reduced inflammation, most prominently the fecal biomarker myeloperoxidase (MPO) (no sanitation facility compared with those with an onsite toilet had −0.43 log MPO, 95% confidence interval [CI]: −0.74, −0.13; and households with an intermittent connection versus those with a continuous supply had +0.36 log MPO, 95% CI: 0.08, 0.63). These results provide preliminary evidence for the hypothesis that children less than 24 months of age living in unsanitary conditions will have elevated gut inflammation. PMID:29436350

A Longitudinal Study of Household Water, Sanitation, and Hygiene Characteristics and Environmental Enteropathy Markers in Children Less than 24 Months in Iquitos, Peru.

PubMed

Exum, Natalie G; Lee, Gwenyth O; Olórtegui, Maribel Paredes; Yori, Pablo Peñataro; Salas, Mery Siguas; Trigoso, Dixner Rengifo; Colston, Josh M; Schwab, Kellogg J; McCormick, Benjamin J J; Kosek, Margaret N

2018-04-01

Poor child gut health, resulting from a lack of access to an improved toilet or clean water, has been proposed as a biological mechanism underlying child stunting and oral vaccine failure. Characteristics related to household sanitation, water use, and hygiene were measured among a birth cohort of 270 children from peri-urban Iquitos Peru. These children had monthly stool samples and urine samples at four time points and serum samples at (2-4) time points analyzed for biomarkers related to intestinal inflammation and permeability. We found that less storage of fecal matter near the household along with a reliable water connection were associated with reduced inflammation, most prominently the fecal biomarker myeloperoxidase (MPO) (no sanitation facility compared with those with an onsite toilet had -0.43 log MPO, 95% confidence interval [CI]: -0.74, -0.13; and households with an intermittent connection versus those with a continuous supply had +0.36 log MPO, 95% CI: 0.08, 0.63). These results provide preliminary evidence for the hypothesis that children less than 24 months of age living in unsanitary conditions will have elevated gut inflammation.

FNIRS-based evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy

NASA Astrophysics Data System (ADS)

Cao, Jianwei; Khan, Bilal; Hervey, Nathan; Tian, Fenghua; Delgado, Mauricio R.; Clegg, Nancy J.; Smith, Linsley; Roberts, Heather; Tulchin-Francis, Kirsten; Shierk, Angela; Shagman, Laura; MacFarlane, Duncan; Liu, Hanli; Alexandrakis, George

2015-03-01

Sensorimotor cortex plasticity induced by constraint-induced movement therapy (CIMT) in six children (10.2 ± 2.1 years old) with hemiplegic cerebral palsy (CP) was assessed by functional near-infrared spectroscopy (fNIRS). The activation laterality index and time-to-peak/duration during a finger tapping task were quantified before, immediately after, and six months after CIMT. Five age-matched healthy children (9.8 ± 1.3 years old) were also imaged at the same time points to provide comparative activation metrics for normal controls. In children with CP the activation time-to-peak/duration for all sensorimotor centers displayed significant normalization immediately after CIMT that persisted six months later. In contrast to this longer term improvement in localized activation response, the laterality index that depended on communication between sensorimotor centers improved immediately after CIMT, but relapsed six months later.

No difference in learning retention in manikin-based simulation based on role

PubMed Central

Giuliano, Dominic; DC, Marion McGregor

2016-01-01

Objective: We evaluated learning retention in interns exposed to simulation. It was hypothesized that learning would degrade after 6 months and there would be a difference in retention between interns who played a critical role versus those who did not. Methods: A total of 23 groups of 5 to 9 interns underwent a cardiac scenario twice during 1 simulation experience and again 6 months later. We captured 69 recordings (23 before debrief at baseline [PrDV], 23 after debrief at baseline [PoDV], and 23 at 6-month follow-up [FUV]). Students were assigned different roles, including the critical role of “doctor” in a blinded, haphazard fashion. At 6-month follow-up, 12 interns who played the role of doctor initially were assigned that role again, while 11 interns who played noncritical roles initially were newly assigned to doctor. All videos of intern performance were scored independently and in a blinded fashion, by 3 judges using a 15-item check list. Results: Repeated-measures analysis of variance for interns completing all 3 time points indicated a significant difference between time points (F2,22 = 112, p = .00). Contrasts showed a statistically significant difference between PrDV and PoDV (p = .00), and PrDV and FUV (p = .00), but no difference between PoDV and FUV (p = .98). This was consistent with results including all data points. Checklist scores were more than double for PoDV recordings (16) and FUV (15), compared to PrDV recordings (6.6). Follow-up scores comparing old to new doctors showed no statistically significant difference (15.4 vs 15.2 respectively, t21 = 0.26, p = .80, d = .11). Conclusions: Learning retention was maintained regardless of role. PMID:26367345

Cognitive function during and six months following chemotherapy for front-line treatment of ovarian, primary peritoneal or fallopian tube cancer: An NRG oncology/gynecologic oncology group study.

PubMed

Hess, Lisa M; Huang, Helen Q; Hanlon, Alexandra L; Robinson, William R; Johnson, Rhonda; Chambers, Setsuko K; Mannel, Robert S; Puls, Larry; Davidson, Susan A; Method, Michael; Lele, Shashikant; Havrilesky, Laura; Nelson, Tina; Alberts, David S

2015-12-01

Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy. Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy. Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p<0.001) and attention (p<0.001) but not in motor response time (p=0.066), from baseline through the six-month follow up time period. This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain. Copyright © 2015 Elsevier Inc. All rights reserved.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PubMed

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

[Retrospective cohort study on period of incubation and survival among former commercial plasma donors infected with HIV in Hebei province].

PubMed

Chen, Su-liang; Bai, Guang-yi; Li, Qiao-min; Li, Bao-jun; Hui, Yan-liang; Liang, Liang; Wang, Wei; Chen, Zhi-qiang; Lu, Xin-li; Wang, Xiao-feng; Zhang, Yu-qi; Zhao, Hong-ru

2012-04-01

To examine the state of incubation period and survival time of former commercial plasma donors (FCPDs) infected with HIV. All objects infected with HIV were from Hebei province and found from general investigation for FCPDs in 1995. The infector cohort by 142 cases was used to estimate incubation period. In the infector cohort, the time which infectors entered the cohort was their infection time, which was the middle value of the origin date, which was January 1, 1995. The onset of AIDS was defined as an outcome event. End point of observation was Dec 31, 2010. There were 192 months in all from beginning to end. The AIDS cohort by 57 cases was used to estimate the survival of the patients. In the patient cohort, the time of AIDS onset was defined as the time entering the cohort, and death of AIDS was defined as an outcome event. The cumulative incidence ratio, cumulative mortality, illness intensity and mortality intensity were analyzed through Kaplan-Meier. During the observation period, 123 cases of 142 infectors developed into AIDS, the cumulative incidence was 86.42% (123/142) and the intensity was 8.53/100 person-years and the median time of incubation period was 112.0 months (95%CI: 108.8 - 115.2). The death dates of 57 patients were from 1 to 24 months after onset. The cumulative mortality was 100%, and the intensity was 250.66/100 person-years and the median survival time was 3.0 months (95%CI: 1.8 - 4.2). It was estimated that the median time was 115.0 months (9.6 years) from infection to death. The median times of incubation and median survival time were 112.0 and 3.0 months, respectively.

Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire - Parent Form in children 0-12 years following positive and negative food challenges.

PubMed

DunnGalvin, A; Cullinane, C; Daly, D A; Flokstra-de Blok, B M J; Dubois, A E J; Hourihane, J O'B

2010-03-01

There are no published studies of longitudinal health-related quality of life (HRQL) assessments of food-allergic children using a disease-specific measure. This study assessed the longitudinal measurement properties of the Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF) in a sample of children undergoing food challenge. Parents of children 0-12 years completed the FAQLQ-PF and the Food Allergy Independent Measure (FAIM) pre-challenge and at 2 and 6 months post food challenge. In order to evaluate longitudinal validity, differences between Group A (positive challenge) and Group B (negative challenge) were expected over time. We computed correlation coefficients between change scores in the FAQLQ-PF and change scores in the FAIM. To determine the minimally important difference (MID), we used distributional criterion and effect size approaches. A logistic regression model profiled those children falling below this point. Eighty-two children underwent a challenge (42 positive; 40 negative). Domains and total score improved significantly at pos-challenge time-points for both groups (all P<0.05). Sensitivity was demonstrated by significant differences between positive and negative groups at 6 months [F(2, 59)=6.221, P<0.003] and by differing improvement on relevant subscales (P<0.05). MID was 0.45 on a seven-point response scale. Poorer quality of life at baseline increased the odds by over 2.0 of no improvement in HRQL scores 6-month time-point. General maternal health (OR 1.252), number of foods avoided (OR 1.369) and children >9 years (OR 1.173) were also predictors. The model correctly identified 84% of cases below MID. The FAQLQ-PF is sensitive to change, and has excellent longitudinal reliability and validity in a food-allergic patient population. The standard error of measurement value of 0.5 points as a threshold for meaningful change in HRQL questionnaires was confirmed. The FAQLQ-PF may be used to identify problems in children, to assess the effectiveness of clinical trials or interventions, and to guide the development of regulatory policies.

Obesity and Postmenopausal Breast Cancer Risk: Determining the Role of Growth Factor-Induced Aromatase Expression

DTIC Science & Technology

2014-03-01

those placed on the low -fat control diet at the end of each of the study’s time points (the final average weight for each group excludes mice...diet in the 2-month and 4-month on diet groups, but not the 6-month group.  Figure 1c: No difference in tumor latency between the DIO and control...not promote more or less total ER expression in MCF-7 or ZR75 cells vs Con sera. Tasks 5g and 5j:  Figure 5: MCF-7 cells exposed to Ob serum for

Exploratory study of serum ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest.

PubMed

Fink, Ericka L; Berger, Rachel P; Clark, Robert S B; Watson, R Scott; Angus, Derek C; Panigrahy, Ashok; Richichi, Rudolph; Callaway, Clifton W; Bell, Michael J; Mondello, Stefania; Hayes, Ronald L; Kochanek, Patrick M

2016-04-01

Brain injury is the leading cause of morbidity and death following pediatric cardiac arrest. Serum biomarkers of brain injury may assist in outcome prognostication. The objectives of this study were to evaluate the properties of serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) to classify outcome in pediatric cardiac arrest. Single center prospective study. Serum biomarkers were measured at 2 time points during the initial 72 h in children after cardiac arrest (n=19) and once in healthy children (controls, n=43). We recorded demographics and details of the cardiac arrest and resuscitation. We determined the associations between serum biomarker concentrations and Pediatric Cerebral Performance Category (PCPC) at 6 months (favorable (PCPC 1-3) or unfavorable (PCPC 4-6)). The initial assessment (time point 1) occurred at a median (IQR) of 10.5 (5.5-17.0)h and the second assessment (time point 2) at 59.0 (54.5-65.0)h post-cardiac arrest. Serum UCH-L1 was higher among children following cardiac arrest than among controls at both time points (p<0.05). Serum GFAP in subjects with unfavorable outcome was higher at time point 2 than in controls (p<0.05). Serum UCH-L1 at time point 1 (AUC 0.782) and both UCH-L1 and GFAP at time point 2 had good classification accuracy for outcome (AUC 0.822 and 0.796), p<0.05 for all. Preliminary data suggest that serum UCH-L1 and GFAP may be of use to prognosticate outcome after pediatric cardiac arrest at clinically-relevant time points and should be validated prospectively. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Exploratory Study of Serum Ubiquitin Carboxyl-Terminal Esterase L1 and Glial Fibrillary Acidic Protein for Outcome Prognostication after Pediatric Cardiac Arrest

PubMed Central

Fink, Ericka L; Berger, Rachel P; Clark, Robert SB; Watson, R. Scott; Angus, Derek C; Panigrahy, Ashok; Richichi, Rudolph; Callaway, Clifton W; Bell, Michael J; Mondello, Stefania; Hayes, Ronald L.; Kochanek, Patrick M

2016-01-01

Introduction Brain injury is the leading cause of morbidity and death following pediatric cardiac arrest. Serum biomarkers of brain injury may assist in outcome prognostication. The objectives of this study were to evaluate the properties of serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) to classify outcome in pediatric cardiac arrest. Methods Single center prospective study. Serum biomarkers were measured at 2 time points during the initial 72 h in children after cardiac arrest (n=19) and once in healthy children (controls, n=43). We recorded demographics and details of the cardiac arrest and resuscitation. We determined the associations between serum biomarker concentrations and Pediatric Cerebral Performance Category (PCPC) at 6 months (favorable (PCPC 1–3) or unfavorable (PCPC 4–6)). Results The initial assessment (time point 1) occurred at a median (IQR) of 10.5 (5.5–17.0) h and the second assessment (time point 2) at 59.0 (54.5–65.0) h post-cardiac arrest. Serum UCH-L1 was higher among children following cardiac arrest than among controls at both time points (p<0.05). Serum GFAP in subjects with unfavorable outcome was higher at time point 2 than in controls (p<0.05). Serum UCH-L1 at time point 1 (AUC 0.782) and both UCH-L1 and GFAP at time point 2 had good classification accuracy for outcome (AUC 0.822 and 0.796), p<0.05 for all. Conclusion Preliminary data suggest that serum UCH-L1 and GFAP may be of use to prognosticate outcome after pediatric cardiac arrest at clinically-relevant time points and should be validated prospectively. PMID:26855294

Confirming the timing of phase-based costing in oncology studies: a case example in advanced melanoma.

PubMed

Atkins, Michael; Coutinho, Anna D; Nunna, Sasikiran; Gupte-Singh, Komal; Eaddy, Michael

2018-02-01

The utilization of healthcare services and costs among patients with cancer is often estimated by the phase of care: initial, interim, or terminal. Although their durations are often set arbitrarily, we sought to establish data-driven phases of care using joinpoint regression in an advanced melanoma population as a case example. A retrospective claims database study was conducted to assess the costs of advanced melanoma from distant metastasis diagnosis to death during January 2010-September 2014. Joinpoint regression analysis was applied to identify the best-fitting points, where statistically significant changes in the trend of average monthly costs occurred. To identify the initial phase, average monthly costs were modeled from metastasis diagnosis to death; and were modeled backward from death to metastasis diagnosis for the terminal phase. Points of monthly cost trend inflection denoted ending and starting points. The months between represented the interim phase. A total of 1,671 patients with advanced melanoma who died met the eligibility criteria. Initial phase was identified as the 5-month period starting with diagnosis of metastasis, after which there was a sharp, significant decline in monthly cost trend (monthly percent change [MPC] = -13.0%; 95% CI = -16.9% to -8.8%). Terminal phase was defined as the 5-month period before death (MPC = -14.0%; 95% CI = -17.6% to -10.2%). The claims-based algorithm may under-estimate patients due to misclassifications, and may over-estimate terminal phase costs because hospital and emergency visits were used as a death proxy. Also, recently approved therapies were not included, which may under-estimate advanced melanoma costs. In this advanced melanoma population, optimal duration of the initial and terminal phases of care was 5 months immediately after diagnosis of metastasis and before death, respectively. Joinpoint regression can be used to provide data-supported phase of cancer care durations, but should be combined with clinical judgement.

47 CFR 51.331 - Notice of network changes: Timing of notice.

Code of Federal Regulations, 2012 CFR

2012-10-01

... changes at the make/buy point, as defined in paragraph (b) of this section, but at least 12 months before... change. (1) For purposes of this section, a product is any hardware r software for use in an incumbent...

Long-term effect of tetracycline fibers on recurrent lesions in periodontal maintenance patients.

PubMed

Corsair, A

1994-01-01

Thirty-one patients with chronic adult periodontitis participated in this long-term private practice study. Sixty-one sites with moderate (4-6 mm, n = 21) or deep (> or = 7 mm, n = 40) periodontal pockets and bleeding on probing were treated with an antibiotic-releasing fiber, Actisite (Periodontal Therapeutic System) (tetracycline hydrochloride). Scaling/root planing (SRP) was performed on all teeth 3 weeks before start of the study, and on most teeth immediately before fiber insertion. Monolithic fibers loaded with 25% tetracycline hydrochloride were inserted in periodontal pockets, where they were retained for a mean of 6.7 days, at which point they were removed. Patients were evaluated at 1, 3, and 6 months after treatment; subgroups were also evaluated at normalized 12-month (10 patients, 20 sites) and 24-month (13 patients, 20 sites) time points. Sites showed a mean probing depth reduction of 2.5 mm at 6 months, and 2.2 mm at 24 months, with the deepest sites showing the greatest reduction. Bleeding on probing was 100% at baseline, 34% at 3 months, and 50% at 6 months. Attachment gains in 18 patients (25 sites) were 2.4 mm at 1 month, 3.0 mm at 3 months, and 2.5 mm at 6 months. Fibers were well tolerated; no adverse effects from treatment were noted. These results indicate that use of tetracycline fiber plus SRP clearly reduced the clinical signs of periodontal disease and maintained or improved attachment for up to 24 months in sites previously refractory to treatment.

Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors

PubMed Central

Steiner, Victoria; Pierce, Linda; Drahuschak, Sean; Nofziger, Erin; Buchman, Debra; Szirony, Tracy

2008-01-01

Guided by Orem’s self-care deficit nursing theory, the purpose of this descriptive comparative study was to examine the emotional support, physical help, and health of caregivers of stroke survivors. Seventy-three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke. Caregivers were randomized to an online intervention of support and education (n = 36 Web users) or a control group (n = 37 non-Web users). A secondary analysis of data collected during telephone interviews at baseline, 3, 6, and 12 months after stroke was performed. No significant mean differences were found between Web and non-Web users in the above variables at these points in time. Consequently, the caregivers were merged into one group, and the relationships among the variables at the different points in time were analyzed. Significant, moderately positive relationships were found between emotional support and physical help at baseline, 3, and 12 months. There were also significant, moderately positive relationships between emotional support and caregiver health at 6 and 12 months. Results highlight the importance of caregivers (dependent care agents in Orem’s terms) establishing an adequate self-care system that provides emotional support and physical help. Findings also denote the need for nurses (as caring agents) to assess caregiver health later in the caring process and be aware of its relationship to emotional support. PMID:18330410

[PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

PubMed

Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

2016-02-01

To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P<0.05); the score at 6 months after operation was significantly lower than that at other time points (P<0.05), but no significant difference was shown between the other time points (P>0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor can supply strong strain and decrease the shear forces of suture. So part-Kessler technique with suture anchor is successful in repairing spontaneous Achilles tendon rupture.

A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial

PubMed Central

2013-01-01

Background Mobile technology offers the potential to deliver health-related interventions to individuals who would not otherwise present for in-person treatment. Text messaging (short message service, SMS), being the most ubiquitous form of mobile communication, is a promising method for reaching the most individuals. Objective The goal of the present study was to evaluate the feasibility and preliminary efficacy of a smoking cessation intervention program delivered through text messaging. Methods Adult participants (N=60, age range 18-52 years) took part in a single individual smoking cessation counseling session, and were then randomly assigned to receive either daily non-smoking related text messages (control condition) or the TXT-2-Quit (TXT) intervention. TXT consisted of automated smoking cessation messages tailored to individual’s stage of smoking cessation, specialized messages provided on-demand based on user requests for additional support, and a peer-to-peer social support network. Generalized estimating equation analysis was used to assess the primary outcome (7-day point-prevalence abstinence) using a 2 (treatment groups)×3 (time points) repeated measures design across three time points: 8 weeks, 3 months, and 6 months. Results Smoking cessation results showed an overall significant group difference in 7-day point prevalence abstinence across all follow-up time points. Individuals given the TXT intervention, with higher odds of 7-day point prevalence abstinence for the TXT group compared to the Mojo group (OR=4.52, 95% CI=1.24, 16.53). However, individual comparisons at each time point did not show significant between-group differences, likely due to reduced statistical power. Intervention feasibility was greatly improved by switching from traditional face-to-face recruitment methods (4.7% yield) to an online/remote strategy (41.7% yield). Conclusions Although this study was designed to develop and provide initial testing of the TXT-2-Quit system, these initial findings provide promising evidence that a text-based intervention can be successfully implemented with a diverse group of adult smokers. Trial Registration ClinicalTrials.gov: NCT01166464; http://clinicaltrials.gov/ct2/show/NCT01166464 (Archived by WebCite at http://www.webcitation.org/6IOE8XdE0). PMID:25098502

Evolution of Randomized Trials in Advanced/Metastatic Soft Tissue Sarcoma: End Point Selection, Surrogacy, and Quality of Reporting.

PubMed

Zer, Alona; Prince, Rebecca M; Amir, Eitan; Abdul Razak, Albiruni

2016-05-01

Randomized controlled trials (RCTs) in soft tissue sarcoma (STS) have used varying end points. The surrogacy of intermediate end points, such as progression-free survival (PFS), response rate (RR), and 3-month and 6-month PFS (3moPFS and 6moPFS) with overall survival (OS), remains unknown. The quality of efficacy and toxicity reporting in these studies is also uncertain. A systematic review of systemic therapy RCTs in STS was performed. Surrogacy between intermediate end points and OS was explored using weighted linear regression for the hazard ratio for OS with the hazard ratio for PFS or the odds ratio for RR, 3moPFS, and 6moPFS. The quality of reporting for efficacy and toxicity was also evaluated. Fifty-two RCTs published between 1974 and 2014, comprising 9,762 patients, met the inclusion criteria. There were significant correlations between PFS and OS (R = 0.61) and between RR and OS (R = 0.51). Conversely, there were nonsignificant correlations between 3moPFS and 6moPFS with OS. A reduction in the use of RR as the primary end point was observed over time, favoring time-based events (P for trend = .02). In 14% of RCTs, the primary end point was not met, but the study was reported as being positive. Toxicity was comprehensively reported in 47% of RCTs, whereas 14% inadequately reported toxicity. In advanced STS, PFS and RR seem to be appropriate surrogates for OS. There is poor correlation between OS and both 3moPFS and 6moPFS. As such, caution is urged with the use of these as primary end points in randomized STS trials. The quality of toxicity reporting and interpretation of results is suboptimal. © 2016 by American Society of Clinical Oncology.

Different stability of social-communication problems and negative demanding behaviour from infancy to toddlerhood in a large Dutch population sample

PubMed Central

2014-01-01

Background Little is known about the stability of behavioural and developmental problems as children develop from infants to toddlers in the general population. Therefore, we investigated behavioural profiles at two time points and determined whether behaviours are stable during early development. Methods Parents of 4,237 children completed questionnaires with 62 items about externalizing, internalizing, and social-communicative behaviour when the children were 14–15 and 36–37 months old. Factor mixture modelling identified five homogeneous profiles at both time points: three with relatively normal behaviour or with mild/moderate problems, one with clear communication and interaction problems, and another with pronounced negative and demanding behaviour. Results More than 85% of infants with normal behaviour or mild problems at 14–15 months were reported to behave relatively typically as toddlers at 36–37 months. A similar percentage of infants with moderate communication problems outgrew their problems by the time they were toddlers. However, infants with severe problems had mild to severe problems as toddlers, and did not show completely normal behaviour. Improvement over time occurred more often in children with negative and demanding behaviour than in children with communication and interaction problems. The former showed less homotypic continuity than the latter. Conclusions Negative and demanding behaviour is more often transient and a less specific predictor of problems in toddlerhood than communication and interaction problems. PMID:25061477

A LONGITUDINAL, PERSON-CENTERED ANALYSIS OF EARLY HEAD START MOTHERS' PARENTING.

PubMed

Paschall, Katherine W; Mastergeorge, Ann M

2018-01-01

This study used a person-centered approach to examine stability and change in parenting typologies across early childhood. Profiles were associated within and across time with contextual covariates, including demographic characteristics, risk factors, and Early Head Start participation. Participants were drawn from the Early Head Start Research and Evaluation Project (N = 2, 876). Parenting profiles were identified based on observed parenting dimensions at 14, 24, and 36 months, and pre-Kindergarten (pre-K). Results suggested a four-profile solution at each time point: Supportive, Lukewarm (14 & 24 months)/Sufficient (36 months and pre-K), Harsh, and Detached. Supportive was the largest, most stable, and most likely transitioned into profile while Harsh and Detached represented rare profiles with moderate to low membership stability across time. Depression and family conflict emerged as important correlates of unsupportive parenting profiles both within and across time. Findings are discussed in terms of their relevance for both policy and implementation practices for low-income mothers with young children. © 2017 Michigan Association for Infant Mental Health.

Outcomes of Cutaneous Scar Revision During Surgical Implant Removal in Children with Cerebral Palsy.

PubMed

Davids, Jon R; Diaz, Kevin; Leba, Thu-Ba; Adams, Samuel; Westberry, David E; Bagley, Anita M

2016-08-17

Children who have had surgery involving the placement of an implant frequently undergo a subsequent surgery for hardware removal. The cosmesis of surgical scars following initial and subsequent surgeries is unpredictable. Scar incision (subsequent surgical incision through the initial scar) or excision (around the initial scar) is selected on the basis of the quality of the initial scar. The outcomes following these techniques have not been determined. This prospective, consecutive case series was designed to compare outcomes following surgical scar incision versus excision at the time of implant removal in children with cerebral palsy. Photographs of the scars were made preoperatively and at 6 and 12 months following implant removal and were graded for scar quality utilizing the modified Stony Brook Scar Evaluation Scale (SBSES). Parental assessment of scar appearance was performed at the same time points utilizing a visual analog cosmetic scale (VACS). The scars that were selected for incision had significantly worse SBSES scores at 6 and 12 months following the second surgery compared with preoperative values. However, parents' VACS scores of the incised scars, although worse at 6 months, were comparable with preoperative scores at 12 months. Scars that were selected for excision had significantly worse SBSES scores at 6 months but scores that were comparable with preoperative values at 12 months. VACS scores for the excised scars were comparable at the 3 time points. Surgical incisions that initially healed with good scar quality generally healed well (from the parents' perspective) following subsequent incision through the previous scar. Surgical incisions that initially healed with poor scar quality did not heal better following excision of the previous scar. In such situations, surgical excision of the existing scar should occur in conjunction with additional adjuvant therapies to improve cosmesis. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Influence of Hip Abductor Strength on Functional Outcomes Before and After Total Knee Arthroplasty: Post Hoc Analysis of a Randomized Controlled Trial.

PubMed

Loyd, Brian J; Jennings, Jason M; Judd, Dana L; Kim, Raymond H; Wolfe, Pamela; Dennis, Douglas A; Stevens-Lapsley, Jennifer E

2017-09-01

Total knee arthroplasty (TKA) is associated with declines in hip abductor (HA) muscle strength; however, a longitudinal analysis demonstrating the influence of TKA on trajectories of HA strength change has not been conducted. The purpose of this study was to quantify changes in HA strength from pre-TKA through 3 months post-TKA and to characterize the relationship between HA strength changes and physical performance. This study is a post hoc analysis of a randomized controlled trial. Data from 162 participants (89 women, mean age = 63 y) were used for analysis. Data were collected by masked assessors preoperatively and at 1 and 3 months following surgery. Outcomes included: Timed "Up and Go" test (TUG), Stair Climbing Test (SCT), Six-Minute Walk Test (6MWT), and walking speed. Paired t tests were used for between- and within-limb comparisons of HA strength. Multivariable regression was used to determine contributions of independent variables, HA and knee extensor strength, to the dependent variables of TUG, SCT, 6MWT, and walking speed at each time point. Hip abductor strength was significantly lower in the surgical limb pre-TKA (mean = 0.015; 95% CI = 0.010-0.020), 1 month post-TKA (0.028; 0.023-0.034), and 3 months post-TKA (0.02; 0.014-0.025) compared with the nonsurgical limb. Hip abductor strength declined from pre-TKA to 1 month post-TKA (18%), but not at the 3-month time point (0%). Hip abductor strength independently contributed to performance-based outcomes pre-TKA; however, this contribution was not observed post-TKA. The post hoc analysis prevents examining all outcomes likely to be influenced by HA strength. Surgical limb HA strength is impaired prior to TKA, and worsens following surgery. Furthermore, HA strength contributes to performance-based outcomes, supporting the hypothesis that HA strength influences functional recovery. © 2017 American Physical Therapy Association

Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow-up study.

PubMed

Nova, Esther; Lopez-Vidriero, Irene; Varela, Pilar; Toro, Olga; Casas, J José; Marcos, A Ascensión

2004-12-01

Despite severely reduced intakes, anorexia nervosa (AN) patients seem to maintain serum biochemical parameters within the safe limit. The aim of this study was to assess the evolution of some traditional serum biochemical indicators of nutritional status in a 1-year follow-up of patients with restricting-type AN. 14 adolescent female patients were studied at four different time points: (1) on hospital admission (t0), (2) 1 month later (t1), (3) 6 months after admission (t6) and (4) 12 months after admission (t12). At each time point serum albumin, prealbumin, retinol-binding protein, transferrin, complement factors C3 and C4, zinc and iron status were analysed. 15 healthy adolescents formed the control group. Among the liver-synthesised proteins, a significant time effect was only demonstrated on transferrin and C3 and C4 (ANOVA, P<0.05). Transferrin level in patients on admission was lower than in controls, increased significantly during the first month and showed an opposite pattern in subjects gaining and non-gaining weight between t1 and t12, decreasing only in the group failing to gain further weight. C3 and C4 decreased significantly in t12. Changes in ferritin and zinc showed significant negative correlations with changes in anthropometrical parameters. The changes in transferrin, C3 and C4 levels during the out-patient treatment reveal an increased risk of relapses after 1 year since hospital admission. Ferritin and zinc levels seem to be affected by the nutrient requirements for anabolic processes during nutritional recovery.

A multicenter experience with generic tacrolimus conversion.

PubMed

McDevitt-Potter, Lisa M; Sadaka, Basma; Tichy, Eric M; Rogers, Christin C; Gabardi, Steven

2011-09-27

The first generic tacrolimus product gained Food and Drug Administration approval in August 2009. This prospective, observational trial sought to determine the need for dose titrations and measure drug cost savings on conversion to generic tacrolimus. Transplant recipients on stable tacrolimus doses were converted from brand to generic tacrolimus on a mg:mg basis. Data were collected at the time of generic conversion (study arm) and at a time point exactly 6 months before conversion (control arm) for all subjects. Seventy conversions from four centers are reported. Subjects were a mean of 70 months after kidney (n=37), liver (n=28), or multiorgan (n=5) transplant. In the study arm, mean tacrolimus doses were 4.4 and 4.5 mg/d and mean tacrolimus trough concentrations were 5.8 and 5.9 ng/mL before and after conversion, respectively. In the control arm, mean tacrolimus doses were 4.6 and 4.6 mg/d and mean tacrolimus trough concentrations were 6.1 and 5.9 ng/mL before and after the control time point, respectively. Dose titrations occurred in five patients (7%) in the control arm and 15 patients (21%) in the study arm (P=0.028). Mean monthly drug costs were $645 for brand, $593 for generic, and $595 for generic after dose titrations. Mean monthly patient copays were $38 for brand and $15 for generic. These cumulative data show that dose requirements and trough levels are similar between brand and generic tacrolimus and that generic substitution allows for savings. However, postconversion monitoring is prudent as patients may require dose titration.

A medulloblastoma showing an unusually long doubling time: reflection of its singular nature.

PubMed

Doron, Omer; Zauberman, Jacob; Feldman, Ze'ev

2016-06-01

In this paper, we present a case of a 4-year-old male diagnosed with a desmoplastic, SHH-type medulloblastoma. Retrospectively, we discovered that the patient underwent an MRI scan at 21 months for reasons unrelated, revealing a T1-enhanced lesion at the vermis, later recognized as the source of the tumor. This unique case provides us with a glimpse into the natural history of this tumor. Our ability to measure tumor volume at two defined time points, 31 months apart, enabled us to deduce the tumor's doubling time. This is defined as the time of one cell cycle divided by the amount of cycling cells, multiplied by cell loss factor. Potential doubling time (Tpot) and actual doubling time (Td), calculated using the Gompertzian model, are the most clinically relevant with regard to a tumor's response to radiotherapy. Here, we show an actual doubling-time (Td) of 78 days, and an extrapolated tumor diameter at the time of birth of 0.25 mm. These results both support the medulloblastoma's embryonic origin, and indicating a threefold longer actual doubling time when compared to previous studies. Taking into account the reported range of medulloblastoma potential doubling time, we deduced a cell loss factor of between 48.9 and 95.5 %. These percentages fall in line with other malignant tumors. Although limited due to the obvious reliance on only two points in time and using the Gompertzian model to complete the remainder, to the best of our knowledge, this is the longest follow-up period reported for medulloblastoma. We have described how a unique turn of events enabled us to get a glimpse into the in situ development of a medulloblastoma over a 31-month period. Regarded sometimes as an idiosyncratic tumor comprised of an array of molecular changes, the complexity of medulloblastoma is displayed here, by revealing for the first time an actual doubling time three- to fourfold the previously known length.

Hopelessness as a predictor of attempted suicide among first admission patients with psychosis: A 10-year cohort study

PubMed Central

Klonsky, E. David; Kotov, Roman; Bakst, Shelly; Rabinowitz, Jonathan; Bromet, Evelyn J.

2011-01-01

Little is known about the longitudinal relationship of hopelessness to attempted suicide in psychotic disorders. The present study addresses this gap by assessing hopelessness and attempted suicide at multiple time-points over 10-years in a first-admission cohort with psychosis (n=414). Approximately 1 in 5 participants attempted suicide during the 10-year follow-up, and those who attempted suicide scored significantly higher at baseline on the Beck Hopelessness Scale. In general, a given assessment of hopelessness (i.e., baseline, 6-months, 24-months, and 48-months) reliably predicted attempted suicide up to 4–6 years later, but not beyond. Structural equation modeling indicated that hopelessness prospectively predicted attempted suicide even when controlling for previous attempts. Notably, a cut-point of 3 or greater on the Beck Hopelessness Scale yielded sensitivity and specificity values similar to those found in non-psychotic populations using a cut-point of 9. Results suggest that hopelessness in individuals with psychotic disorders confers information about suicide risk above and beyond history of attempted suicide. Moreover, in comparison to non-psychotic populations, even relatively modest levels of hopelessness appear to confer risk for suicide in psychotic disorders. PMID:22320192

Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery.

PubMed

Chung, Byunghoon; Lee, Hun; Choi, Bong Joon; Seo, Kyung Ryul; Kim, Eung Kwon; Kim, Dae Yune; Kim, Tae-Im

2017-02-01

The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.

Do you see what I hear? Vantage point preference and visual dominance in a time-space synaesthete.

PubMed

Jarick, Michelle; Stewart, Mark T; Smilek, Daniel; Dixon, Michael J

2013-01-01

Time-space synaesthetes "see" time units organized in a spatial form. While the structure might be invariant for most synaesthetes, the perspective by which some view their calendar is somewhat flexible. One well-studied synaesthete L adopts different viewpoints for months seen vs. heard. Interestingly, L claims to prefer her auditory perspective, even though the month names are represented visually upside down. To verify this, we used a spatial-cueing task that included audiovisual month cues. These cues were either congruent with L's preferred "auditory" viewpoint (auditory-only and auditory + month inverted) or incongruent (upright visual-only and auditory + month upright). Our prediction was that L would show enhanced cueing effects (larger response time difference between valid and invalid targets) following the audiovisual congruent cues since both elicit the "preferred" auditory perspective. Also, when faced with conflicting cues, we predicted L would choose the preferred auditory perspective over the visual perspective. As we expected, L did show enhanced cueing effects following the audiovisual congruent cues that corresponded with her preferred auditory perspective, but that the visual perspective dominated when L was faced with both viewpoints simultaneously. The results are discussed with relation to the reification hypothesis of sequence space synaesthesia (Eagleman, 2009).

Do you see what I hear? Vantage point preference and visual dominance in a time-space synaesthete

PubMed Central

Jarick, Michelle; Stewart, Mark T.; Smilek, Daniel; Dixon, Michael J.

2013-01-01

Time-space synaesthetes “see” time units organized in a spatial form. While the structure might be invariant for most synaesthetes, the perspective by which some view their calendar is somewhat flexible. One well-studied synaesthete L adopts different viewpoints for months seen vs. heard. Interestingly, L claims to prefer her auditory perspective, even though the month names are represented visually upside down. To verify this, we used a spatial-cueing task that included audiovisual month cues. These cues were either congruent with L's preferred “auditory” viewpoint (auditory-only and auditory + month inverted) or incongruent (upright visual-only and auditory + month upright). Our prediction was that L would show enhanced cueing effects (larger response time difference between valid and invalid targets) following the audiovisual congruent cues since both elicit the “preferred” auditory perspective. Also, when faced with conflicting cues, we predicted L would choose the preferred auditory perspective over the visual perspective. As we expected, L did show enhanced cueing effects following the audiovisual congruent cues that corresponded with her preferred auditory perspective, but that the visual perspective dominated when L was faced with both viewpoints simultaneously. The results are discussed with relation to the reification hypothesis of sequence space synaesthesia (Eagleman, 2009). PMID:24137140

Persistence and innovation effects in genetic and environmental factors in negative emotionality during infancy: A twin study.

PubMed

Schumann, Lyndall; Boivin, Michel; Paquin, Stéphane; Lacourse, Eric; Brendgen, Mara; Vitaro, Frank; Dionne, Ginette; Tremblay, Richard E; Booij, Linda

2017-01-01

Difficult temperament in infancy is a risk factor for forms of later internalizing and externalizing psychopathology, including depression and anxiety. A better understanding of the roots of difficult temperament requires assessment of its early development with a genetically informative design. The goal of this study was to estimate genetic and environmental contributions to individual differences in infant negative emotionality, their persistence over time and their influences on stability between 5 and 18 months of age. Participants were 244 monozygotic and 394 dizygotic twin pairs (49.7% male) recruited from birth. Mothers rated their twins for negative emotionality at 5 and 18 months. Longitudinal analysis of stability and innovation between the two time points was performed in Mplus. There were substantial and similar heritability (approximately 31%) and shared environmental (57.3%) contributions to negative emotionality at both 5 and 18 months. The trait's interindividual stability across time was both genetically- and environmentally- mediated. Evidence of innovative effects (i.e., variance at 18 months independent from variance at 5 months) indicated that negative emotionality is developmentally dynamic and affected by persistent and new genetic and environmental factors at 18 months. In the first two years of life, ongoing genetic and environmental influences support temperamental negative emotionality but new genetic and environmental factors also indicate dynamic change of those factors across time. A better understanding of the source and timing of factors on temperament in early development, and role of sex, could improve efforts to prevent related psychopathology.

Mobile Device Trends in Orthopedic Surgery: Rapid Change and Future Implications.

PubMed

Andrawis, John P; Muzykewicz, David A; Franko, Orrin I

2016-01-01

Mobile devices are increasingly becoming integral communication and clinical tools. Monitoring the prevalence and utilization characteristics of surgeons and trainees is critical to understanding how these new technologies can be best used in practice. The authors conducted a prospective Internet-based survey over 7 time points from August 2010 to August 2014 at all nationwide American Council for Graduate Medical Education-accredited orthopedic programs. The survey questionnaire was designed to evaluate the use of devices and mobile applications (apps) among trainees and physicians in the clinical setting. Results were analyzed and summarized for orthopedic surgeons and trainees. During the 48-month period, there were 7 time points with 467, 622, 329, 223, 237, 111, and 134 responses. Mobile device use in the clinical setting increased across all fields and levels of training during the study period. Orthopedic trainees increased their use of Smartphone apps in the clinical setting from 60% to 84%, whereas attending use increased from 41% to 61%. During this time frame, use of Apple/Android platforms increased from 45%/13% to 85%/15%, respectively. At all time points, 70% of orthopedic surgeons believed their institution/hospital should support mobile device use. As measured over a 48-month period, mobile devices have become an ubiquitous tool in the clinical setting among orthopedic surgeons and trainees. The authors expect these trends to continue and encourage providers and trainees to be aware of the limitations and risks inherent with new technology. Copyright 2016, SLACK Incorporated.

Enhancing Teacher Beliefs through an Inquiry-Based Professional Development Program

PubMed Central

McKeown, Tammy R.; Abrams, Lisa M.; Slattum, Patricia W.; Kirk, Suzanne V.

2017-01-01

Inquiry-based instructional approaches are an effective means to actively engage students with science content and skills. This article examines the effects of an ongoing professional development program on middle and high school teachers’ efficacy beliefs, confidence to teach research concepts and skills, and science content knowledge. Professional development activities included participation in a week long summer academy, designing and implementing inquiry-based lessons within the classroom, examining and reflecting upon practices, and documenting ways in which instruction was modified. Teacher beliefs were assessed at three time points, pre- post- and six months following the summer academy. Results indicate significant gains in reported teaching efficacy, confidence, and content knowledge from pre- to post-test. These gains were maintained at the six month follow-up. Findings across the three different time points suggest that participation in the professional development program strongly influenced participants’ fundamental beliefs about their capacity to provide effective instruction in ways that are closely connected to the features of inquiry-based instruction. PMID:29732236

Enhancing Teacher Beliefs through an Inquiry-Based Professional Development Program.

PubMed

McKeown, Tammy R; Abrams, Lisa M; Slattum, Patricia W; Kirk, Suzanne V

2016-01-01

Inquiry-based instructional approaches are an effective means to actively engage students with science content and skills. This article examines the effects of an ongoing professional development program on middle and high school teachers' efficacy beliefs, confidence to teach research concepts and skills, and science content knowledge. Professional development activities included participation in a week long summer academy, designing and implementing inquiry-based lessons within the classroom, examining and reflecting upon practices, and documenting ways in which instruction was modified. Teacher beliefs were assessed at three time points, pre- post- and six months following the summer academy. Results indicate significant gains in reported teaching efficacy, confidence, and content knowledge from pre- to post-test. These gains were maintained at the six month follow-up. Findings across the three different time points suggest that participation in the professional development program strongly influenced participants' fundamental beliefs about their capacity to provide effective instruction in ways that are closely connected to the features of inquiry-based instruction.

Characteristics of Intratendinous Microcirculation Shortly After an Achilles Rupture and Subsequent Treatment Outcomes.

PubMed

Chang, Yi-Ping; Shih, Kao-Shang; Chiang, Hongsen; Ma, Hsiao-Li; Lin, Leou-Chyr; Peng, Wei-Chen; Wen, Che-Sheng; Wang, Hsing-Kuo

2017-01-01

Early microcirculatory responses after experimental tenotomy are critical to the healing of tendons and their ultimate tensile strength. The effects of changes in microcirculation on the outcomes of tendon healing, however, have not been determined. To assess microcirculation values in injured Achilles tendons in the first 3 months after surgical repair and to correlate the inter-limb microcirculatory changes with functional outcomes at 3 and 6 months after surgery. Case-control study. A university sports physiotherapy laboratory. Thirteen subjects (median age: 45 years; range: 34.8-51.9 years) with a repaired Achilles tendon were recruited. Surgical repair. Measurements were obtained at 1, 2, 3, and 6 months after surgery. Bilateral measurements of tendon microcirculation (total hemoglobin [THb] and oxygen saturation [StO 2 ]) were recorded at the first 3 time points, whereas outcome measures of a Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire, one-leg hopping distance, the star excursion balance test, and the heel raise index were conducted at the third and fourth time points. Correlations between the inter-limb microcirculatory changes, eg, between the measurements at 2 months and 1 month (2-1) after surgery, at 3 months and 2 months (3-2) after surgery, and at 3 months and 1 month (3-1) after surgery, and the outcome measures were investigated. Compared with the noninjured tendons, the repaired Achilles demonstrated greater THb (at 1, 2, and 3 months; P = .017, .008, and .012 respectively) and StO 2 (at 3 months; P = .017). Furthermore, the THb2-1 and THb3-2, StO 2 2-1, and StO 2 3-2 showed correlations with the heel raise index, differences in the star excursion balance test and one-leg hopping distance between the noninjured leg and injured leg, and Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire scores (rho -0.921 to 0.855). Changes in the inter-limb microcirculation shortly after Achilles repair were correlated with subsequent symptoms and functional symmetry. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Comparing Weight-for-Length Status of Young Children in Two Infant Feeding Programs.

PubMed

Aldrich, Heather; Gance-Cleveland, Bonnie

2016-12-01

Objectives A cross-sectional study comparing weight-for-length status of children 6-24 months old who participated in Nurse-Family Partnership (NFP) or Special Supplemental Program for Women, Infants, and Children (WIC). Methods Secondary analysis of NFP (n = 44,980) and WIC (n = 31,294) national datasets was conducted to evaluate infant and toddler growth trajectories. Weight-for-length status was calculated at 6, 12, 18, and 24 months based on World Health Organization criteria. Demographics and breastfeeding rates were also evaluated. Binary logistic regression was used to calculate odds ratios for high weight-for-length (≥97.7 percentile) at each time point. Results At 6 months, approximately 10 % of WIC and NFP children were classified as high weight-for-length. High weight-for-length rates increased for both groups similarly until 24 months. At 24 months, NFP children had significantly lower rates of excess weight (P = 0.03) than WIC children, 15.5 and 17.5 % respectively. At all time points, non-Hispanic white children had lower rates of high-weight for length than Hispanic and non-Hispanic black children. NFP infants were also found to have higher rates of ever being breastfed than WIC infants (P < 0.0001). Conclusions for Practice Infant and toddler populations served by NFP or WIC were found to be at increased risk for high weight-for-length. This study found NFP participation was associated with a small, but significant, protective impact on weight-for-length status at 24 months. Continued efforts need to be made in addressing weight-related racial/ethnic and socioeconomic disparities during early childhood.

Association of Graft Ischemic Time with Survival after Heart Transplant Among Children in the United States

PubMed Central

Ford, Mackenzie A.; Almond, Christopher S.; Gauvreau, Kimberlee; Piercey, Gary; Blume, Elizabeth D.; Smoot, Leslie B.; Fynn-Thompson, Francis; Singh, Tajinder P.

2014-01-01

BACKGROUND Previous studies have found no association between graft ischemic time (IT) and survival in pediatric heart transplant (HTx) recipients. However, previous studies were small or analyzed risk only at the extremes of IT, where observations are few. We sought to determine whether graft IT is independently associated with graft survival in a large cohort of children with no a priori assumptions about where the risk threshold may lie. METHODS All children aged <18 years in the U.S. undergoing primary HTx (1987 to 2008) were included. The primary end point was graft loss (death or retransplant) within 6 months. Multivariate analysis was performed to analyze the association between graft IT and graft loss within 6 months after transplant. A secondary end point of longer-term graft loss was assessed among recipients who survived the first 6 months after transplant. RESULTS Of 4,716 pediatric HTxs performed, the median IT was 3.5 hours (interquartile range, 2.7–4.3 hours). Adjusted analysis showed that children with an IT > 3.5 hours were at increased risk of graft loss within 6 months after transplant (hazard ratio, 1.3; 95% confidence interval, 1.1–1.5; p = 0.002). Among 6-month survivors, IT was not associated with longer-term graft loss. CONCLUSIONS IT beyond 3.5 hours is associated with a 30% increase in risk of graft loss within 6 months in pediatric HT recipients. Although the magnitude of risk associated with IT is small compared with the risk associated with recipient factors, these findings may be important during donor assessment for high-risk transplant candidates. PMID:21676628

Change in Pain and Quality of Life Among Women Enrolled in a Trial Examining the Use of Narrow Band Imaging During Laparoscopic Surgery for Suspected Endometriosis.

PubMed

Gallicchio, Lisa; Helzlsouer, Kathy J; Audlin, Kevin M; Miller, Charles; MacDonald, Ryan; Johnston, Mary; Barrueto, Fermin F

2015-01-01

To examine whether the addition of narrow band imaging (NBI) to traditional white light imaging during laparoscopic surgery impacts pain and quality of life (QOL) at 3 and 6 months after surgery among women with suspected endometriosis and/or infertility. A randomized controlled trial (Canadian Task Force classification level I). The trial was conducted in 2 medical centers. From October 2011 to November 2013, 167 patients undergoing laparoscopic examination for suspected endometriosis and/or infertility were recruited. The analytic study sample includes 148 patients with pain and QOL outcome data. Patients were randomized in a 3:1 ratio to receive white light imaging followed by NBI (WL/NBI) or white light imaging only (WL/WL). Questionnaires were administered at baseline and at 3- and 6-month follow-up time points. Average and most severe pain at each time point were assessed using a 10-cm visual analog scale. QOL was measured using the Endometriosis Health Profile-30. Baseline characteristics were similar for the study groups. The WL/NBI and WL/WL groups had similar reductions in pain at 3 and 6 months. In addition, QOL improved similarly for both the WL/NBI and WL/WL groups at 3 and 6 months. Laparoscopic surgery for suspected endometriosis is associated with a reduction in pain and an improvement in QOL. The differences in pain reduction and QOL improvement, which are noted at 3 months and remain stable at 6 months after surgery, are similar for those undergoing surgery with WL/NBI compared with those undergoing surgery under traditional white light conditions. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

[Tossy III injuries of the acromioclavicular joint. In what circumstances is surgery still justified? Personal results and literature review].

PubMed

Prokop, A; Helling, H J; Andermahr, J; Mönig, S; Rehm, K E

2003-05-01

In Germany AC-joint-dislocations type Tossy III are treated in most of the cases operatively. Over two times of period we treated AC-joint-dislocations type Tossy III with biodegradable PDS-cords. 54 patients were operated between 1989 and 1997 and followed up after 39 months. 87.5% of patients are satisfied with results and have 10.2 points at Taftscore. In this period we couldn't differentiated the results by Rockwood classification. 12 patients with Rockwood V were operated between 1998 and 2002 and followed up after 14 months. Excellent and good results were seen in 92% of cases. At Taftscore we seen 10.7 points. 3 patients with Rockwood III were treated conservative with 10.3 points and 3 patients were operated with 10.7 points at Taftscore. AC-joint dislocations should be classified to Rockwood. No differences were seen between operation and conservative treatment in Rockwood III in literature. We recommend operation with PDS cords with good results in Rockwood V.

Injection System for Multi-Well Injection Using a Single Pump

PubMed Central

Wovkulich, Karen; Stute, Martin; Protus, Thomas J.; Mailloux, Brian J.; Chillrud, Steven N.

2015-01-01

Many hydrological and geochemical studies rely on data resulting from injection of tracers and chemicals into groundwater wells. The even distribution of liquids to multiple injection points can be challenging or expensive, especially when using multiple pumps. An injection system was designed using one chemical metering pump to evenly distribute the desired influent simultaneously to 15 individual injection points through an injection manifold. The system was constructed with only one metal part contacting the fluid due to the low pH of the injection solutions. The injection manifold system was used during a three-month pilot scale injection experiment at the Vineland Chemical Company Superfund site. During the two injection phases of the experiment (Phase I = 0.27 L/min total flow, Phase II = 0.56 L/min total flow), flow measurements were made 20 times over three months; an even distribution of flow to each injection well was maintained (RSD <4%). This durable system is expandable to at least 16 injection points and should be adaptable to other injection experiments that require distribution of air-stable liquids to multiple injection points with a single pump. PMID:26140014

Meta-Analysis of Effect Sizes Reported at Multiple Time Points Using General Linear Mixed Model.

PubMed

Musekiwa, Alfred; Manda, Samuel O M; Mwambi, Henry G; Chen, Ding-Geng

2016-01-01

Meta-analysis of longitudinal studies combines effect sizes measured at pre-determined time points. The most common approach involves performing separate univariate meta-analyses at individual time points. This simplistic approach ignores dependence between longitudinal effect sizes, which might result in less precise parameter estimates. In this paper, we show how to conduct a meta-analysis of longitudinal effect sizes where we contrast different covariance structures for dependence between effect sizes, both within and between studies. We propose new combinations of covariance structures for the dependence between effect size and utilize a practical example involving meta-analysis of 17 trials comparing postoperative treatments for a type of cancer, where survival is measured at 6, 12, 18 and 24 months post randomization. Although the results from this particular data set show the benefit of accounting for within-study serial correlation between effect sizes, simulations are required to confirm these results.

Maternal Obesity, 25-Hydroxy Vitamin D Concentration, and Bone Density in Breastfeeding Dyads.

PubMed

Sen, Sarbattama; Penfield-Cyr, Annie; Hollis, Bruce W; Wagner, Carol L

2017-08-01

To examine the association between maternal body mass index (BMI) and serum 25-hydroxy vitamin D [25(OH)D] concentration and bone density in mother-infant pairs. The study was a secondary analysis of 234 exclusively breastfeeding dyads who were recruited in the first postpartum month for a randomized controlled trial of maternal vs infant vitamin D supplementation. Mean 25(OH)D concentrations and bone mineral density (BMD) were compared by BMI group. The adjusted association between maternal BMI and 25(OH)D and bone density was examined at 1, 4, and 7 months postpartum. Obese breastfeeding women had lower 25(OH)D concentrations and higher BMD than lean women at all 3 time points (P  <  .01). Higher maternal BMI was associated with lower maternal serum levels of 25(OH)D at 1, 4, and 7 months postpartum (adjusted β = -0.45 ng/ml per kg/m 2 , 95% CI -.076, -0.14, at 1 month) and higher BMD at the same time points (β = 0.006 BMD z score; 95% CI 0.003, 0.01 at 1 month). Seventy-six percent of infants were vitamin D deficient at 1 month of age. Infants born to overweight and obese mothers had lower 25(OH)D concentrations than infants of lean mothers (P < .01). For infants in the maternal supplementation group, higher maternal BMI was associated with lower 25(OH)D concentrations at 4 months (β = -0.68; 95% CI -1.17, -0.20) and lower bone density at 7 months (β = -0.001; 95% CI -0.002, -0.0001). In exclusively breastfeeding dyads, maternal obesity is associated with lower maternal and infant serum 25(OH)D concentrations, which may impact infant bone density. ClinicalTrials.gov: NCT00412074. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinically Significant Behavior Problems During the Initial 18 Months Following Early Childhood Traumatic Brain Injury

PubMed Central

Chapman, Leah A.; Wade, Shari L.; Walz, Nicolay C.; Taylor, H. Gerry; Stancin, Terry; Yeates, Keith O.

2014-01-01

The present study looked at the emergence of clinically significant problems in behavior, executive function skills (EF), and social competence during the initial 18 months following TBI in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Children, ages 3-7 years, hospitalized for severe TBI moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point post injury. Results suggest that, compared to the OI group, the severe TBI developed significantly more externalizing behavior problems and EF problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low SES. The findings are similar to those found in school-aged children. PMID:20175634

Paternal alcoholism, negative parenting, and the mediating role of marital satisfaction

PubMed Central

Kachadourian, Lorig K.; Eiden, Rina D.; Leonard, Kenneth E.

2013-01-01

Given the documented association between paternal alcoholism and negative parenting behaviors, the purpose of this study was to examine longitudinally whether marital satisfaction mediates this relationship. Participants consisted of 197 families (102 without an alcoholic father, 95 with an alcoholic father) who were assessed at three time points: when children were 12, 24, and 36 months old. Results indicated that paternal alcoholism at 12 months was associated with decreased marital satisfaction at 24 months for both mothers and fathers. Marital satisfaction at 24 months in turn was associated with decreases in parental warmth and sensitivity at 36 months. Furthermore, marital satisfaction mediated the association between paternal alcoholism and parental warmth and sensitivity for both mothers and fathers. The implications of these findings for interventions for alcoholic families are discussed. PMID:19541430

Divorcing Mothers’ Use of Protective Strategies: Differences Over Time and by Violence Experience

PubMed Central

Haselschwerdt, Megan L.; Mitchell, Elissa Thomann; Raffaelli, Marcela; Hardesty, Jennifer L.

2015-01-01

Objective The current study considered protective strategy use at various points in time for divorcing mothers with a range of marital violence experiences (including no history of violence and different types of violence). Method Divorcing mothers (N = 170) from one Midwestern county participated in two in-person interviews that included structured assessments of intimate partner violence (IPV) during the last year of marriage and use of protective strategies at three time points – last year of marriage and at separation (both assessed at Time 1) and since the first interview (at a three month follow-up). Results Divorcing mothers, regardless of marital violence experience, used an array of private and public protective strategies during the last year of marriage, at separation, and at the three-month follow up interview. In general, mothers who experienced coercive controlling violence reported using more protective strategies than mothers who experienced situational couple violence or no violence. Strategy use peaked at separation with an increase in public strategy use. Conclusions All divorcing mothers use a range of active coping strategies over time, yet findings emphasize the importance of making distinctions between types of IPV so that divorcing mothers receive individualized resources and support that best meet their needs and minimize potentials risks and losses as they navigate the divorce process. PMID:26858851

Access to care for children and young people diagnosed with localized scleroderma or juvenile SSc in the UK.

PubMed

Hawley, Daniel P; Baildam, Eileen M; Amin, Tania S; Cruikshank, Mary K; Davidson, Joyce E; Dixon, Jennifer; Martin, Neil S; Ohlsson, Victoria; Pilkington, Clarissa; Rangaraj, Satyapal; Riley, Philip; Sundaramoorthy, Chitra; Walsh, Jo; Foster, Helen E

2012-07-01

To describe pathways of care and referral to paediatric rheumatology from onset of first symptom (noticed by the patient or their family) to diagnosis for children and young people diagnosed with localized scleroderma (LS) or juvenile SSc (jSSc). Retrospective case note audit of patients under paediatric rheumatology care who presented during January 2005-January 2010. Data included disease subtype, sex, age at key points in the referral pathway and health care professional (HCP) contact. All patient and HCP data were pseudo-anonymized in accordance with good clinical practice. Data were from eight UK centres that saw 89 cases: 62 females, 26 males; 73 LS, 16 jSSc. Median time from first symptom to first HCP review was 4 (range 0-72) months (LS) and 1 (range 0-50) month (jSSc). Median time from first symptom to paediatric rheumatology review was 15 (range 1-103) months (LS) and 7 (range 0-50) months (jSSc). Median time from first HCP review to first paediatric rheumatology review was 11 (range 0-103) months (LS) and 2 (range 0-10) months. First HCP seen (74%) was usually a general practitioner. The referring HCP to paediatric rheumatology was usually a dermatologist (56%) for LS. Median time from first symptom to diagnosis was 13 (range 1-102) months (LS) and 8 (range 1-50) months (jSSc). A prolonged interval occurs from first symptom to definitive diagnosis, which may adversely affect outcome. There is a need to raise awareness of this rare diagnosis and facilitate earlier recognition.

Prospective computerized analyses of sensibility in breast reconstruction with non-reinnervated DIEP flap.

PubMed

Santanelli, Fabio; Longo, Benedetto; Angelini, Matteo; Laporta, Rosaria; Paolini, Guido

2011-05-01

The deep inferior epigastric perforator (DIEP) flap is considered the definitive standard for autologous breast reconstruction because of its ability to restore shape, its consistency, and its static and dynamic symmetry, but the degree of spontaneous sensory recovery is still widely discussed. To clarify the real need for sensitive nerve coaptation, return of sensibility in DIEP flaps was investigated using a pressure-specifying sensory device. Thirty consecutive patients with breast cancer scheduled for modified radical mastectomy, axillary node dissection, and immediate reconstruction with cutaneous-adipose DIEP flaps without nerve repair were enrolled in the study. Sensibility for one and two points, static and moving, was tested preoperatively on the breasts and abdomen, and postoperatively at 6 and 12 months on the DIEP flaps. A t test was used for comparison of paired data and to investigate which factors affected sensory recovery. Preoperative healthy breast and abdomen pressure thresholds were lower for two-point than one-point discrimination and for moving discriminations compared with static ones at 6 and 12 months. Although they were significantly higher than those for contralateral healthy breasts (p < 0.05), pressure thresholds in DIEP flaps at 12 months were lower than at 6 months, showing a significant progressive sensory recovery (p < 0.05). At 12 months postoperatively, the best sensibility recovery was found at the inferior lateral quadrant, the worst at the superior medial quadrant. Age and flap weight were factors related to the performance of sensory recovery. DIEP flap transfer for immediate breast reconstruction undergoes satisfactory progressive spontaneous sensitive recovery at 6 and 12 months after surgery, and operative time spent dissecting sensitive perforator branches and their coaptation in recipient site could be spared.

[Effect of different porcelain-fused-to-metal crown inner metal materials on the level of soluble intercellular adhesion molecule-1 and interleukin-1beta in gingival crevicular fluid].

PubMed

Yuan, Tangxia; Zhang, Yanbiao; Wu, Zheng-Hua

2011-10-01

To investigate the effect of different inner metal materials of porcelain-fused-to-metal (PFM) crown on periodontal tissue by means of measuring the level of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-1beta (IL-1beta) in gingival crevicular fluid (GCF) after PFM restorations. 30 teeth were divided into three groups (Ni-Cr alloy group, Co-Cr alloy group and Au-Pt alloy group, 10 teeth each group), and restored by Ni-Cr alloy, Co-Cr alloy and Au-Pt alloy PFM crown according grouping. At the point of pre-restoration, 6-month and 12-month after cementation, the clinical parameters including plaque index (PLI), gingival index (GI) and gingival crevice depth (GCD) were detected, and GCF was collected from labial and lingual of mesial site and distal site. The level of sICAM-1 and IL-1beta were detected. At the point of 6-month and 12-month after cementation, Ni-Cr alloy group showed significant difference for GI, GCD and all GCF indexes when compared to pre-restoration, Co-Cr alloy group and Au-Pt alloy group (P < 0.05). At the point of 12-month after cementation, Co-Cr alloy group showed significant difference for GI, GCD and all GCF indexes when compared to pre-restoration and Au-Pt alloy group (P < 0.05). All indexes have no significant difference for Au-Pt alloy group during the 12-month experiment times when compared to pre-restoration (P > 0.05). Non-noble metal has bad effect on the periodontal tissue.

Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Witnessed Out-of-Hospital Cardiac Arrest in Adults.

PubMed

Hara, Masahiko; Hayashi, Kenichi; Hikoso, Shungo; Sakata, Yasushi; Kitamura, Tetsuhisa

2015-05-01

It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). We enrolled 257,354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38,661, 96,906, and 121,787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome. © 2015 American Heart Association, Inc.

Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

PubMed Central

Shen, Christopher C; Salim, Sarwat; Du, Haiming; Netland, Peter A

2011-01-01

Purpose: To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation. Patients and methods: This was a retrospective comparative case series. We reviewed 40 eyes of 39 patients with underlying diagnosis of neovascular glaucoma, divided into two groups: Ahmed Glaucoma Valve (N = 20) and trabeculectomy with mitomycin C (N = 20). Surgical success was defined as 6 mm Hg ≤ intraocular pressure ≤21 mm Hg, with or without the use of glaucoma medications, with no further glaucoma surgery, and light perception or better vision. Early postoperative hypotony was defined as intraocular pressure <5 mm Hg during the first postoperative week. Results: The average follow-up was 31 months (range 6–87 months) for the Ahmed Glaucoma Valve group and 25 months (6–77 months) for the trabeculectomy group. Although the mean number of postoperative intraocular pressure-lowering medications was significantly higher in the trabeculectomy group compared with the Ahmed Glaucoma Valve group at 3 and 6 month time points, there was no statistically significant difference at any other time point. There was no statistically significant difference between both groups in postoperative visual acuity and intraocular pressure. Success was 70% and 65% at 1 year and 60% and 55% at 2 years after Ahmed Glaucoma Valve and trabeculectomy, respectively. Kaplan–Meier survival curve analysis showed no significant difference in success between the two groups (P = 0.815). Hyphema was the most common complication in both groups. Conclusion: We found similar results after trabeculectomy with mitomycin C and Ahmed Glaucoma Valve implantation in eyes with neovascular glaucoma. PMID:21468334

Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes.

PubMed

Helminen, Heli; Luukkaala, Tiina; Saarnio, Juha; Nuotio, Maria

2017-04-01

Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture. Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type. All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility. All measures were strong indicators of short- and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements. Copyright © 2017 Elsevier Ltd. All rights reserved.

Healthcare Coinsurance Elasticity Coefficient Estimation Using Monthly Cross-sectional, Time-series Claims Data.

PubMed

Scoggins, John F; Weinberg, Daniel A

2017-06-01

Published estimates of the healthcare coinsurance elasticity coefficient have typically relied on annual observations of individual healthcare expenditures even though health plan membership and expenditures are traditionally reported in monthly units and several studies have stressed the need for demand models to recognize the episodic nature of healthcare. Summing individual healthcare expenditures into annual observations complicates two common challenges of statistical inference, heteroscedasticity, and regressor endogeneity. This paper estimates the elasticity coefficient using a monthly panel data model that addresses the heteroscedasticity and endogeneity problems with relative ease. Healthcare claims data from employees of King County, Washington, during 2005 to 2011 were used to estimate the mean point elasticity coefficient: -0.314 (0.015 standard error) to -0.145 (0.015 standard error) depending on model specification. These estimates bracket the -0.2 point estimate (range: -0.22 to -0.17) derived from the famous Rand Health Insurance Experiment. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Cognitive rehabilitation for individuals with opioid use disorder: A randomized controlled trial.

PubMed

Rezapour, Tara; Hatami, Javad; Farhoudian, Ali; Sofuoglu, Mehmet; Noroozi, Alireza; Daneshmand, Reza; Samiei, Ahmadreza; Ekhtiari, Hamed

2017-11-21

To examine the efficacy of cognitive rehabilitation treatment (CRT) for people with opioid use disorder who were recruited into a methadone maintenance treatment (MMT) programme. 120 male subjects were randomly assigned to (1) MMT plus CRT in two months or (2) MMT plus a control intervention. Subjects were assessed at the beginning, mid-point and post-intervention as well as at 1-, 3- and 6-month follow-up time points. Analysis with repeated measure ANOVA showed that the CRT group performed significantly better in tests of learning, switching, processing speed, working memory and memory span. Moreover, the CRT group had significantly lower opiate use over the control group during 3-months follow-up. Analysis including only those with a history of methamphetamine use showed that the CRT group had significantly lower amphetamine use. No group differences were observed for treatment retention. Our findings provide evidence that adding CRT as an adjunct intervention to MMT can improve cognitive performance as well as abstinence from both opiates and stimulants.

Edgar Degas in New Orleans

ERIC Educational Resources Information Center

Herberholz, Barbara

2009-01-01

Edgar Degas was not yet famous, but was on the point of aesthetic and commercial success when he left Paris in the fall for his New Orleans visit of about four months, during which time he painted 22 major works. It might be said that he was having a midlife crisis at this time. He had been painting ballet and horse pictures to assist his father's…

A quantitative evaluation of two methods for preserving hair samples

USGS Publications Warehouse

Roon, David A.; Waits, L.P.; Kendall, K.C.

2003-01-01

Hair samples are an increasingly important DNA source for wildlife studies, yet optimal storage methods and DNA degradation rates have not been rigorously evaluated. We tested amplification success rates over a one-year storage period for DNA extracted from brown bear (Ursus arctos) hair samples preserved using silica desiccation and -20C freezing. For three nuclear DNA microsatellites, success rates decreased significantly after a six-month time point, regardless of storage method. For a 1000 bp mitochondrial fragment, a similar decrease occurred after a two-week time point. Minimizing delays between collection and DNA extraction will maximize success rates for hair-based noninvasive genetic sampling projects.

Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

PubMed Central

Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.

2013-01-01

Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54–$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893–$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost. PMID:22729481

The Impact of Transport Time on Outcomes Following Evacuation from Point of Injury

DTIC Science & Technology

2017-06-16

FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 1. Your paper, entitled The Impact of Transport Time on Outcomes Following Evacuation from...mail) that your presentation was given. At that time , we will need the date (month, day and year) along with the location of your presentation. It is...Congratulations, and thank you for your efforts and time . Your contributions are vital to the medical mission. We look forward to assisting you in your future

Development and validation of a set of six adaptable prognosis prediction (SAP) models based on time-series real-world big data analysis for patients with cancer receiving chemotherapy: A multicenter case crossover study

PubMed Central

Kanai, Masashi; Okamoto, Kazuya; Yamamoto, Yosuke; Yoshioka, Akira; Hiramoto, Shuji; Nozaki, Akira; Nishikawa, Yoshitaka; Yamaguchi, Daisuke; Tomono, Teruko; Nakatsui, Masahiko; Baba, Mika; Morita, Tatsuya; Matsumoto, Shigemi; Kuroda, Tomohiro; Okuno, Yasushi; Muto, Manabu

2017-01-01

Background We aimed to develop an adaptable prognosis prediction model that could be applied at any time point during the treatment course for patients with cancer receiving chemotherapy, by applying time-series real-world big data. Methods Between April 2004 and September 2014, 4,997 patients with cancer who had received systemic chemotherapy were registered in a prospective cohort database at the Kyoto University Hospital. Of these, 2,693 patients with a death record were eligible for inclusion and divided into training (n = 1,341) and test (n = 1,352) cohorts. In total, 3,471,521 laboratory data at 115,738 time points, representing 40 laboratory items [e.g., white blood cell counts and albumin (Alb) levels] that were monitored for 1 year before the death event were applied for constructing prognosis prediction models. All possible prediction models comprising three different items from 40 laboratory items (40C3 = 9,880) were generated in the training cohort, and the model selection was performed in the test cohort. The fitness of the selected models was externally validated in the validation cohort from three independent settings. Results A prognosis prediction model utilizing Alb, lactate dehydrogenase, and neutrophils was selected based on a strong ability to predict death events within 1–6 months and a set of six prediction models corresponding to 1,2, 3, 4, 5, and 6 months was developed. The area under the curve (AUC) ranged from 0.852 for the 1 month model to 0.713 for the 6 month model. External validation supported the performance of these models. Conclusion By applying time-series real-world big data, we successfully developed a set of six adaptable prognosis prediction models for patients with cancer receiving chemotherapy. PMID:28837592

Adult attachment status predicts the developmental trajectory of maternal sensitivity in new motherhood among Chinese mothers.

PubMed

Liang, X; Wang, Z-Y; Liu, H-Y; Lin, Q; Wang, Z; Liu, Y

2015-01-01

to investigate adult attachment status in first-time mothers, and stability and/or changes in maternal sensitivity during infancy. longitudinal study using quantitative and qualitative methods, and statistical modelling. Three home visits were undertaken when the infant was approximately six, nine and 14 months old. The Adult-to-Parental Attachment Experience Survey was used, and scores for three dimensions were obtained: secure-autonomous, preoccupied and dismissive. Maternal sensitivity was assessed at each time point using the Maternal Behaviour Q-Sort by observing interaction between the mother and infant at home. homes and community settings in greater metropolitan Beijing, North China. 83 mothers and infants born in 2010 enrolled in this study. Data were missing for one or more time points in 20 cases. the mean score for maternal sensitivity tended to increase from six to 14 months. Post-hoc analyses of one-way repeated-measures analysis of variance revealed that maternal sensitivity was significantly higher at 14 months than at six or nine months. An unconditional latent growth model (LGM) of maternal sensitivity, estimated using the Bayesian approach, provided a good fit for the data. Using three attachment-related variables as predictors in the conditional LGM, the model fitting indices were found to be sufficient, and the results suggested that the secure score positively predicted the intercept of the growth model, and the dismissive score negatively predicted both the intercept and slope of the growth model. maternal sensitivity increased over time during infancy. Furthermore, individual differences existed in the developmental trajectory, which was influenced by maternal attachment status. knowledge about attachment-related differences in the trajectory of first-time mothers' sensitivity to infants may help midwives and doctors to provide individualised information and support, with special attention given to mothers with a dismissive attachment status. Copyright © 2014 Elsevier Ltd. All rights reserved.

Availability of arsenic in human milk in women and its correlation with arsenic in urine of breastfed children living in arsenic contaminated areas in Bangladesh.

PubMed

Islam, Md Rafiqul; Attia, John; Alauddin, Mohammad; McEvoy, Mark; McElduff, Patrick; Slater, Christine; Islam, Md Monirul; Akhter, Ayesha; d'Este, Catherine; Peel, Roseanne; Akter, Shahnaz; Smith, Wayne; Begg, Stephen; Milton, Abul Hasnat

2014-12-04

Early life exposure to inorganic arsenic may be related to adverse health effects in later life. However, there are few data on postnatal arsenic exposure via human milk. In this study, we aimed to determine arsenic levels in human milk and the correlation between arsenic in human milk and arsenic in mothers and infants urine. Between March 2011 and March 2012, this prospective study identified a total of 120 new mother-baby pairs from Kashiani (subdistrict), Bangladesh. Of these, 30 mothers were randomly selected for human milk samples at 1, 6 and 9 months post-natally; the same mother baby pairs were selected for urine sampling at 1 and 6 months. Twelve urine samples from these 30 mother baby pairs were randomly selected for arsenic speciation. Arsenic concentration in human milk was low and non-normally distributed. The median arsenic concentration in human milk at all three time points remained at 0.5 μg/L. In the mixed model estimates, arsenic concentration in human milk was non-significantly reduced by -0.035 μg/L (95% CI: -0.09 to 0.02) between 1 and 6 months and between 6 and 9 months. With the progression of time, arsenic concentration in infant's urine increased non-significantly by 0.13 μg/L (95% CI: -1.27 to 1.53). Arsenic in human milk at 1 and 6 months was not correlated with arsenic in the infant's urine at the same time points (r = -0.13 at 1 month and r = -0.09 at 6 month). Arsenite (AsIII), arsenate (AsV), monomethyl arsonic acid (MMA), dimethyl arsinic acid (DMA) and arsenobetaine (AsB) were the constituents of total urinary arsenic; DMA was the predominant arsenic metabolite in infant urine. We observed a low arsenic concentration in human milk. The concentration was lower than the World Health Organization's maximum permissible limit (WHO Permissible Limit 15 μg/kg-bw/week). Our findings support the safety of breastfeeding even in arsenic contaminated areas.

Social Cognitive Theory Predictors of Exercise Behavior in Endometrial Cancer Survivors

PubMed Central

Basen-Engquist, Karen; Carmack, Cindy L.; Li, Yisheng; Brown, Jubilee; Jhingran, Anuja; Hughes, Daniel C.; Perkins, Heidi Y.; Scruggs, Stacie; Harrison, Carol; Baum, George; Bodurka, Diane C.; Waters, Andrew

2014-01-01

Objective This study evaluated whether social cognitive theory (SCT) variables, as measured by questionnaire and ecological momentary assessment (EMA), predicted exercise in endometrial cancer survivors. Methods One hundred post-treatment endometrial cancer survivors received a 6-month home-based exercise intervention. EMAs were conducted using hand-held computers for 10- to 12-day periods every 2 months. Participants rated morning self-efficacy and positive and negative outcome expectations using the computer, recorded exercise information in real time and at night, and wore accelerometers. At the midpoint of each assessment period participants completed SCT questionnaires. Using linear mixed-effects models, we tested whether morning SCT variables predicted minutes of exercise that day (Question 1) and whether exercise minutes at time point Tj could be predicted by questionnaire measures of SCT variables from time point Tj-1 (Question 2). Results Morning self-efficacy significantly predicted that day’s exercise minutes (p<.0001). Morning positive outcome expectations was also associated with exercise minutes (p=0.0003), but the relationship was attenuated when self-efficacy was included in the model (p=0.4032). Morning negative outcome expectations was not associated with exercise minutes. Of the questionnaire measures of SCT variables, only exercise self-efficacy predicted exercise at the next time point (p=0.003). Conclusions The consistency of the relationship between self-efficacy and exercise minutes over short (same day) and longer (Tj to Tj-1) time periods provides support for a causal relationship. The strength of the relationship between morning self-efficacy and exercise minutes suggest that real-time interventions that target daily variation in self-efficacy may benefit endometrial cancer survivors’ exercise adherence. PMID:23437853

A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique

PubMed Central

Heiney, Jake; Cher, Daniel

2015-01-01

Background A number of studies have been published regarding minimally invasive surgical (MIS) fusion of the sacroiliac (SI) joint using a lateral transarticular approach. Herein we report a systematic review and meta-analysis to summarize operative measures and clinical outcomes reported in published studies of MIS SI joint fusion. Methods The systematic review was done according to PRISMA standards. PubMed and EMBASE were searched using the terms sacroiliac joint AND fusion. Original peer-reviewed articles in the English language that reported clinical outcomes on at least 5 cases of MIS SI joint fusion using a lateral transarticular approach were included. Random effects meta-analysis (RMA) was performed on selected variables using the DerSimonian and Laird method, including operative measures, VAS SI joint pain ratings (0-10 scale) and Oswestry Disability Index (ODI). Mean and 95% confidence intervals (CI) were calculated and heterogeneity was assessed. Other findings were summarized qualitatively. Results A total of 18 articles met the inclusion criteria. After accounting for overlapping cohorts, 12 unique cohorts from 4 countries were extracted for a total of 432 subjects. The RMA mean (range) was 59 minutes (27-78) for procedure time, 36.9cc (10-70) for estimated blood loss and 1.7 days (range 0-7) for length of stay (LOS). The RMA mean [95% CI] pain score dropped by 5.2 points at 6 months and 5.3 points at 12 months (baseline score of 8.1 [7.8-8.4], 12-month score of 2.7 [2.1-3.3]), and a 24-month score of 2.0(1.4-2.5). ODI decreased by 31 points at 12 months (baseline score of 56.2 [51.0-61.5], 6-month score of 30.7 [21.8-39.6], and 12-month score of 25.1 [12.3-37.9]). Some estimates showed significant variation across studies and between the types of implants used. Other reported outcomes were supportive of the positive effects of SI joint fusion. Conclusion Published studies of MIS SI joint fusion using a lateral transarticular approach confirm its minimally invasive characteristics with minimal blood loss and short operating room times, and show consistent, rapid, sustained and clinically important improvements in patient reported SI joint pain, disability and quality of life scores. PMID:26273558

A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique.

PubMed

Heiney, Jake; Capobianco, Robyn; Cher, Daniel

2015-01-01

A number of studies have been published regarding minimally invasive surgical (MIS) fusion of the sacroiliac (SI) joint using a lateral transarticular approach. Herein we report a systematic review and meta-analysis to summarize operative measures and clinical outcomes reported in published studies of MIS SI joint fusion. The systematic review was done according to PRISMA standards. PubMed and EMBASE were searched using the terms sacroiliac joint AND fusion. Original peer-reviewed articles in the English language that reported clinical outcomes on at least 5 cases of MIS SI joint fusion using a lateral transarticular approach were included. Random effects meta-analysis (RMA) was performed on selected variables using the DerSimonian and Laird method, including operative measures, VAS SI joint pain ratings (0-10 scale) and Oswestry Disability Index (ODI). Mean and 95% confidence intervals (CI) were calculated and heterogeneity was assessed. Other findings were summarized qualitatively. A total of 18 articles met the inclusion criteria. After accounting for overlapping cohorts, 12 unique cohorts from 4 countries were extracted for a total of 432 subjects. The RMA mean (range) was 59 minutes (27-78) for procedure time, 36.9cc (10-70) for estimated blood loss and 1.7 days (range 0-7) for length of stay (LOS). The RMA mean [95% CI] pain score dropped by 5.2 points at 6 months and 5.3 points at 12 months (baseline score of 8.1 [7.8-8.4], 12-month score of 2.7 [2.1-3.3]), and a 24-month score of 2.0(1.4-2.5). ODI decreased by 31 points at 12 months (baseline score of 56.2 [51.0-61.5], 6-month score of 30.7 [21.8-39.6], and 12-month score of 25.1 [12.3-37.9]). Some estimates showed significant variation across studies and between the types of implants used. Other reported outcomes were supportive of the positive effects of SI joint fusion. Published studies of MIS SI joint fusion using a lateral transarticular approach confirm its minimally invasive characteristics with minimal blood loss and short operating room times, and show consistent, rapid, sustained and clinically important improvements in patient reported SI joint pain, disability and quality of life scores.

Dynamics of the serologic response in vaccinated and unvaccinated mumps cases during an epidemic.

PubMed

Kaaijk, Patricia; Gouma, Sigrid; Hulscher, Hinke I; Han, Wanda G; Kleijne, Deborah E; van Binnendijk, Rob S; van Els, Cécile A

2015-01-01

In the last decade, several mumps outbreaks were reported in various countries despite high vaccination coverage. In most cases, young adults were affected who have acquired immunity against mumps solely by vaccination and not by previous wild-type mumps virus infection. To investigate mumps-specific antibody levels, functionality and dynamics during a mumps epidemic, blood samples were obtained longitudinally from 23 clinical mumps cases, with or without a prior history of vaccination, and from 20 healthy persons with no serological evidence of recent mumps virus infection. Blood samples from mumps cases were taken 1-2 months and 7-10 months after onset of disease. Both vaccinated and unvaccinated mumps cases had significantly higher geomean concentrations of mumps-specific IgG (resp. 13,617 RU/ml (95% CI of 9,574-19,367 RU/ml) vs. 1,552 (445-5412) RU/ml at 1-2 months; and 6,514 (5,247-8,088) RU/ml vs. 1,143 (480-2,725) RU/ml at 7-10 months) than healthy controls (169 (135-210) RU/ml) (p = 0.001). Patterns in virus-neutralizing (VN) antibody responses against the mumps vaccine virus were similar, vaccinated and unvaccinated mumps cases had significantly higher ND50 values at both time points of sampling (resp 4,695 (3,779-5,832) RU/ml vs. 1,533 (832-2,825) RU/ml at 1-2 months; 2,478 (1,968-3,122) RU/ml vs. 1,221 (1,029-1,449) RU/ml at 7-10 months) compared with (previously vaccinated) healthy controls (122 (196-76)) RU/ml) (p = 0.001) The unvaccinated mumps cases had significantly lower mumps-specific IgG and VN antibody concentrations at both sampling points compared with previously vaccinated cases, but their antibody concentrations did not differ significantly at the 2 time points. In contrast, the mumps-specific IgG and VN antibody concentrations of the previously vaccinated mumps cases were significantly higher within the first 2 months after onset of mumps and declined thereafter, characteristic for a secondary response. A moderate correlation was found between the level of mumps-specific IgG serum antibodies and VN antibodies for the mumps cases (r = 0.64; p<0.001).

Dynamics of the serologic response in vaccinated and unvaccinated mumps cases during an epidemic

PubMed Central

Kaaijk, Patricia; Gouma, Sigrid; Hulscher, Hinke I; Han, Wanda G; Kleijne, Deborah E; van Binnendijk, Rob S; van Els, Cécile A

2015-01-01

In the last decade, several mumps outbreaks were reported in various countries despite high vaccination coverage. In most cases, young adults were affected who have acquired immunity against mumps solely by vaccination and not by previous wild-type mumps virus infection. To investigate mumps-specific antibody levels, functionality and dynamics during a mumps epidemic, blood samples were obtained longitudinally from 23 clinical mumps cases, with or without a prior history of vaccination, and from 20 healthy persons with no serological evidence of recent mumps virus infection. Blood samples from mumps cases were taken 1–2 months and 7–10 months after onset of disease. Both vaccinated and unvaccinated mumps cases had significantly higher geomean concentrations of mumps-specific IgG (resp. 13,617 RU/ml (95% CI of 9,574–19,367 RU/ml) vs. 1,552 (445–5412) RU/ml at 1–2 months; and 6,514 (5,247–8,088) RU/ml vs. 1,143 (480–2,725) RU/ml at 7–10 months) than healthy controls (169 (135–210) RU/ml) (p = 0.001). Patterns in virus-neutralizing (VN) antibody responses against the mumps vaccine virus were similar, vaccinated and unvaccinated mumps cases had significantly higher ND50 values at both time points of sampling (resp 4,695 (3,779–5,832) RU/ml vs. 1,533 (832–2,825) RU/ml at 1–2 months; 2,478 (1,968–3,122) RU/ml vs. 1,221 (1,029–1,449) RU/ml at 7–10 months) compared with (previously vaccinated) healthy controls (122 (196–76)) RU/ml) (p = 0.001) The unvaccinated mumps cases had significantly lower mumps-specific IgG and VN antibody concentrations at both sampling points compared with previously vaccinated cases, but their antibody concentrations did not differ significantly at the 2 time points. In contrast, the mumps-specific IgG and VN antibody concentrations of the previously vaccinated mumps cases were significantly higher within the first 2 months after onset of mumps and declined thereafter, characteristic for a secondary response. A moderate correlation was found between the level of mumps-specific IgG serum antibodies and VN antibodies for the mumps cases (r = 0.64; p<0.001). PMID:26047038

Effect of total body irradiation on late lung effects: hidden dangers.

PubMed

Johnston, Carl J; Manning, Casey; Hernady, Eric; Reed, Christina; Thurston, Sally W; Finkelstein, Jacob N; Williams, Jacqueline P

2011-08-01

In our ongoing investigation into the consequences of a radiological terrorism or nuclear dispersion event, we assessed whether a dose range that is believed to be sub-threshold for the development of lung endpoints results in late pathological changes and, secondarily, whether those late changes affect the lung's ability to respond to subsequent challenge. C57BL/6J mice received total body irradiation (0.5-10 Gy) and were followed for 6-18 months after irradiation. At 12 and 15 months, a subset of mice was exposed to a second challenge (aerosolised lipopolysaccharide [LPS]). Cytokines shown to be upregulated early (hours) following irradiation (interleukin [IL]6, keratinocyte chemoattractant [KC], IL1B, and IL1R2) demonstrated increases in messenger ribose nucleic acid (mRNA) expression at late time points, beginning at nine months. Although persistent, dose-dependent increases in T cell counts were seen, no other overt changes in pathophysiology were observed. Nonetheless, animals that were exposed to a secondary challenge at late time points demonstrated an increased inflammatory cell recruitment and persistence in response relative to controls. We propose that, following doses that elicit little change in pathophysiology, sub-clinical radiation-induced injury increases the lungs' susceptibility to a secondary challenge, possibly through a radiation-induced alteration in the immune defense system.

Psychiatric symptoms and psychosocial functioning among hospital personnel during the Gaza War: a repeated cross-sectional study.

PubMed

Ben-Ezra, Menachem; Palgi, Yuval; Wolf, Jonathan Jacob; Shrira, Amit

2011-10-30

Studies of mental health among hospital personnel during armed conflict are scarce and usually include single time point investigations without a comparison group. The authors compared the psychiatric symptoms and psychosocial functioning of exposed and unexposed hospital personnel at two time points. The research was conducted during 2009 and included a survey of two random samples of hospital personnel (physicians and nurses), one collected during the Gaza War and the other 6 months later. Each sample included hospital personnel who were exposed to war-related stress and others who were not (Study 1: n=67 and 74 for exposed and unexposed, respectively; Study 2: n=57 and 50 for exposed and unexposed, respectively). Levels of psychiatric symptoms and psychosocial functioning were measured. Compared to unexposed hospital personnel, exposed hospital personnel had a significantly higher level of post-traumatic symptoms during the Gaza War and 6 months later. In addition, during the Gaza War, exposed hospital personnel had a significantly higher level of depressive symptoms. However, in the second study, depressive symptoms were similar to those found in the unexposed group. These findings may suggest that war-related stress is associated with post-traumatic symptoms among hospital personnel even 6 months after exposure. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVEALS INTERNAL LIMITING MEMBRANE PEELING ALTERS DEEP RETINAL VASCULATURE.

PubMed

Michalewska, Zofia; Nawrocki, Jerzy

2018-04-30

To describe morphology of retinal and choroidal vessels in swept-source optical coherence tomography angiography before and after vitrectomy with the temporal inverted internal limiting membrane (ILM) flap technique for full-thickness macular holes. Prospective, observational study of 36 eyes of 33 patients with full-thickness macular holes swept-source optical coherence tomography angiography was performed in patients before and 1 month after vitrectomy. Vitrectomy with the temporal inverted ILM flap technique was performed. In this method, ILM is peeled only at one side of the fovea. An ILM flap is created to cover the macular hole. Comparison of retina vasculature in the areas of ILM peeling vs. no ILM peeling at 1 and 3 months after successful vitrectomy was performed. The study demonstrated lower density of vessels in the deep retinal plexus in the area where ILM was peeled as compared to the rest of the fovea. Visual acuity and central retinal thickness 1 month after surgery correlates with fovea avascular zone diameter in deep retinal layers at the same time point (P = 0.001). This study confirmed that ILM peeling might alter blood flow in deep retinal vessels below the peeling area in the early postoperative period. The area of the fovea avascular zone corresponds to functional results at the same time point.

Binge Eating Behavior and Weight Loss Maintenance over a 2-Year Period

PubMed Central

Pacanowski, Carly R.; Senso, Meghan M.; Crain, A. Lauren; Sherwood, Nancy E.

2014-01-01

Objective. To investigate the relationship between binge eating behavior and weight loss maintenance over a two-year period in adults. Design. Secondary data analysis using the Keep It Off study, a randomized trial evaluating an intervention to promote weight loss maintenance. Participants. 419 men and women (ages: 20 to 70 y; BMI: 20–44 kg/m2) who had intentionally lost ≥10% of their weight during the previous year. Measurements. Body weight was measured and binge eating behavior over the past 6 months was reported at baseline, 12 months and 24 months. Height was measured at baseline. Results. Prevalence of binge eating at baseline was 19.4% (n = 76). Prevalence of binge eating at any time point was 30.1% (n = 126). Although rate of weight regain did not differ significantly between those who did or did not report binge eating at baseline, binge eating behavior across the study period (additive value of presence or absence at each time point) was significantly associated with different rates of weight regain. Conclusion. Tailoring weight loss maintenance interventions to address binge eating behavior is warranted given the prevalence and the different rates of weight regain experienced by those reporting this behavior. PMID:24891946

A 6-month follow-up study of posttraumatic stress and anxiety/depressive symptoms in Korean children after direct or indirect exposure to a single incident of trauma.

PubMed

Kim, Boong-Nyun; Kim, Jae-Won; Kim, Hyo-Won; Shin, Min-Sup; Cho, Soo-Churl; Choi, Nam Hee; Ahn, Hyunnie; Lee, Seung-Yeon; Ryu, Jeong; Yun, Myoung-Joo

2009-08-01

The aims of this study were to examine the symptoms of posttraumatic stress and anxiety/depression in Korean children after direct or indirect exposure to a single incident of trauma during a fire-escape drill and to assess the incidence of psychiatric disorders in this population. A total of 1,394 students who attended the elementary school at which the traumatic event took place were evaluated using self-administered questionnaires (the Child Posttraumatic Stress Disorder-Reaction Index [CPTSD-RI], State Anxiety Scale of the State-Trait Anxiety Inventory for Children [STAIC], and Children's Depression Inventory [CDI]), as well as structured diagnostic interviews (Diagnostic Interview Schedule for Children, Version-IV [DISC-IV]) at 2 days (time point 1), 2 months (time point 2), and 6 months (time point 3) after the incident. The 335 students who witnessed the accident were defined as the direct-exposure group, and the remaining students (n = 1,059) were defined as the indirect-exposure group. The study was conducted from May to November 2007. At time point 1, the prevalence of severe posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms was 18.2%, 5.5%, and 3.4%, respectively. The prevalence of severe PTSD symptoms, as measured by the CPTSD-RI, was significantly higher in the direct-exposure group than in the indirect-exposure group (36.6% vs 12.7%, respectively; P < .001). At time point 2, the prevalence of severe PTSD symptoms was 7.4% (14.0% in the direct-exposure group and 4.9% in the indirect-exposure group, P < .001). The mean total CPTSD-RI score was significantly higher (P < .001) in the direct-exposure group than in the indirect-exposure group. At time point 3, thirty-eight of the 58 subjects (65.5%) evaluated with the DISC-IV in the direct-exposure group had 1 or more of the 7 anxiety/depressive disorders assessed, including subthreshold diagnoses. Among the diagnoses meeting full DSM-IV criteria for each disorder, agoraphobia was the most prevalent (22.4%), followed by generalized anxiety disorder (13.8%), separation anxiety disorder (6.9%), PTSD (5.2%), and social phobia (5.2%). When the subthreshold diagnoses were considered along with the full syndrome diagnoses, separation anxiety disorder was the most common diagnosis (41.4%), followed by agoraphobia (34.5%), obsessive-compulsive disorder (22.4%), PTSD (20.7%), and social phobia (20.7%). The results of this study provide important evidence that various anxiety/depressive disorders, in addition to PTSD, might follow after direct or indirect exposure to trauma. Our findings highlight the importance of comprehensive screening for psychiatric problems in children exposed to trauma of any scale. ©Copyright 2009 Physicians Postgraduate Press, Inc.

Infant Developmental Outcomes: A Family Systems Perspective

ERIC Educational Resources Information Center

Parfitt, Ylva; Pike, Alison; Ayers, Susan

2014-01-01

The aim of the current study was to examine whether parental mental health, parent-infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty-two families took part at three time points. The first, at 3?months postpartum, involved a video recorded observation (CARE-index) of…

40 CFR 461.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

... GUIDELINES AND STANDARDS BATTERY MANUFACTURING POINT SOURCE CATEGORY Lead Subcategory § 461.33 New source... times. (4) Subpart C—Battery Wash (Detergent)—NSPS. Pollutant or pollutant Property Maximum for any 1... day Maximum for monthly average Metric units—mg/kg of lead in trucked batteries English units—pounds...

40 CFR 461.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... GUIDELINES AND STANDARDS BATTERY MANUFACTURING POINT SOURCE CATEGORY Lead Subcategory § 461.33 New source... times. (4) Subpart C—Battery Wash (Detergent)—NSPS. Pollutant or pollutant Property Maximum for any 1... day Maximum for monthly average Metric units—mg/kg of lead in trucked batteries English units—pounds...

Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach

PubMed Central

Anderson, John A.; Suero, Eduardo; O’Loughlin, Padhraig F.

2008-01-01

For patients with refractory retrocalcaneal bursitis (Haglund’s syndrome), the most effective surgical approach has not been defined. We asked whether patients undergoing the tendon-splitting approach and the lateral approach would have comparably effective relief of pain for both types of calcaneal ostectomies. We retrospectively reviewed 30 patients (31 feet) who underwent the tendon-splitting approach and compared their results with 32 previous patients (35 feet) who had a lateral incision. Minimum followup was 12 months (mean, 16 months; range, 12–23 months) for the tendon-splitting group and 15 months (mean, 51 months; range, 15–109 months) for the lateral group. The mean American Orthopaedic Foot and Ankle Society score improved from 43 points preoperatively to 81 points (range, 8–100 points) postoperatively in the tendon-splitting group and from 54 points to 86 points (range, 55–100 points) in the lateral group. The mean physical component score of the Short Form-36, version 2, at followup was 52 (range, 22–61) in the tendon-splitting group and 49 (range, 34–63) in the lateral group. The median return to normal function was 4.1 months (range, 3–13 months) in the tendon-splitting group and 6.4 months (range, 4–20 months) in the lateral group. Both approaches to calcaneal ostectomy provided symptomatic pain relief. However, patients in the tendon-splitting group returned to normal function quicker than patients in the lateral group. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18465183

Development of using experimenter-given cues in infant chimpanzees: longitudinal changes in behavior and cognitive development.

PubMed

Okamoto-Barth, Sanae; Tomonaga, Masaki; Tanaka, Masayuki; Matsuzawa, Tetsuro

2008-01-01

The use of gaze shifts as social cues has various evolutionary advantages. To investigate the developmental processes of this ability, we conducted an object-choice task by using longitudinal methods with infant chimpanzees tested from 8 months old until 3 years old. The experimenter used one of six gestures towards a cup concealing food; tapping, touching, whole-hand pointing, gazing plus close-pointing, distant-pointing, close-gazing, and distant-gazing. Unlike any other previous study, we analyzed the behavioral changes that occurred before and after choosing the cup. We assumed that pre-choice behavior indicates the development of an attentional and spatial connection between a pointing cue and an object (e.g. Woodward, 2005); and post-choice behavior indicates the emergence of object permanence (e.g. Piaget, 1954). Our study demonstrated that infant chimpanzees begin to use experimenter-given cues with age (after 11 months of age). Moreover, the results from the behavioral analysis showed that the infants gradually developed the spatial link between the pointing as an object-directed action and the object. Moreover, when they were 11 months old, the infants began to inspect the inside of the cup, suggesting the onset of object permanence. Overall, our results imply that the ability to use the cues is developing and mutually related with other cognitive developments. The present study also suggests what the standard object-choice task actually measures by breaking the task down into the developmental trajectories of its component parts, and describes for the first time the social-physical cognitive development during the task with a longitudinal method.

Differences in bio-incompatibility among four biocompatible dialyzer membranes using in maintenance hemodialysis patients.

PubMed

Zhang, Dong-Liang; Liu, Jing; Cui, Wen-Ying; Ji, Dan-Ying; Zhang, Yue; Liu, Wen-Hu

2011-01-01

Following the introduction of modified cellulosic and then synthetic membrane dialyzers, it was realized that the dialyzer bio-incompatibility depends on the membrane composition. We designed a prospective, randomized, cohort study of 6 months to determine several parameters of biocompatibility in maintenance hemodialysis (MHD) patients treated with four different membrane dialyzers. There were 60 MHD patients enrolled in the study. In baseline, synthetic low-flux dialyzer, polysulfone (PS) membrane was used in all patients for at least 3 months. Then the patients were randomly divided into three groups according to different dialyzer membranes. Synthetic high-flux dialyzer group, polyethersulfone membrane, cellulose triacetate (CTA) high-flux membrane, and synthetic low-flux dialyzer, polymethylmethacrylate (PMMA) membrane were used in 6 months. A new dialyzer was used for each study treatment, and there was no dialyzer reuse. The biocompatibility markers and solutes removal markers were detected repeatedly at different time points. The blood levels of highly sensitive C reactive protein, interleukin (IL)-1β, and interleukin (IL)-13 showed no difference among different groups at al time points. However, the blood complement levels and white blood cell counts were significantly different among three groups. When the dialyzers changed from PS to PMMA membrane, C3a levels and white blood cell counts changed significantly (p < 0.05). Moreover, the changes of C5a levels were significantly different between group CTA and group PMMA in month 3 (p < 0.05). There were much more differences on bio-incompatibility among different dialyzer membranes.

Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS.

PubMed

Svedbom, Axel; Borgström, Fredrik; Hernlund, Emma; Ström, Oskar; Alekna, Vidmantas; Bianchi, Maria Luisa; Clark, Patricia; Curiel, Manuel Díaz; Dimai, Hans Peter; Jürisson, Mikk; Uusküla, Anneli; Lember, Margus; Kallikorm, Riina; Lesnyak, Olga; McCloskey, Eugene; Ershova, Olga; Sanders, Kerrie M; Silverman, Stuart; Tamulaitiene, Marija; Thomas, Thierry; Tosteson, Anna N A; Jönsson, Bengt; Kanis, John A

2018-03-01

The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation.

PubMed

Fortune, Dónal G; Walsh, R Stephen; Waldron, Brian; McGrath, Caroline; Harte, Maurice; Casey, Sarah; McClean, Brian

2015-01-01

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

The Roles of Maternal Depression, Serotonin Reuptake Inhibitor Treatment, and Concomitant Benzodiazepine Use on Infant Neurobehavioral Functioning Over the First Postnatal Month.

PubMed

Salisbury, Amy L; O'Grady, Kevin E; Battle, Cynthia L; Wisner, Katherine L; Anderson, George M; Stroud, Laura R; Miller-Loncar, Cynthia L; Young, Marion E; Lester, Barry M

2016-02-01

The purpose of this article was to systematically compare the developmental trajectory of neurobehavior over the first postnatal month for infants with prenatal exposure to pharmacologically untreated maternal depression, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (collectively: SSRIs), SSRIs with concomitant benzodiazepines (SSRI plus benzodiazepine), and no maternal depression or drug treatment (no exposure). Women (N=184) were assessed at two prenatal time points to determine psychiatric diagnoses, symptom severity, and prenatal medication usage. Infants were examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at multiple time points across the first postnatal month. SSRI exposure was confirmed in a subset of participants with plasma SSRI levels. General linear-mixed models were used to examine group differences in neurobehavioral scores over time with adjustment for demographic variables and depression severity. Infants in the SSRI and SSRI plus benzodiazepine groups had lower motor scores and more CNS stress signs across the first postnatal month, as well as lower self-regulation and higher arousal at day 14. Infants in the depression group had low arousal throughout the newborn period. Infants in all three clinical groups had a widening gap in scores from the no-exposure group at day 30 in their response to visual and auditory stimuli while asleep and awake. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Neonatal adaptation syndrome was not limited to the first 2 weeks postbirth. The profile of neurobehavioral development was different for SSRI exposure than depression alone. Concomitant benzodiazepine use may exacerbate adverse behavioral effects.

Does a 3-month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia?

PubMed

Carbonell-Baeza, Ana; Aparicio, Virginia A; Ortega, Francisco B; Cuevas, Ana M; Alvarez, Inmaculada C; Ruiz, Jonatan R; Delgado-Fernandez, Manuel

2011-12-01

To determine the effects of a 3-month multidisciplinary intervention on pain (primary outcome), body composition and physical fitness (secondary outcomes) in women with fibromyalgia (FM). 75 women with FM were allocated to a low-moderate intensity 3-month (three times/week) multidisciplinary (pool, land-based and psychological sessions) programme (n=33) or to a usual care group (n=32). The outcome variables were pain threshold, body composition (body mass index and estimated body fat percentage) and physical fitness (30 s chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go and 6 min walk test). The authors observed a significant interaction effect (group*time) for the left (L) and right (R) side of the anterior cervical (p<0.001) and the lateral epicondyle R (p=0.001) tender point. Post hoc analysis revealed that pain threshold increased in the intervention group (positive) in the anterior cervical R (p<0.001) and L (p=0.012), and in the lateral epicondyle R (p=0.010), whereas it decreased (negative) in the anterior cervical R (p<0.001) and L (p=0.002) in the usual care group. There was also a significant interaction effect for chair sit and reach. Post hoc analysis revealed improvement in the intervention group (p=0.002). No significant improvement attributed to the training was observed in the rest of physical fitness or body composition variables. A 3-month multidisciplinary intervention three times/week had a positive effect on pain threshold in several tender points in women with FM. Though no overall improvements were observed in physical fitness or body composition, the intervention had positive effects on lower-body flexibility.

Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation

PubMed Central

Fortune, Dónal G.; Walsh, R. Stephen; Waldron, Brian; McGrath, Caroline; Harte, Maurice; Casey, Sarah; McClean, Brian

2015-01-01

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments. PMID:26441744

[Infraoccipital needle-knife for cervical vertigo].

PubMed

Li, Shaofang; Huang, Manhua; Lin, Zhuopeng; Chen, Xinze; Lin, Dongna; Lu, Peng; Lu, Qu

2017-03-12

To observe the clinical effect differences between infraoccipital needle-knife and massage for cervical vertigo. A total of 366 patients with cervical vertigo were randomly assigned into a needle-knife group (186 cases) and a massage group (180 cases). With cases dropping excluded, 183 cases in the needle-knife group and 176 cases in the massage group were included. Needle-knife was used at Fengchi (GB 20), infraoccipital ashi point, etc. in the needle-knife group. The treatment was given for one course, once three days, 5 times as one course. The traditional massage was applied in the massage group for one course, including systematic stroking, kneading, and the application of pressure and plucking, etc., once every two days and 7 times as one course. The dizziness handicap inventory (DHI) score was observed before and after treatment, as well as 3, 6, and 12 months after treatment. The effects were also evaluated. The total effective rate was 92.3% (169/183) in the needle-knife group, which was better than 85.2% (150/176) in the massage group ( P <0.05). Compared with those before treatment, the DHI scores at all the observation time points after treatment were improved in the two groups (all P <0.05), with better improvements after treatment as well as 3 and 6 months after treatment in the needle-knife group (all P <0.05). There was no significant difference in the improvement of DHI scores between the two groups 12 months after treatment ( P >0.05). The recurrence rate was 10.3% (12/117) in the needle-knife group, and it was 10.7% (11/103) in the massage group 12 months after treatment ( P >0.05). Infraoccipital needle-knife achieves apparent effect for cervical vertigo, which is superior to massage in short period.

Longitudinal study of objective and subjective cognitive performance and psychological distress in OEF/OIF Veterans with and without traumatic brain injury.

PubMed

Donnelly, Kerry; Donnelly, James P; Warner, Gary C; Kittleson, C James; King, Paul R

2018-04-01

To describe changes in post-deployment objective and subjective cognitive performance in combat Veterans over 18 months, relative to traumatic brain injury (TBI) status and psychological distress. This prospective cohort study examined 500 Veterans from Upstate New York at four time points, six months apart. TBI status was determined by a structured clinical interview. Neuropsychological instruments focused on attention, memory, and executive functions. Subjective cognitive complaints were assessed with the Neurobehavioral Symptom Inventory (NSI). A psychological distress composite included measures of post-traumatic stress disorder (PTSD), depression, and generalized anxiety. Forty-four percent of the sample was found to have sustained military-related TBI, 97% of which were classified as mild (mTBI), with a mean time since injury of 41 months. Veterans with TBI endorsed moderate cognitive symptoms on the NSI. In contrast to these subjective complaints, mean cognitive test performance was within normal limits at each time point in all domains, regardless of TBI status. Multilevel models examined effects of TBI status, time, and psychological distress. Psychological distress was a strong predictor of all cognitive domains, especially the subjective domain. Substantial proportions of both TBI+ and TBI- groups remained in the clinically significant range at the initial and final assessment for all three distress measures, but the TBI+ group had higher proportions of clinically significant cases. Objective cognitive performance was generally within normal limits for Veterans with mTBI across all assessments. Psychological distress was elevated and significantly related to both objective and subjective cognitive performance.

Estimating the Time Interval Between Exposure to the World Trade Center Disaster and Incident Diagnoses of Obstructive Airway Disease

PubMed Central

Glaser, Michelle S.; Webber, Mayris P.; Zeig-Owens, Rachel; Weakley, Jessica; Liu, Xiaoxue; Ye, Fen; Cohen, Hillel W.; Aldrich, Thomas K.; Kelly, Kerry J.; Nolan, Anna; Weiden, Michael D.; Prezant, David J.; Hall, Charles B.

2014-01-01

Respiratory disorders are associated with occupational and environmental exposures. The latency period between exposure and disease onset remains uncertain. The World Trade Center (WTC) disaster presents a unique opportunity to describe the latency period for obstructive airway disease (OAD) diagnoses. This prospective cohort study of New York City firefighters compared the timing and incidence of physician-diagnosed OAD relative to WTC exposure. Exposure was categorized by WTC arrival time as high (on the morning of September 11, 2001), moderate (after noon on September 11, 2001, or on September 12, 2001), or low (during September 13–24, 2001). We modeled relative rates and 95% confidence intervals of OAD incidence by exposure over the first 5 years after September 11, 2001, estimating the times of change in the relative rate with change point models. We observed a change point at 15 months after September 11, 2001. Before 15 months, the relative rate for the high- versus low-exposure group was 3.96 (95% confidence interval: 2.51, 6.26) and thereafter, it was 1.76 (95% confidence interval: 1.26, 2.46). Incident OAD was associated with WTC exposure for at least 5 years after September 11, 2001. There were higher rates of new-onset OAD among the high-exposure group during the first 15 months and, to a lesser extent, throughout follow-up. This difference in relative rate by exposure occurred despite full and free access to health care for all WTC-exposed firefighters, demonstrating the persistence of WTC-associated OAD risk. PMID:24980522

I See Your Point: Infants under 12 Months Understand that Pointing Is Communicative

ERIC Educational Resources Information Center

Krehm, Madelaine; Onishi, Kristine H.; Vouloumanos, Athena

2014-01-01

Do young infants understand that pointing gestures allow the pointer to change the information state of a recipient? We used a third-party experimental scenario to examine whether 9- and 11-month-olds understand that a pointer's pointing gesture can inform a recipient about a target object. When the pointer pointed to a target, infants…

High-dose rifapentine with moxifloxacin for pulmonary tuberculosis.

PubMed

Jindani, Amina; Harrison, Thomas S; Nunn, Andrew J; Phillips, Patrick P J; Churchyard, Gavin J; Charalambous, Salome; Hatherill, Mark; Geldenhuys, Hennie; McIlleron, Helen M; Zvada, Simbarashe P; Mungofa, Stanley; Shah, Nasir A; Zizhou, Simukai; Magweta, Lloyd; Shepherd, James; Nyirenda, Sambayawo; van Dijk, Janneke H; Clouting, Heather E; Coleman, David; Bateson, Anna L E; McHugh, Timothy D; Butcher, Philip D; Mitchison, Denny A

2014-10-23

Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed. We randomly assigned patients with newly diagnosed, smear-positive, drug-sensitive tuberculosis to one of three regimens: a control regimen that included 2 months of ethambutol, isoniazid, rifampicin, and pyrazinamide administered daily followed by 4 months of daily isoniazid and rifampicin; a 4-month regimen in which the isoniazid in the control regimen was replaced by moxifloxacin administered daily for 2 months followed by moxifloxacin and 900 mg of rifapentine administered twice weekly for 2 months; or a 6-month regimen in which isoniazid was replaced by daily moxifloxacin for 2 months followed by one weekly dose of both moxifloxacin and 1200 mg of rifapentine for 4 months. Sputum specimens were examined on microscopy and after culture at regular intervals. The primary end point was a composite treatment failure and relapse, with noninferiority based on a margin of 6 percentage points and 90% confidence intervals. We enrolled a total of 827 patients from South Africa, Zimbabwe, Botswana, and Zambia; 28% of patients were coinfected with the human immunodefiency virus. In the per-protocol analysis, the proportion of patients with an unfavorable response was 4.9% in the control group, 3.2% in the 6-month group (adjusted difference from control, -1.8 percentage points; 90% confidence interval [CI], -6.1 to 2.4), and 18.2% in the 4-month group (adjusted difference from control, 13.6 percentage points; 90% CI, 8.1 to 19.1). In the modified intention-to-treat analysis these proportions were 14.4% in the control group, 13.7% in the 6-month group (adjusted difference from control, 0.4 percentage points; 90% CI, -4.7 to 5.6), and 26.9% in the 4-month group (adjusted difference from control, 13.1 percentage points; 90% CI, 6.8 to 19.4). The 6-month regimen that included weekly administration of high-dose rifapentine and moxifloxacin was as effective as the control regimen. The 4-month regimen was not noninferior to the control regimen. (Funded by the European and Developing Countries Clinical Trials Partnership and the Wellcome Trust; RIFAQUIN Current Controlled Trials number, ISRCTN44153044.).

Accuracy of Two Motor Assessments during the First Year of Life in Preterm Infants for Predicting Motor Outcome at Preschool Age

PubMed Central

Spittle, Alicia J.; Lee, Katherine J.; Spencer-Smith, Megan; Lorefice, Lucy E.; Anderson, Peter J.; Doyle, Lex W.

2015-01-01

Aim The primary aim of this study was to investigate the accuracy of the Alberta Infant Motor Scale (AIMS) and Neuro-Sensory Motor Developmental Assessment (NSMDA) over the first year of life for predicting motor impairment at 4 years in preterm children. The secondary aims were to assess the predictive value of serial assessments over the first year and when using a combination of these two assessment tools in follow-up. Method Children born <30 weeks’ gestation were prospectively recruited and assessed at 4, 8 and 12 months’ corrected age using the AIMS and NSMDA. At 4 years’ corrected age children were assessed for cerebral palsy (CP) and motor impairment using the Movement Assessment Battery for Children 2nd-edition (MABC-2). We calculated accuracy of the AIMS and NSMDA for predicting CP and MABC-2 scores ≤15th (at-risk of motor difficulty) and ≤5th centile (significant motor difficulty) for each test (AIMS and NSMDA) at 4, 8 and 12 months, for delay on one, two or all three of the time points over the first year, and finally for delay on both tests at each time point. Results Accuracy for predicting motor impairment was good for each test at each age, although false positives were common. Motor impairment on the MABC-2 (scores ≤5th and ≤15th) was most accurately predicted by the AIMS at 4 months, whereas CP was most accurately predicted by the NSMDA at 12 months. In regards to serial assessments, the likelihood ratio for motor impairment increased with the number of delayed assessments. When combining both the NSMDA and AIMS the best accuracy was achieved at 4 months, although results were similar at 8 and 12 months. Interpretation Motor development during the first year of life in preterm infants assessed with the AIMS and NSMDA is predictive of later motor impairment at preschool age. However, false positives are common and therefore it is beneficial to follow-up children at high risk of motor impairment at more than one time point, or to use a combination of assessment tools. Trial Registration ACTR.org.au ACTRN12606000252516 PMID:25970619

Persistence and innovation effects in genetic and environmental factors in negative emotionality during infancy: A twin study

PubMed Central

Boivin, Michel; Paquin, Stéphane; Lacourse, Eric; Brendgen, Mara; Vitaro, Frank; Dionne, Ginette; Tremblay, Richard E.; Booij, Linda

2017-01-01

Background Difficult temperament in infancy is a risk factor for forms of later internalizing and externalizing psychopathology, including depression and anxiety. A better understanding of the roots of difficult temperament requires assessment of its early development with a genetically informative design. The goal of this study was to estimate genetic and environmental contributions to individual differences in infant negative emotionality, their persistence over time and their influences on stability between 5 and 18 months of age. Method Participants were 244 monozygotic and 394 dizygotic twin pairs (49.7% male) recruited from birth. Mothers rated their twins for negative emotionality at 5 and 18 months. Longitudinal analysis of stability and innovation between the two time points was performed in Mplus. Results There were substantial and similar heritability (approximately 31%) and shared environmental (57.3%) contributions to negative emotionality at both 5 and 18 months. The trait’s interindividual stability across time was both genetically- and environmentally- mediated. Evidence of innovative effects (i.e., variance at 18 months independent from variance at 5 months) indicated that negative emotionality is developmentally dynamic and affected by persistent and new genetic and environmental factors at 18 months. Conclusions In the first two years of life, ongoing genetic and environmental influences support temperamental negative emotionality but new genetic and environmental factors also indicate dynamic change of those factors across time. A better understanding of the source and timing of factors on temperament in early development, and role of sex, could improve efforts to prevent related psychopathology. PMID:28448561

A Pilot Feasibility Study of Whole-systems Ayurvedic Medicine and Yoga Therapy for Weight Loss.

PubMed

Rioux, Jennifer; Thomson, Cynthia; Howerter, Amy

2014-01-01

To develop and test the feasibility of a whole-systems lifestyle intervention for obesity treatment based on the practices of Ayurvedic medicine/ Yoga therapy. A pre-post weight loss intervention pilot study using conventional and Ayurvedic diagnosis inclusion criteria, tailored treatment within a standardized treatment algorithm, and standardized data collection instruments for collecting Ayurvedic outcomes. A convenience sample of overweight/obese adult community members from Tucson, Arizona interested in a "holistic weight loss program" and meeting predetermined inclusion/exclusion criteria. A comprehensive diet, activity, and lifestyle modification program based on principles of Ayurvedic medicine/yoga therapy with significant self-monitoring of lifestyle behaviors. The 3-month program was designed to change eating and activity patterns and to improve self-efficacy, quality of life, well-being, vitality, and self-awareness around food choices, stress management, and barriers to weight loss. Changes in body weight, body mass index; body fat percentage, fat/lean mass, waist/hip circumference and ratio, and blood pressure. Diet and exercise self-efficacy scales; perceived stress scale; visual analog scales (VAS) of energy, appetite, stress, quality of life, well-being, and program satisfaction at all time points. Twenty-two adults attended an in-person Ayurvedic screening; 17 initiated the intervention, and 12 completed the 3-month intervention. Twelve completed follow-up at 6 months and 11 completed follow-up at 9 months. Mean weight loss at 3 months was 3.54 kg (SD 4.76); 6 months: 4.63 kg, (SD 6.23) and 9 months: 5.9 kg (SD 8.52). Self-report of program satisfaction was more than 90% at all time points. An Ayurveda-/yoga-based lifestyle modification program is an acceptable and feasible approach to weight management. Data collection, including self-monitoring and conventional and Ayurvedic outcomes, did not unduly burden participants, with attrition similar to that of other weight loss studies.

Effects of laser in situ keratomileusis on mental health-related quality of life

PubMed Central

Tounaka-Fujii, Kaoru; Yuki, Kenya; Negishi, Kazuno; Toda, Ikuko; Abe, Takayuki; Kouyama, Keisuke; Tsubota, Kazuo

2016-01-01

Purpose The aims of our study were to investigate whether laser in situ keratomileusis (LASIK) improves health-related quality of life (HRQoL) and to identify factors that affect postoperative HRQoL. Materials and methods A total of 213 Japanese patients who underwent primary LASIK were analyzed in this study. The average age of patients was 35.0±9.4 years. The subjects were asked to answer questions regarding subjective quality of vision, satisfaction, and quality of life (using the Japanese version of 36-Item Short Form Health Survey Version 2) at three time points: before LASIK, 1 month after LASIK, and 6 months after LASIK. Longitudinal changes over 6 months in the outputs of mental component summary (MCS) score and the physical component summary (PCS) score from the 36-Item Short Form Health Survey Version 2 questionnaire were compared between time points using a linear mixed-effects model. Delta MCS and PCS were calculated by subtracting the postoperative score (1 month after LASIK) from the preoperative score. Preoperative and postoperative factors associated with a change in the MCS score or PCS score were evaluated via a linear regression model. Results The preoperative MCS score was 51.0±9.4 and increased to 52.0±9.8 and 51.5±9.6 at 1 month and 6 months after LASIK, respectively, and the trend for the change from baseline in MCS through 6 months was significant (P=0.03). PCS score did not change following LASIK. Delta MCS was significantly negatively associated with preoperative spherical equivalent, axial length, and postoperative quality of vision, after adjusting for potential confounding factors. Conclusion Mental HRQoL is not lost with LASIK, and LASIK may improve mental HRQoL. Preoperative axial length may predict postoperative mental HRQoL. PMID:27713617

The stability of 'food addiction' as assessed by the Yale Food Addiction Scale in a non-clinical population over 18-months.

PubMed

Pursey, Kirrilly M; Collins, Clare E; Stanwell, Peter; Burrows, Tracy L

2016-01-01

The Yale Food Addiction Scale (YFAS) is a widely used tool to assess the behavioural indicators of addictive-like eating. No studies, however, have used a longitudinal design to determine whether these addictive-like eating behaviours are a stable or transient phenomenon in a community-based population. This study aimed to evaluate whether food addiction Diagnosis and Symptom scores as assessed by the YFAS remain stable over 18-months in a non-clinical population. Young adults aged 18-35 years were recruited from the community to a web-based survey in 2013. The survey included demographics, anthropometrics and the YFAS. Participants who volunteered to be recontacted for future research were invited to complete the same survey 18-months later. The YFAS scoring outputs Diagnosis and Symptom scores were tested for agreement and reliability between the two time points. Of the 303 participants who completed the original survey and agreed to be recontacted, 69 participants (22.8% of those recontacted, 94% female, 67% normal weight at baseline) completed the 18-month follow-up survey. At baseline, thirteen participants met the YFAS predefined criteria for Diagnosis, while eleven participants met these criteria at the 18-month follow-up. YFAS Diagnosis was found to have moderate agreement [K = .50, 95% CI (.23, .77)] between the two time points while Symptom scores had good agreement [K = .70, 95% CI (.54, .83)]. Intraclass correlation coefficients were interpreted as moderate over the 18-month period for both the Diagnosis [ICC = .71, 95% CI (.45, .88)] and Symptom scores [ICC = .72, 95% CI (.58, .82)]. YFAS assessed food addiction Diagnosis and Symptom scores were found to be relatively stable over 18-months in a non-clinical population of predominantly female, young adults. Future research is required to determine the impact of behavioural weight loss interventions on YFAS assessed addictive-like eating. Copyright © 2015 Elsevier Ltd. All rights reserved.

Objectively measured physical activity of young Canadian children using accelerometry.

PubMed

Borkhoff, Cornelia M; Heale, Liane D; Anderson, Laura N; Tremblay, Mark S; Maguire, Jonathon L; Parkin, Patricia C; Birken, Catherine S

2015-12-01

The objective of the study was to describe objectively measured physical activity (PA) and sedentary time of infants, toddlers, and preschoolers and determine the proportion meeting Canadian age-specific PA guidelines. Ninety children (47 girls, 43 boys; mean age 32 (range, 4-70) months) attending scheduled health supervision visits and in the TARGet Kids! (The Applied Research Group for Kids) cohort wore an Actical accelerometer for 7 days. Participants with 4 or more valid days were included in the analysis. Time, in mean minutes per day (min/day), spent sedentary and in light PA, moderate to vigorous PA (MVPA), and total PA was determined using published cut-points; age groups were compared using ANOVA. Twenty-three percent of children <18 months (n = 28) and 76% of children aged 18-59 months (n = 45) met the guideline of 180 min/day of total PA; 13% of children ≥60 months (n = 17) met the guideline of 60 min/day of MVPA. Children <18 months spent more of their waking time per day engaged in sedentary behaviours (79%; ∼7.3 h) compared with children aged 18-59 months (63%; ∼6.6 h) and children ≥60 months (58%; ∼6.6 h). In conclusion, most children aged 18-59 months met the Canadian PA guidelines for children aged 0-4 years, whereas few younger than 18 months met the same guidelines. Only 13% of children ≥5 years met their age-specific PA guidelines. Further research is needed to develop, test, and implement effective strategies to promote PA and reduce sedentary behaviour in very young children.

Overgeneral autobiographical memory predicts changes in depression in a community sample.

PubMed

Van Daele, Tom; Griffith, James W; Van den Bergh, Omer; Hermans, Dirk

2014-01-01

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of symptoms of depression and anxiety in a community sample, after 5, 6, 12 and 18 months. Participants (N=156) completed the Autobiographical Memory Test and the Depression Anxiety Stress Scales-21 (DASS-21) at baseline and were subsequently reassessed using the DASS-21 at four time points over a period of 18 months. Using latent growth curve modelling, we found that OGM was associated with a linear increase in depression. We were unable to detect changes over time in anxiety. OGM may be an important marker to identify people at risk for depression in the future, but more research is needed with anxiety.

Heuristic Modeling for TRMM Lifetime Predictions

NASA Technical Reports Server (NTRS)

Jordan, P. S.; Sharer, P. J.; DeFazio, R. L.

1996-01-01

Analysis time for computing the expected mission lifetimes of proposed frequently maneuvering, tightly altitude constrained, Earth orbiting spacecraft have been significantly reduced by means of a heuristic modeling method implemented in a commercial-off-the-shelf spreadsheet product (QuattroPro) running on a personal computer (PC). The method uses a look-up table to estimate the maneuver frequency per month as a function of the spacecraft ballistic coefficient and the solar flux index, then computes the associated fuel use by a simple engine model. Maneuver frequency data points are produced by means of a single 1-month run of traditional mission analysis software for each of the 12 to 25 data points required for the table. As the data point computations are required only a mission design start-up and on the occasion of significant mission redesigns, the dependence on time consuming traditional modeling methods is dramatically reduced. Results to date have agreed with traditional methods to within 1 to 1.5 percent. The spreadsheet approach is applicable to a wide variety of Earth orbiting spacecraft with tight altitude constraints. It will be particularly useful to such missions as the Tropical Rainfall Measurement Mission scheduled for launch in 1997, whose mission lifetime calculations are heavily dependent on frequently revised solar flux predictions.

Actigraphy--a useful tool for motor activity monitoring in stroke patients.

PubMed

Reiterer, Veronika; Sauter, Cornelia; Klösch, Gerhard; Lalouschek, Wolfgang; Zeitlhofer, Josef

2008-01-01

The aim of the present study was the evaluation of actigraphy as a tool to objectify the recovery process after motor paresis due to stroke. The motor activity of both arms of patients suffering from stroke was actigraphically recorded at four different time points during the course of rehabilitation: 24-36 h, 5-7 days, 3 months, and 6 months after stroke. Motor activity monitored by wrist-worn actigraphs located at the impaired side revealed an increase in activity between the first two time points and the subsequent ones. Additionally, actigraphic recordings showed lower total motor activity at the impaired side as compared to the nonimpaired side. A significant positive correlation was found between the actigraphically recorded motor activity and the results of the Scandinavian Stroke scale, the Barthel Index, the Rankin Scale Score and with the Motoricity Index during the 1st week, which corresponds to the time when neurological deficits were most pronounced. Our results suggest that actigraphy is a useful tool in the objective evaluation of motor activity after stroke. Moreover, actigraphy covers additional aspects that are not reflected by the usual stroke scales in a clinical situation. Copyright 2008 S. Karger AG, Basel.

Taste, Enjoyment, and Desire of Flavors Change After Sleeve Gastrectomy-Short Term Results.

PubMed

Van Vuuren, Michele A Janse; Strodl, Esben; White, Katherine M; Lockie, Philip David

2017-06-01

Laparoscopic sleeve gastrectomy (LSG) incidence continues to increase worldwide because of its efficacy and low surgical risks. This study aimed to investigate satisfaction with eating and the change in taste perception, desire, and enjoyment of flavor changes and associations with extent of percentage excess weight loss (%excess weight loss (EWL)) post-LSG. One hundred six participants completed an online questionnaire 4 to 6 weeks as well as 6 to 8 months post-LSG bariatric surgery. The questionnaire included study-specific questions about changes in taste, desire, and enjoyment of eight major categories of flavor, as well as the Suter Quality of Alimentation Questionnaire to measure satisfaction with eating. The majority of participants reported a post-surgery increase in the intensity of the flavor of sweet (60, 55%) and fatty (57, 70%) at both time points, respectively. Participants also reported a decreased enjoyment for sweet (77, 61%) and fatty (77, 83%) flavors and decreased desire for fatty (83, 84%) and sweet (82, 68%) flavors at both time periods. This study found an increase in intensity of flavor of all eight taste modalities and a decrease in desire and enjoyment of all taste modalities except salty and savory flavors following surgery. Participants reported an increased acuity of spicy flavors and fatty tastes over time, and the desire and enjoyment of sweet, bitter, and metallic flavors increased over time. Changes in savory enjoyment over a 6- to 8-month period post-LSG were weakly associated with extent of % EWL at 6 months post-surgery. The participants reported average (40, 37%), good (33, 42%), and excellent (15, 11%) satisfaction with eating at both time points. This preliminary study indicates that subjective changes in taste, desire, and enjoyment of flavors of eight taste modalities are very common after LSG.

Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial.

PubMed

James, Alicia M; Williams, Cylie M; Haines, Terry P

2016-10-01

Calcaneal apophysitis, is a relatively common cause of heel pain in children. Very few randomised studies have evaluated treatment options. This trial compared the effectiveness of currently employed treatment options for the relief of pain and disability associated with calcaneal apophysitis. Factorial 2×2 randomised comparative effectiveness trial with 1, 2, 6 and 12-month follow-up. Participants were recruited from the caseload of podiatrists at Monash health and Peninsula Health. Children aged 8-14 years with clinically diagnosed calcaneal apophysitis. Treatment factor 1: two different types of in-shoe orthoses: a heel raise or prefabricated orthoses. Treatment factor 2: footwear replacement or no footwear replacement. Our primary outcome was functional disability, the secondary outcomes were pain and ankle dorsiflexion range. A total of 133 children and their parents responded to the recruitment advertisement, 124 participated in the trial.At the 1 and 2-month follow-up points, there was a main effect of the shoe insert (heel raise) in only the physical domain for the Oxford ankle foot questionnaire (p=0.04). At the 6 and 12-month follow-up points, there was no main effect or interaction effect for any outcome measure. This trial indicates at the 2-month time point there is a relative advantage in the use of heel raises over prefabricated orthoses for the treatment for calcaneal apophysitis. At 12 months there was no relative advantage to any one of the investigated treatment choices over another. Therefore, if a physical impact is experienced for greater than 2 months, the selection of treatment choice may defer to clinical judgement, cost-minimisation and or patient preference. ACTRN12609000696291. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Clinical comparison between two hyaluronic acid-derived fillers in the treatment of nasolabial folds in Chinese subjects: BioHyalux versus Restylane.

PubMed

Wu, Yan; Sun, Nan; Xu, Yue; Liu, Huixian; Zhong, Shaomin; Chen, Liyang; Li, Dong

2016-04-01

Hyaluronic acid fillers are used to improve the appearance of nasolabial folds (NLF). This study aimed to compare the efficacy, safety, and durability of a new hyaluronic acid gel (BioHyalux) versus Restylane for the correction of NLF. This was a multicenter, double-blinded, randomized, controlled, non-inferiority clinical trial involving 88 subjects with moderate to severe NLF. Subjects were randomized to BioHyalux and Restylane on either sides of the NLF. NLF was assessed before and right after injection, and at 1 week, 1, 3, and 6 months. Patients were followed up for 13-15 months to evaluate the durability and long-term safety. A clinically meaningful response was predefined as at least one-point improvement on the Wrinkle Severity Rating Scale, which is a five-point scale. At 6 months, the response rate of BioHyalux was not inferior to that of Restylane (P < 0.05). At the 13-15 months follow-up, the response rate by investigators was 58.0 % on the BioHyalux side versus 63.8 % on the Restylane side. The response rate by subjects showed similar results, which was 56.5 % on the BioHyalux side versus 60.9 % on the Restylane side at 13-15 months. The subjects' Global Aesthetic Improvement Scale (GAIS) showed that most subjects felt improvements on both sides of NLF (P > 0.05) at all time points. At 6 months, 100 % reported improvements on both side; at 13-15 months, 60 % of subjects reported improvements with BioHyalux versus 64 % with Restylane. Adverse events were transient and predominantly mild or moderate in severity including injection site swelling, pain, itching, bruising, and tenderness. BioHyalux had reliable safety and tolerance, and could be an effective injectable filler for correcting NLF.

Development of Feeding Cues during Infancy and Toddlerhood

PubMed Central

Hodges, Eric A.; Wasser, Heather M.; Colgan, Brook K.; Bentley, Margaret E.

2016-01-01

Purpose To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood. Study Design and Methods A secondary analysis was performed on a dataset of first time, low-income African-American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant body mass index (BMI) Z-scores at 18 months was selected (n=45). Using video-recorded home feedings, early, active, and late receptiveness and fullness cues were assessed using the Responsiveness to Child Feeding Cues Scale at each time point. Descriptive statistics were used to characterize development. Results Early receptiveness cues were relatively rare over time, whereas active receptiveness cues were much more common. However, there were changes over time. For example, settling into the feeding decreased from ~50% at 3 and 6 months to 4.8% by 18 months, whereas postural attention and reaching for food increased after 6 months. In the first six months, falling asleep and decreasing muscle tone and activity level were the most common early fullness cues. Thereafter, taking interest in surroundings was most prevalent. Active fullness cues became increasingly diverse after 6 months, led by more assertive cues such as pushing or pulling away and communicating “no” verbally or non-verbally. Clinical Implications These findings provide an empirical description of waxing and waning in feeding cues and indicate increasing intentionality of cues over the first 18 months of life. Knowing common cues across development may aid clinicians in enhancing parental feeding responsiveness, avoiding overfeeding, thereby decreasing risk of early childhood obesity. PMID:27710994

Differential Attention to Faces in Infant Siblings of Children with Autism Spectrum Disorder and Associations with Later Social and Language Ability.

PubMed

Wagner, Jennifer B; Luyster, Rhiannon J; Moustapha, Hana; Tager-Flusberg, Helen; Nelson, Charles A

2018-01-01

A growing body of literature has begun to explore social attention in infant siblings of children with autism spectrum disorder (ASD) with hopes of identifying early differences that are associated with later ASD or other aspects of development. The present study used eye-tracking to familiar (mother) and unfamiliar (stranger) faces in two groups of 6-month-old infants: infants with no family history of ASD (low-risk controls; LRC), and infants at high risk for ASD (HRA), by virtue of having an older sibling with ASD. HRA infants were further characterized based on autism classification at 24 months or older as HRA- (HRA without an ASD outcome) or HRA+ (HRA with an ASD outcome). For time scanning faces overall, HRA+ and LRC showed similar patterns of attention, and this was significantly greater than in HRA-. When examining duration of time spent on eyes and mouth, all infants spent more time on eyes than mouth, but HRA+ showed the greatest amount of time looking at these regions, followed by LRC, then HRA-. LRC showed a positive association between 6-month attention to eyes and 18-month social-communicative behavior, while HRA- showed a negative association between attention to eyes at 6 months and expressive language at 18 months (all correlations controlled for non-verbal IQ; HRA- correlations held with and without the inclusion of the small sample of HRA+). Differences found in face scanning at 6 months, as well as associations with social communication at 18 months, point to potential variation in the developmental significance of early social attention in children at low and high risk for ASD.

Multicenter phase II study of irinotecan, cisplatin, and bevacizumab in patients with metastatic gastric or gastroesophageal junction adenocarcinoma.

PubMed

Shah, Manish A; Ramanathan, Ramesh K; Ilson, David H; Levnor, Alissa; D'Adamo, David; O'Reilly, Eileen; Tse, Archie; Trocola, Robin; Schwartz, Lawrence; Capanu, Marinela; Schwartz, Gary K; Kelsen, David P

2006-11-20

Bevacizumab improves survival in several solid tumor malignancies when combined with chemotherapy. We evaluated the efficacy and safety of the addition of bevacizumab to chemotherapy in the treatment of gastric and gastroesophageal junction (GEJ) adenocarcinoma. Forty-seven patients with metastatic or unresectable gastric/GEJ adenocarcinoma were treated with bevacizumab 15 mg/kg on day 1, irinotecan 65 mg/m2, and cisplatin 30 mg/m2 on days 1 and 8, every 21 days. The primary end point was to demonstrate a 50% improvement in time to progression over historical values. Secondary end points included safety, response, and survival. Patient characteristics were as follows: median age 59 years (range, 25 to 75); Karnofsky performance status 90% (70% to 100%); male:female, 34:13; and gastric/GEJ, 24:23. With a median follow-up of 12.2 months, median time to progression was 8.3 months (95% CI, 5.5 to 9.9 months). In 34 patients with measurable disease, the overall response rate was 65% (95% CI, 46% to 80%). Median survival was 12.3 months (95% CI, 11.3 to 17.2 months). We observed no increase in chemotherapy related toxicity. Possible bevacizumab-related toxicity included a 28% incidence of grade 3 hypertension, two patients with a gastric perforation and one patient with a near perforation (6%), and one patient with a myocardial infarction (2%). Grade 3 to 4 thromboembolic events occurred in 25% of patients. Although the primary tumor was unresected in 40 patients, we observed only one patient with a significant upper gastrointestinal bleed. Bevacizumab can be safely given with chemotherapy even with primary gastric and GEJ tumors in place. The response rate, time to disease progression (TTP), and overall survival are encouraging, with TTP improved over historical controls by 75%. Further development of bevacizumab in gastric and GEJ cancers is warranted.

Long-term Serologic Follow-up of Children Vaccinated with a Pediatric Formulation of Virosomal Hepatitis A Vaccine Administered With Routine Childhood Vaccines at 12-15 Months of Age.

PubMed

Dagan, Ron; Ashkenazi, Shai; Livni, Gilat; Go, Oscar; Bagchi, Partha; Sarnecki, Michal

2016-07-01

The aim of this open-label, active-controlled, parallel group, phase 2 follow-up study was to assess the long-term immunogenicity of Epaxal Junior, the pediatric dose of an aluminum-free virosomal inactivated hepatitis A virus (HAV) vaccine, in children receiving routine childhood vaccines (RCV). Healthy children (12-15 months old, ≥8 kg weight) were randomized (1:1:1) to group A: Epaxal Junior + RCV (day 1); group B: Epaxal Junior (day 1) + RCV (day 29) and group C: Havrix 720 + RCV (day 1). All 3 groups received 2 doses of HAV vaccines 6 months apart. Children who completed the primary study were followed up from 18 months to 7.5 years post booster. Of 291/327 randomized children who had completed the primary study, 157 were followed for the 7.5-year analysis (group A: 50; group B: 54; and group C: 53). Of these, 152 children had protective levels of anti-HAV antibodies [≥10 mIU/mL; 98% (group A); 96.3% (group B); 96.2% (group C)]. Anti-HAV geometric mean concentrations were similar in groups A and B at all the time points (1.5-, 2.5-, 3.5-, 5.25- and 7.5-year time point) but slightly lower in group C. Predictions of the median duration of persistence of seroprotective antibody levels, using the linear mixed model were similar in all groups: (group A: 19.1 years, group B: 18.7 years, group C: 17.3 years). Immunization with Epaxal Junior administered with RCVs at 12 months elicited protective response beyond 7.5 years in almost all children. Assessing the kinetic of anti-HAV antibody titers decline over time, the moment to reach antibody concentrations below the accepted protective level may occur earlier than previously estimated.

The microbiology of the peri-implant sulcus following successful implantation of oral prosthetic treatments.

PubMed

Asadzadeh, Nafiseh; Naderynasab, Mahbobeh; Fard, Fojhan Ghorbanian; Rohi, Ali; Haghi, Hamidreza Rajati

2012-01-01

Oral implants are widely used in partially and fully edentulous patients; however, the integration of an implant can be endangered by factors such as intraoral bacteria or inflammatory reactions. The purpose of this study was to evaluate the microbial flora present in the sulcus around dental implants and to assess the relationship between gingival health and microbial flora present. Twenty patients who had received oral implants with no complications were followed for a period of 9 months. Assessment of probing depth, the presence of bleeding on probing and microbial sampling from the peri-implant sulcus were performed at three different time points- 4 weeks after surgery, 1 month and 6 months after loading. The samples were taken by paper points and transferred to the microbiology lab in thioglyocolate cultures. In order to do a colony count and isolate the aerobic capnophilic and anerobic bacteria the samples were cultured and incubated on laboratory media. The colonies were also identified using various diagnostic tests. Alterations in the presence of various bacterial species over time and gum health were tested using analysis of variance (ANOVA) with Tukey's test post hoc. The average pocket depth for each patient ranged from 1.37 ± 0.39 mm to 2.55 ± 0.72 mm. The bacteria isolated from the cultured samples included aerobic, facultative anerobic, obligate anerobic and capnophilic bacteria. The anerobic conditions created in the peri-implant sulcus might with time enhance the number of anerobic bacteria present following dental implant loading.

Altered network topology in pediatric traumatic brain injury

NASA Astrophysics Data System (ADS)

Dennis, Emily L.; Rashid, Faisal; Babikian, Talin; Mink, Richard; Babbitt, Christopher; Johnson, Jeffrey; Giza, Christopher C.; Asarnow, Robert F.; Thompson, Paul M.

2017-11-01

Outcome after a traumatic brain injury (TBI) is quite variable, and this variability is not solely accounted for by severity or demographics. Identifying sub-groups of patients who recover faster or more fully will help researchers and clinicians understand sources of this variability, and hopefully lead to new therapies for patients with a more prolonged recovery profile. We have previously identified two subgroups within the pediatric TBI patient population with different recovery profiles based on an ERP-derived (event-related potential) measure of interhemispheric transfer time (IHTT). Here we examine structural network topology across both patient groups and healthy controls, focusing on the `rich-club' - the core of the network, marked by high degree nodes. These analyses were done at two points post-injury - 2-5 months (post-acute), and 13-19 months (chronic). In the post-acute time-point, we found that the TBI-slow group, those showing longitudinal degeneration, showed hyperconnectivity within the rich-club nodes relative to the healthy controls, at the expense of local connectivity. There were minimal differences between the healthy controls and the TBI-normal group (those patients who show signs of recovery). At the chronic phase, these disruptions were no longer significant, but closer analysis showed that this was likely due to the loss of power from a smaller sample size at the chronic time-point, rather than a sign of recovery. We have previously shown disruptions to white matter (WM) integrity that persist and progress over time in the TBI-slow group, and here we again find differences in the TBI-slow group that fail to resolve over the first year post-injury.

Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer.

PubMed

Antonia, Scott J; Villegas, Augusto; Daniel, Davey; Vicente, David; Murakami, Shuji; Hui, Rina; Yokoi, Takashi; Chiappori, Alberto; Lee, Ki H; de Wit, Maike; Cho, Byoung C; Bourhaba, Maryam; Quantin, Xavier; Tokito, Takaaki; Mekhail, Tarek; Planchard, David; Kim, Young-Chul; Karapetis, Christos S; Hiret, Sandrine; Ostoros, Gyula; Kubota, Kaoru; Gray, Jhanelle E; Paz-Ares, Luis; de Castro Carpeño, Javier; Wadsworth, Catherine; Melillo, Giovanni; Jiang, Haiyi; Huang, Yifan; Dennis, Phillip A; Özgüroğlu, Mustafa

2017-11-16

Most patients with locally advanced, unresectable, non-small-cell lung cancer (NSCLC) have disease progression despite definitive chemoradiotherapy (chemotherapy plus concurrent radiation therapy). This phase 3 study compared the anti-programmed death ligand 1 antibody durvalumab as consolidation therapy with placebo in patients with stage III NSCLC who did not have disease progression after two or more cycles of platinum-based chemoradiotherapy. We randomly assigned patients, in a 2:1 ratio, to receive durvalumab (at a dose of 10 mg per kilogram of body weight intravenously) or placebo every 2 weeks for up to 12 months. The study drug was administered 1 to 42 days after the patients had received chemoradiotherapy. The coprimary end points were progression-free survival (as assessed by means of blinded independent central review) and overall survival (unplanned for the interim analysis). Secondary end points included 12-month and 18-month progression-free survival rates, the objective response rate, the duration of response, the time to death or distant metastasis, and safety. Of 713 patients who underwent randomization, 709 received consolidation therapy (473 received durvalumab and 236 received placebo). The median progression-free survival from randomization was 16.8 months (95% confidence interval [CI], 13.0 to 18.1) with durvalumab versus 5.6 months (95% CI, 4.6 to 7.8) with placebo (stratified hazard ratio for disease progression or death, 0.52; 95% CI, 0.42 to 0.65; P<0.001); the 12-month progression-free survival rate was 55.9% versus 35.3%, and the 18-month progression-free survival rate was 44.2% versus 27.0%. The response rate was higher with durvalumab than with placebo (28.4% vs. 16.0%; P<0.001), and the median duration of response was longer (72.8% vs. 46.8% of the patients had an ongoing response at 18 months). The median time to death or distant metastasis was longer with durvalumab than with placebo (23.2 months vs. 14.6 months; P<0.001). Grade 3 or 4 adverse events occurred in 29.9% of the patients who received durvalumab and 26.1% of those who received placebo; the most common adverse event of grade 3 or 4 was pneumonia (4.4% and 3.8%, respectively). A total of 15.4% of patients in the durvalumab group and 9.8% of those in the placebo group discontinued the study drug because of adverse events. Progression-free survival was significantly longer with durvalumab than with placebo. The secondary end points also favored durvalumab, and safety was similar between the groups. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).

Allostasis and Allostatic Load in the Context of Poverty in Early Childhood

PubMed Central

Blair, Clancy; Raver, Cybele; Granger, Douglas; Mills-Koonce, Roger; Hibel, Leah

2014-01-01

This paper examined the relation of early environmental adversity associated with poverty to child resting or basal level of cortisol in a prospective longitudinal sample of 1,135 children seen at 7, 15, 24, 35, and 48 months of age. We found main effects for length of time in poverty, poor housing quality, African American ethnicity, and low positive caregiving behavior in which each was uniquely associated with an overall higher level of cortisol from age 7 months to 48 months. We also found that two aspects of the early environment in the context of poverty, adult exits from the home and perceived economic insufficiency, were related to salivary cortisol in a time dependent manner. The effect for the first of these, exits from the home, was consistent with the principle of allostatic load in which the effects of adversity on stress physiology accumulate over time. The effect for perceived economic insufficiency was one in which insufficiency was associated with higher levels of cortisol in infancy but with a typical but steeper decline in cortisol with age at subsequent time points. PMID:21756436

Health-Related Quality-of-Life Findings for the Prostate Cancer Prevention Trial

PubMed Central

2012-01-01

Background The Prostate Cancer Prevention Trial (PCPT)—a randomized placebo-controlled study of the efficacy of finasteride in preventing prostate cancer—offered the opportunity to prospectively study effects of finasteride and other covariates on the health-related quality of life of participants in a multiyear trial. Methods We assessed three health-related quality-of-life domains (measured with the Health Survey Short Form–36: Physical Functioning, Mental Health, and Vitality scales) via questionnaires completed by PCPT participants at enrollment (3 months before randomization), at 6 months after randomization, and annually for 7 years. Covariate data obtained at enrollment from patient-completed questionnaires were included in our model. Mixed-effects model analyses and a cross-sectional presentation at three time points began at 6 months after randomization. All statistical tests were two-sided. Results For the physical function outcome (n = 16 077), neither the finasteride main effect nor the finasteride interaction with time were statistically significant. The effects of finasteride on physical function were minor and accounted for less than a 1-point difference over time in Physical Functioning scores (mixed-effect estimate = 0.07, 95% confidence interval [CI] = −0.28 to 0.42, P = .71). Comorbidities such as congestive heart failure (estimate = −5.64, 95% CI = −7.96 to −3.32, P < .001), leg pain (estimate = −2.57, 95% CI = −3.04 to −2.10, P < .001), and diabetes (estimate = −1.31, 95% CI = −2.04 to −0.57, P < .001) had statistically significant negative effects on physical function, as did current smoking (estimate = −2.34, 95% CI = −2.97 to −1.71, P < .001) and time on study (estimate = −1.20, 95% CI = −1.36 to −1.03, P < .001). Finasteride did not have a statistically significant effect on the other two dependent variables, mental health and vitality, either in the mixed-effects analyses or in the cross-sectional analysis at any of the three time points. Conclusion Finasteride did not negatively affect SF–36 Physical Functioning, Mental Health, or Vitality scores. PMID:22972968

Reasons for Distress Among Burn Survivors at 6, 12, and 24 Months Postdischarge: A Burn Injury Model System Investigation.

PubMed

Wiechman, Shelley A; McMullen, Kara; Carrougher, Gretchen J; Fauerbach, Jame A; Ryan, Colleen M; Herndon, David N; Holavanahalli, Radha; Gibran, Nicole S; Roaten, Kimberly

2017-12-16

To identify important sources of distress among burn survivors at discharge and 6, 12, and 24 months postinjury, and to examine if the distress related to these sources changed over time. Exploratory. Outpatient burn clinics in 4 sites across the country. Participants who met preestablished criteria for having a major burn injury (N=1009) were enrolled in this multisite study. Participants were given a previously developed list of 12 sources of distress among burn survivors and asked to rate on a 10-point Likert-type scale (0=no distress to 10=high distress) how much distress each of the 12 issues was causing them at the time of each follow-up. The Medical Outcomes Study 12-Item Short-Form Health Survey was administered at each time point as a measure of health-related quality of life. The Satisfaction With Appearance Scale was used to understand the relation between sources of distress and body image. Finally, whether a person returned to work was used to determine the effect of sources of distress on returning to employment. It was encouraging that no symptoms were worsening at 2 years. However, financial concerns and long recovery time are 2 of the highest means at all time points. Pain and sleep disturbance had the biggest effect on ability to return to work. These findings can be used to inform burn-specific interventions and to give survivors an understanding of the temporal trajectory for various causes of distress. In particular, it appears that interventions targeted at sleep disturbance and high pain levels can potentially effect distress over financial concerns by allowing a person to return to work more quickly. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Toddlers’ transition to out-of-home day care: Settling into a new care environment

PubMed Central

Datler, Wilfried; Ereky-Stevens, Katharina; Hover-Reisner, Nina; Malmberg, Lars-Erik

2012-01-01

This study investigates toddlers’ initial reaction to day care entry and their behaviour change over the first few months in care. One hundred and four toddlers (10–33 months of age) in Viennese childcare centres participated in the study. One-hour video observations were carried out at 3 time points during the first 4 months in the setting and coded into a total of 36 5-min observation segments. Multilevel models (observation segments nested within children) with an autoregressive error structure fitted data well. Two weeks after entry into care, toddlers’ levels of affect and interaction were low. Overall, changes in all areas of observed behaviour were less than expected. There were considerable individual differences in change over time, mostly unrelated to child characteristics. Significant associations between children's positive affect, their dynamic interactions and their explorative and investigative interest were found. PMID:22721743

Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial.

PubMed

Fielding, S; Rothnie, K; Gray, N M; Little, J; Cruickshank, M E; Neal, K; Walker, L G; Whynes, D; Cotton, S C; Sharp, L

2017-04-01

To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology. Women aged 20-59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity. On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI -3.6 to -1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (-2.4; -3.3 to -1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education. Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Longitudinal Analysis of Early HIV-1-Specific Neutralizing Activity in an Elite Neutralizer and in Five Patients Who Developed Cross-Reactive Neutralizing Activity

PubMed Central

Euler, Zelda; van den Kerkhof, Tom L. G. M.; van Gils, Marit J.; Burger, Judith A.; Edo-Matas, Diana; Phung, Pham; Wrin, Terri

2012-01-01

We previously established that at 3 years postseroconversion, ∼30% of HIV-infected individuals have cross-reactive neutralizing activity (CrNA) in their sera. Here we studied the kinetics with which CrNA develops and how these relate to the development of autologous neutralizing activity as well as viral escape and diversification. For this purpose, sera from five individuals with CrNA and one elite neutralizer that were obtained at three monthly intervals in the first year after seroconversion and at multiple intervals over the disease course were tested for neutralizing activity against an established multiclade panel of six viruses. The same serum samples, as well as sera from three individuals who lacked CrNA, were tested for their neutralizing activities against autologous clonal HIV-1 variants from multiple time points covering the disease course from seroconversion onward. The elite neutralizer already had CrNA at 9.8 months postseroconversion, in contrast with the findings for the other five patients, in whom CrNA was first detected at 20 to 35 months postseroconversion and peaked around 35 months postseroconversion. In all patients, CrNA coincided with neutralizing activity against autologous viruses that were isolated <12 months postseroconversion, while viruses from later time points had already escaped autologous neutralizing activity. Also, the peak in gp160 sequence diversity coincided with the peak of CrNA titers. Individuals who lacked CrNA had lower peak autologous neutralizing titers, viral escape, and sequence diversity than individuals with CrNA. A better understanding of the underlying factors that determine the presence of CrNA or even an elite neutralizer phenotype may aid in the design of an HIV-1 vaccine. PMID:22156522

Work participation in Q-fever patients and patients with Legionnaires' disease: a 12-month cohort study.

PubMed

Van Loenhout, Joris A F; Hautvast, Jeannine L A; Akkermans, Reinier P; Donders, Nathalie C G M; Vercoulen, Jan H; Paget, W John; van der Velden, Koos

2015-05-01

The aim of the study was to assess long-term work participation of Q-fever patients and patients with Legionnaires' disease, and to identify which factors are associated with a reduced work participation in Q-fever patients. Q-fever patients participated at four time points until 12 months after onset of illness, patients with Legionnaires' disease only at 12 months. Data were self-reported using questionnaires on the amount of hours that patients worked, and on socio-demographic, medical, psychosocial and lifestyle aspects. Our study included 336 Q-fever patients and 190 patients with Legionnaires' disease. There was a decrease in the proportion of Q-fever patients with reduced work participation over time, from 45% at 3 months to 19% at 12 months (versus 15% of patients with Legionnaires' disease at 12 months). Factors associated with reduced work participation of Q-fever patients in a multivariate model were having symptoms, a higher level of sorrow, being a former smoker (compared to never smoking), not consuming any alcohol and following additional treatment for the long-term health effects of Q-fever. Despite an increase in work participation of Q-fever patients over time, almost one in five Q-fever patients and one in six patients with Legionnaires' disease still suffer from reduced work participation at 12 months. Occupational and insurance physicians need to be aware of the long-term impact of these diseases on work participation. © 2015 the Nordic Societies of Public Health.

M-type phospholipase A2 receptor autoantibodies and renal function in patients with primary membranous nephropathy.

PubMed

Hoxha, Elion; Harendza, Sigrid; Pinnschmidt, Hans; Panzer, Ulf; Stahl, Rolf A K

2014-11-07

Loss of renal function in patients with primary membranous nephropathy cannot be reliably predicted by laboratory or clinical markers at the time of diagnosis. M-type phospholipase A2 receptor autoantibodies have been shown to be associated with changes in proteinuria. Their eventual effect on renal function, however, is unclear. In this prospective, open, multicenter study, the potential role of M-type phospholipase A2 receptor autoantibodies levels on the increase of serum creatinine in 118 consecutive patients with membranous nephropathy and positivity for serum M-type phospholipase A2 receptor autoantibodies was analyzed. Patients were included in the study between April of 2010 and December of 2012 and observed until December of 2013. The clinical end point was defined as an increase of serum creatinine by ≥ 25% and serum creatinine reaching ≥ 1.3 mg/dl. Patients were divided into tertiles according to their M-type phospholipase A2 receptor autoantibody levels at the time of inclusion in the study: tertile 1 levels=20-86 units/ml (low), tertile 2 levels=87-201 units/ml (medium), and tertile 3 levels ≥ 202 units/ml (high). The median follow-up time of all patients in the study was 27 months (interquartile range=18-33 months). The clinical end point was reached in 69% of patients with high M-type phospholipase A2 receptor autoantibodies levels (tertile 3) but only 25% of patients with low M-type phospholipase A2 receptor autoantibodies levels. The average time to reach the study end point was 17.7 months in patients with high M-type phospholipase A2 receptor autoantibodies levels and 30.9 months in patients with low M-type phospholipase A2 receptor autoantibodies levels. A multivariate Cox regression analysis showed that high M-type phospholipase A2 receptor autoantibodies levels-in addition to men and older age-are an independent predictor for progressive loss of renal function. High M-type phospholipase A2 receptor autoantibodies levels were associated with more rapid loss of renal function in this cohort of patients with primary membranous nephropathy and therefore, could be helpful for treatment decisions. Copyright © 2014 by the American Society of Nephrology.

Analogical Inference and Analogical Access.

DTIC Science & Technology

1987-08-04

Dedre Gentner 13a TYPE OF REPORT 13b TIME COVERED 14. DATE OF REPORT (Year, Month, Day) 15. PAGE COUNT Technical Report FROM 85-9-1 TO 88-8-3j 87-4-8 48...systems of relations, rather than isolated predicates. I will also use the term systeeaetcity at times to refer to the presence of a system of relations...agreement among the judgest they were within one point of each other 97% of the time . 10. These patterns were confirmed by an analysis of variance and by

The long-range correlation and evolution law of centennial-scale temperatures in Northeast China.

PubMed

Zheng, Xiaohui; Lian, Yi; Wang, Qiguang

2018-01-01

This paper applies the detrended fluctuation analysis (DFA) method to investigate the long-range correlation of monthly mean temperatures from three typical measurement stations at Harbin, Changchun, and Shenyang in Northeast China from 1909 to 2014. The results reveal the memory characteristics of the climate system in this region. By comparing the temperatures from different time periods and investigating the variations of its scaling exponents at the three stations during these different time periods, we found that the monthly mean temperature has long-range correlation, which indicates that the temperature in Northeast China has long-term memory and good predictability. The monthly time series of temperatures over the past 106 years also shows good long-range correlation characteristics. These characteristics are also obviously observed in the annual mean temperature time series. Finally, we separated the centennial-length temperature time series into two time periods. These results reveal that the long-range correlations at the Harbin station over these two time periods have large variations, whereas no obvious variations are observed at the other two stations. This indicates that warming affects the regional climate system's predictability differently at different time periods. The research results can provide a quantitative reference point for regional climate predictability assessment and future climate model evaluation.

The honeymoon effect in job performance - Temporal increases in the predictive power of achievement motivation

NASA Technical Reports Server (NTRS)

Helmreich, Robert L.; Sawin, Linda L.; Carsrud, Alan L.

1986-01-01

Correlations between a job performance criterion and personality measures reflecting achievement motivation and an interpersonal orientation were examined at three points in time after completion of job training for a sample of airline reservations agents. Although correlations between the personality predictors and performance were small and nonsignificant for the 3-month period after beginning the job, by the end of six and eight months a number of significant relationships had emerged. Implications for the utility of personality measures in selection and performance prediction are discussed.

Infant Temperament: Stability by Age, Gender, Birth Order, Term Status, and SES

PubMed Central

Bornstein, Marc H.; Putnick, Diane L.; Gartstein, Maria A.; Hahn, Chun-Shin; Auestad, Nancy; O’Connor, Deborah L.

2015-01-01

Two complementary studies focused on stability of infant temperament across the first year and considered infant age, gender, birth order, term status, and socioeconomic status (SES) as moderators. Study 1 consisted of 73 mothers of firstborn term girls and boys queried at 2, 5, and 13 months of age. Study 2 consisted of 335 mothers of infants of different gender, birth order, term status, and SES queried at 6 and 12 months. Consistent positive and negative affectivity factors emerged at all time-points across both studies. Infant temperament proved stable and robust across gender, birth order, term status, and SES. Stability coefficients for temperament factors and scales were medium to large for shorter (<9 months) inter-assessment intervals and small to medium for longer (>10 months) intervals. PMID:25865034

Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years.

PubMed

Albert, Nancy M; Rice, Karen L; Waldo, Mary J; Bena, James F; Mayo, Ann M; Morrison, Shannon L; Westlake, Cheryl; Ellstrom, Kathleen; Powers, Jan; Foster, Jan

2016-01-01

The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research. This study was a descriptive, multicohort design. Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.

A Randomized, Open-Label, Multicenter, Phase III Study of Epoetin Alfa Versus Best Standard of Care in Anemic Patients With Metastatic Breast Cancer Receiving Standard Chemotherapy.

PubMed

Leyland-Jones, Brian; Bondarenko, Igor; Nemsadze, Gia; Smirnov, Vitaliy; Litvin, Iryna; Kokhreidze, Irakli; Abshilava, Lia; Janjalia, Mikheil; Li, Rubi; Lakshmaiah, Kuntegowda C; Samkharadze, Beka; Tarasova, Oksana; Mohapatra, Ranjan Kumar; Sparyk, Yaroslav; Polenkov, Sergey; Vladimirov, Vladimir; Xiu, Liang; Zhu, Eugene; Kimelblatt, Bruce; Deprince, Kris; Safonov, Ilya; Bowers, Peter; Vercammen, Els

2016-04-10

An open-label, noninferiority study to evaluate the impact of epoetin alfa (EPO) on tumor outcomes when used to treat anemia in patients receiving chemotherapy for metastatic breast cancer. Women with hemoglobin ≤ 11.0 g/dL, receiving first- or second-line chemotherapy for metastatic breast cancer, were randomly assigned to EPO 40,000 IU subcutaneously once a week or best standard of care. The primary end point was progression-free survival (PFS). Secondary end points included overall survival, time to tumor progression, overall response rate, RBC transfusions, and thrombotic vascular events. In 2,098 patients randomly assigned, median PFS (based on investigator-determined disease progression [PD]) was 7.4 months in both groups (hazard ratio [HR], 1.089; 95% CI, 0.988 to 1.200); upper bound exceeded prespecified noninferiority margin of 1.15. Median PFS per independent review committee-determined PD was 7.6 months in both groups (HR, 1.028; 95% CI, 0.922 to 1.146); upper bound did not exceed prespecified noninferiority margin. Median overall survival at clinical cutoff (1,337 deaths) was 17.2 months in the EPO and 17.4 months in the best standard of care group (HR, 1.057; 95% CI, 0.949 to 1.177), median time to tumor progression was 7.5 months in both groups (HR, 1.094; 95% CI, 0.991 to 1.209), and overall response rate was 50% versus 51% (odds ratio, 0.950; 95% CI, 0.799 to 1.130). RBC transfusions were 5.8% versus 11.4% (P < .001), and thrombotic vascular events were 2.8% versus 1.4% (P = .038), respectively. The primary end point, PFS based on investigator-determined PD, did not meet noninferiority criteria. As a consistency assessment with the primary finding, PFS based on independent review committee-determined PD met noninferiority criteria. Overall, this study did not achieve noninferiority objective in ruling out a 15% increased risk in PD/death. RBC transfusion should be the preferred approach for the management of anemia in this population. © 2016 by American Society of Clinical Oncology.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces

PubMed Central

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

Purpose To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Setting Assil Eye Institute, Beverly Hills, CA, USA. Design Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients and methods Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Results Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. Conclusion The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient. PMID:26345628

Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation.

PubMed

Chen, Wei; Liu, Bo; Lv, Hongzhi; Su, Yanling; Chen, Xiao; Zhu, Yanbin; Du, Chenguang; Zhang, Xiaolin; Zhang, Yingze

2017-09-01

Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis. From December 2012 to September 2013, patients with unilateral DIACFs were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative day one, week four, week eight, and week 12 to reconstruct coronal, sagittal, and axial images, on which the maximal residual displacements of the fractures were measured. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month. Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between the AOFAS score at post-operative month 12 and the maximal residual displacement of the fractures on the CT images at postoperative week 12. Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice.

Skeletal Muscle Regeneration in a Rat (Rattus norvegicus) Model with CorMatrix and Adipose Derived Stem Cells

DTIC Science & Technology

2015-07-16

outcome or training benefit the DoD/USAF? Yes. This study provided evidence that extracellular matrix made from swine small intestinal submucosa does...Isometric functional testing was implemented prior to euthanasia 2 FDGXXX at 10 months to further evaluate healing at later time points

In and out of Synch: Infant Childcare Teachers' Adaptations to Infants' Developmental Changes

ERIC Educational Resources Information Center

Recchia, Susan L.; Shin, Minsun

2012-01-01

This qualitative multi-case study explored the social exchanges and responsive connections between infants and their infant childcare teachers within a group care context. Infants' naturally occurring behaviours were videotaped purposefully at two separate time points, near the end of their first year and approximately six months later. Findings…

Design and Outcomes of a "Mothers In Motion" Behavioral Intervention Pilot Study

ERIC Educational Resources Information Center

Chang, Mei-Wei; Nitzke, Susan; Brown, Roger

2010-01-01

Objective: This paper describes the design and findings of a pilot "Mothers In Motion" (P-"MIM") program. Design: A randomized controlled trial that collected data via telephone interviews and finger stick at 3 time points: baseline and 2 and 8 months post-intervention. Setting: Three Special Supplemental Nutrition Program for…

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

The Development of Preschoolers' Appreciation of Communicative Ambiguity

ERIC Educational Resources Information Center

Nilsen, Elizabeth S.; Graham, Susan A.

2012-01-01

Using a longitudinal design, preschoolers' appreciation of a listener's knowledge of the location of a hidden sticker after the listener was provided with an ambiguous or unambiguous description was assessed. Preschoolers (N = 34) were tested at 3 time points, each 6 months apart (4, 4 1/2, and 5 years). Eye gaze measures demonstrated that…

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 141.531 - What criteria must a State use to determine that a profile is unnecessary?

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.531 What... the month with the warmest water temperature, and at the point of maximum residence time in your...

40 CFR 461.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2014 CFR

2014-07-01

... GUIDELINES AND STANDARDS (CONTINUED) BATTERY MANUFACTURING POINT SOURCE CATEGORY Lead Subcategory § 461.33... of 7.5 to 10.0 at all times. (4) Subpart C—Battery Wash (Detergent)—NSPS. Pollutant or pollutant... Maximum for any 1 day Maximum for monthly average Metric units—mg/kg of lead in trucked batteries English...

40 CFR 461.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2013 CFR

2013-07-01

... GUIDELINES AND STANDARDS (CONTINUED) BATTERY MANUFACTURING POINT SOURCE CATEGORY Lead Subcategory § 461.33... of 7.5 to 10.0 at all times. (4) Subpart C—Battery Wash (Detergent)—NSPS. Pollutant or pollutant... Maximum for any 1 day Maximum for monthly average Metric units—mg/kg of lead in trucked batteries English...

40 CFR 461.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2012 CFR

2012-07-01

... GUIDELINES AND STANDARDS (CONTINUED) BATTERY MANUFACTURING POINT SOURCE CATEGORY Lead Subcategory § 461.33... of 7.5 to 10.0 at all times. (4) Subpart C—Battery Wash (Detergent)—NSPS. Pollutant or pollutant... Maximum for any 1 day Maximum for monthly average Metric units—mg/kg of lead in trucked batteries English...

Parenting Style, Depressive Symptoms, and Substance Use in Mexican American Adolescents

ERIC Educational Resources Information Center

Ozer, Emily J.; Flores, Elena; Tschann, Jeanne M.; Pasch, Lauri A.

2013-01-01

This study of 151 Mexican American adolescents ages 12 to 15 examined the relationship between parenting and adolescents' self-reported level of depressive symptoms and substance use 6 months and 1 year later. Adolescents and their parents were recruited from a large health-maintenance organization and interviewed at three time points. Lower…

Early Risk and Resiliency Factors Predict Chronic Posttraumatic Stress Disorder in Caregivers of Patients Admitted to a Neuroscience ICU.

PubMed

Choi, Karmel W; Shaffer, Kelly M; Zale, Emily L; Funes, Christopher J; Koenen, Karestan C; Tehan, Tara; Rosand, Jonathan; Vranceanu, Ana-Maria

2018-05-01

Informal caregivers-that is, close family and friends providing unpaid emotional or instrumental care-of patients admitted to ICUs are at risk for posttraumatic stress disorder. As a first step toward developing interventions to prevent posttraumatic stress disorder in ICU caregivers, we examined the predictive validity of psychosocial risk screening during admission for caregiver posttraumatic stress disorder at 3 and 6 months post hospitalization. An observational, prospective study. Ninety-nine caregivers were recruited as part of a longitudinal research program of patient-caregiver dyads in a neuroscience ICU. None. Caregiver posttraumatic stress disorder symptoms were assessed during admission (baseline), 3 months, and 6 months post hospitalization. We 1) characterized prevalence of clinically significant symptoms at each time point 2); calculated sensitivity and specificity of baseline posttraumatic stress disorder screening in predicting posttraumatic stress disorder at 3 and 6 months; and 3) used recursive partitioning to select potential baseline factors and examine the extent to which they helped predict clinically significant posttraumatic stress disorder symptoms at each time point. Rates of caregiver posttraumatic stress disorder remained relatively stable over time (16-22%). Screening for posttraumatic stress disorder at baseline predicted posttraumatic stress disorder at 3 and 6 months with moderate sensitivity (75-80%) and high specificity (92-95%). Screening for posttraumatic stress disorder at baseline was associated with caregiver anxiety, mindfulness (i.e., ability to be aware of one's thoughts and feelings in the moment), and bond with patient. Furthermore, baseline posttraumatic stress disorder screening was the single most relevant predictor of posttraumatic stress disorder at 3 and 6 months, such that other baseline factors did not significantly improve predictive ability. Screening neuroscience ICU caregivers for clinically significant posttraumatic stress disorder symptoms during admission is the single most important way to identify the majority of those likely to suffer from chronic posttraumatic stress disorder following discharge. Addressing early posttraumatic stress disorder symptoms and their psychosocial correlates during admission may help prevent chronic posttraumatic stress disorder in these at-risk caregivers.

Children's appraisals of conflict, beliefs about aggression, and externalizing problems in families characterized by severe intimate partner violence.

PubMed

Jouriles, Ernest N; Vu, Nicole L; McDonald, Renee; Rosenfield, David

2014-12-01

This research examined whether children's threat and self-blame appraisals regarding interparental conflict and their beliefs about the justifiability of aggression predicted children's externalizing problems in families in which there had been recent severe intimate partner violence (IPV). Participants were 106 children (62 boys, 44 girls) aged 7 to 10 and their mothers. Families in which there had been recent severe IPV were recruited during their stay at a domestic violence shelter. Children completed measures of threat, self-blame, beliefs about the justifiability of aggression, and externalizing problems. Mothers completed a measure of children's externalizing problems. Measures were completed at 3 time points, spaced 6 months apart. In multilevel modeling analyses, threat appraisals and beliefs about the justifiability of aggression were positively associated with children's reports of externalizing problems concurrently, and self-blame appraisals were positively associated with mothers' reports of externalizing problems concurrently. In prospective analyses, beliefs about the justifiability of aggression at 1 time point were positively associated with children's reports of externalizing problems 6 months later. The results provide partial support for the modified cognitive-contextual framework.

Language skills of children during the first 12 months after stuttering onset.

PubMed

Watts, Amy; Eadie, Patricia; Block, Susan; Mensah, Fiona; Reilly, Sheena

2017-03-01

To describe the language development in a sample of young children who stutter during the first 12 months after stuttering onset was reported. Language production was analysed in a sample of 66 children who stuttered (aged 2-4 years). The sample were identified from a pre-existing prospective, community based longitudinal cohort. Data were collected at three time points within the first year after stuttering onset. Stuttering severity was measured, and global indicators of expressive language proficiency (length of utterances and grammatical complexity) were derived from the samples and summarised. Language production abilities of the children who stutter were contrasted with normative data. The majority of children's stuttering was rated as mild in severity, with more than 83% of participants demonstrating very mild or mild stuttering at each of the time points studied. The participants demonstrated developmentally appropriate spoken language skills comparable with available normative data. In the first year following the report of stuttering onset, the language skills of the children who were stuttering progressed in a manner that is consistent with developmental expectations. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease.

PubMed

Brodsky, Matthew A; Anderson, Shannon; Murchison, Charles; Seier, Mara; Wilhelm, Jennifer; Vederman, Aaron; Burchiel, Kim J

2017-11-07

To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement. DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an "off"-levodopa Unified Parkinson's Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency. Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in "on" time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index ( p = 0.004) and subscores for cognition ( p = 0.011) and communication ( p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs -6.31 ± 9.7 points ( p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs -5.5 ± 9.6 points, p = 0.038). Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment. NCT01703598. This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging-guided implantation is not significantly different from awake microelectrode recording-guided implantation in improving motor outcomes at 6 months. © 2017 American Academy of Neurology.

Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants.

PubMed

Feng, Sandy; Ekong, Udeme D; Lobritto, Steven J; Demetris, Anthony J; Roberts, John P; Rosenthal, Philip; Alonso, Estella M; Philogene, Mary C; Ikle, David; Poole, Katharine M; Bridges, Nancy D; Turka, Laurence A; Tchao, Nadia K

2012-01-18

Although life-saving, liver transplantation burdens children with lifelong immunosuppression and substantial potential for morbidity and mortality. To establish the feasibility of immunosuppression withdrawal in pediatric living donor liver transplant recipients. Prospective, multicenter, open-label, single-group pilot trial conducted in 20 stable pediatric recipients (11 male; 55%) of parental living donor liver transplants for diseases other than viral hepatitis or an autoimmune disease who underwent immunosuppression withdrawal. Their median age was 6.9 months (interquartile range [IQR], 5.5-9.1 months) at transplant and 8 years 6 months (IQR, 6 years 5 months to 10 years 9 months) at study enrollment. Additional entry requirements included stable allograft function while taking a single immunosuppressive drug and no evidence of acute or chronic rejection or significant fibrosis on liver biopsy. Gradual immunosuppression withdrawal over a minimum of 36 weeks was instituted at 1 of 3 transplant centers between June 5, 2006, and November 18, 2009. Recipients were followed up for a median of 32.9 months (IQR, 1.0-49.9 months). The primary end point was the proportion of operationally tolerant patients, defined as patients who remained off immunosuppression therapy for at least 1 year with normal graft function. Secondary clinical end points included the durability of operational tolerance, and the incidence, timing, severity, and reversibility of rejection. Of 20 pediatric patients, 12 (60%; 95% CI, 36.1%-80.9%) met the primary end point, maintaining normal allograft function for a median of 35.7 months (IQR, 28.1-39.7 months) after discontinuing immunosuppression therapy. Follow-up biopsies obtained more than 2 years after completing withdrawal showed no significant change compared with baseline biopsies. Eight patients did not meet the primary end point secondary to an exclusion criteria violation (n = 1), acute rejection (n = 2), or indeterminate rejection (n = 5). Seven patients were treated with increased or reinitiation of immunosuppression therapy; all returned to baseline allograft function. Patients with operational tolerance compared with patients without operational tolerance initiated immunosuppression withdrawal later after transplantation (median of 100.6 months [IQR, 71.8-123.5] vs 73.0 months [IQR, 57.6-74.9], respectively; P = .03), had less portal inflammation (91.7% [95% CI, 61.5%-99.8%] vs 42.9% [95% CI, 9.9%-81.6%] with no inflammation; P = .04), and had lower total C4d scores on the screening liver biopsy (median of 6.1 [IQR, 5.1-9.3] vs 12.5 [IQR, 9.3-16.8]; P = .03). In this pilot study, 60% of pediatric recipients of parental living donor liver transplants remained off immunosuppression therapy for at least 1 year with normal graft function and stable allograft histology.

Brewer spectrometer total ozone column measurements in Sodankylä

NASA Astrophysics Data System (ADS)

Karppinen, Tomi; Lakkala, Kaisa; Karhu, Juha M.; Heikkinen, Pauli; Kivi, Rigel; Kyrö, Esko

2016-06-01

Brewer total ozone column measurements started in Sodankylä in May 1988, 9 months after the signing of The Montreal Protocol. The Brewer instrument has been well maintained and frequently calibrated since then to produce a high-quality ozone time series now spanning more than 25 years. The data have now been uniformly reprocessed between 1988 and 2014. The quality of the data has been assured by automatic data rejection rules as well as by manual checking. Daily mean values calculated from the highest-quality direct sun measurements are available 77 % of time with up to 75 measurements per day on clear days. Zenith sky measurements fill another 14 % of the time series and winter months are sparsely covered by moon measurements. The time series provides information to survey the evolution of Arctic ozone layer and can be used as a reference point for assessing other total ozone column measurement practices.

The efficacy of intra-articular hyaluronan injection after the microfracture technique for the treatment of articular cartilage lesions.

PubMed

Strauss, Eric; Schachter, Aaron; Frenkel, Sally; Rosen, Jeffrey

2009-04-01

Although the exact mechanism of action has yet to be elucidated, recent animal studies have demonstrated chondroprotective and anti-inflammatory properties of hyaluronic acid viscosupplementation. Intra-articular hyaluronic acid after microfracture improves the quality of the repair leading to a more hyaline-like repair tissue with better defect fill and adjacent area integration. Controlled laboratory study. Full-thickness cartilage defects were created in the weightbearing area of the medial femoral condyle in 36 female New Zealand White rabbits. The defects were then treated with surgical microfracture. Eighteen rabbits formed the 3-month cohort and the other 18 formed the 6-month cohort. Within each cohort, 6 rabbits were randomly assigned to receive 3 weekly injections of hyaluronic acid (group A), 5 weekly injections (group B), or control injections of normal saline (group C). At 3 and 6 months postmicrofracture, the animals were sacrificed and the operative knee harvested. Repair tissue was assessed blinded- both grossly, using a modified component of the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment scoring scale, and histologically, using the modified O'Driscoll histological cartilage scoring system. Comparisons were made with respect to gross and histologic findings between treatment groups at each time point. Effects of each treatment type were also evaluated longitudinally by comparing the 3-month results with the 6-month results. Statistical analysis was performed using unpaired Student t tests with significance defined as P < .05. At 3 months, gross and histologic evaluation of the repair tissue demonstrated that the 3-injection group had significantly better fill of the defects and more normal appearing, hyaline-like tissue than controls (a mean ICRS score of 1.92 vs 1.26; P < .05 and a mean modified O'Driscoll score of 10.3 vs 7.6; P < .02). Specimens treated with 5 weekly injections were not significantly improved compared with controls. At 6 months, the mean gross appearance and histologic scores between the 3 specimen cohorts were not significantly different. However, examination of the entire operative knee demonstrated a significantly greater extent of degenerative changes (synovial inflammation and osteophyte formation) in the control group than in both hyaluronic acid treatment groups (P < .05). Supplementing the microfracture technique with 3 weekly injections of intra-articular hyaluronic acid had a positive effect on the repair tissue that formed within the chondral defect at the early follow-up time point. This improvement was not found for the 3-injection group at 6 months or for the 5-injection group at either time point. Additionally, hyaluronic acid supplementation had a possible chondroprotective and anti-inflammatory effect, limiting the development of degenerative changes within the knee joint. The adjunctive use of hyaluronic acid appears to hold promise in the treatment of chondral injuries and warrants further investigation.

Women's HIV Disclosure to Family and Friends

PubMed Central

Craft, Shonda M.; Reed, Sandra J.

2012-01-01

Abstract Previous researchers have documented rates of HIV disclosure to family at discrete time periods, yet none have taken a dynamic approach to this phenomenon. The purpose of this study is to take the next step and provide a retrospective comparison of rates of women's HIV disclosure to family and friends over a 15-year time span. Of particular interest are the possible influences of social network and relationship characteristics on the time-to-disclosure of serostatus. Time-to-disclosure was analyzed from data provided by 125 HIV-positive women. Participants were primarily married or dating (42%), unemployed (79.2%), African American (68%) women with a high school diploma or less (54.4%). Length of time since diagnosis ranged from 1 month to over 19 years (M=7.1 years). Results pointed to statistically significant differences in time-to-disclosure between family, friends, and sexual partners. Additionally, females and persons with whom the participant had more frequent contact were more likely to be disclosed to, regardless of the type of relationship. The results of this study underscore possible challenges with existing studies which have employed point prevalence designs, and point to new methods which could be helpful in family research. PMID:22313348

Social support buffers the effects of terrorism on adolescent depression: findings from Sderot, Israel.

PubMed

Henrich, Christopher C; Shahar, Golan

2008-09-01

This prospective study of 29 Israeli middle school students experiencing terror attacks by Qassam rockets addressed whether higher levels of baseline social support protected adolescents from adverse psychological effects of exposure to rocket attacks. Participants were assessed at two time points 5 months apart, before and after a period of military escalation from May to September 2007. Adolescent self-reported depression was measured at both time points, using the Center for Epidemiological Studies-Child Depression Scale. Social support from family, friends, and school was measured at time 1, via a short form of the Perceived Social Support Scale. Adolescents also reported their exposure to rocket attacks at both time points. There was a significant interaction between social support and exposure to rocket attacks predicting depression over time. As hypothesized, baseline levels of social support buffered against the effect of exposure to rocket attacks on increased depression. Conversely, social support was associated with increased depression for adolescents who were not exposed to rocket attacks. Findings highlight the potential importance of community mental health efforts to bolster schools, families, and peer groups as protective resources in times of traumatic stress.

Precise Point Positioning technique for short and long baselines time transfer

NASA Astrophysics Data System (ADS)

Lejba, Pawel; Nawrocki, Jerzy; Lemanski, Dariusz; Foks-Ryznar, Anna; Nogas, Pawel; Dunst, Piotr

2013-04-01

In this work the clock parameters determination of several timing receivers TTS-4 (AOS), ASHTECH Z-XII3T (OP, ORB, PTB, USNO) and SEPTENTRIO POLARX4TR (ORB, since February 11, 2012) by use of the Precise Point Positioning (PPP) technique were presented. The clock parameters were determined for several time links based on the data delivered by time and frequency laboratories mentioned above. The computations cover the period from January 1 to December 31, 2012 and were performed in two modes with 7-day and one-month solution for all links. All RINEX data files which include phase and code GPS data were recorded in 30-second intervals. All calculations were performed by means of Natural Resource Canada's GPS Precise Point Positioning (GPS-PPP) software based on high-quality precise satellite coordinates and satellite clock delivered by IGS as the final products. The used independent PPP technique is a very powerful and simple method which allows for better control of antenna positions in AOS and a verification of other time transfer techniques like GPS CV, GLONASS CV and TWSTFT. The PPP technique is also a very good alternative for calibration of a glass fiber link PL-AOS realized at present by AOS. Currently PPP technique is one of the main time transfer methods used at AOS what considerably improve and strengthen the quality of the Polish time scales UTC(AOS), UTC(PL), and TA(PL). KEY-WORDS: Precise Point Positioning, time transfer, IGS products, GNSS, time scales.

[An investigation of psychological state at different stages of occupational AIDS exposure and related influencing factors in Nanning, China].

PubMed

Lin, Q; Ge, X M; Mo, J C; Li, S S; Chen, C C; Chen, S Y

2016-10-20

Objective: To investigate the changes in psychological state after occupational exposure in the AIDS occupational exposure population and related influencing factors, and to provide baseline data and a basis for related departments to conduct mental health prevention and intervention for personnel with occupational AIDS exposure. Methods: AIDS risk assessment was performed for all personnel with occupational AIDS exposure in 2014 in Nanning, China, and the Symptom Checklist - 90 (SCL - 90) psychological scale was used for psychological state evaluation at 24 hours, 1 week, and 3 months after occupational exposure in all persons who met the research criteria. Results: Most of the persons with occupational AIDS exposure came from secondary and tertiary hospitals (85%) , and nurses accounted for the highest percentage (78.3% ). The age ranged from 21 to 50 years, and the mean age was 31.02 ± 7.92 years. The persons with occupational AIDS exposure aged 20~29 years accounted for the highest percentage (51.6%) , and most persons (76.7%) graduated from junior colleges. Compared with the adult norm, there was significant increases in the total psychological score and the number of positive items after occupational exposure ( P <0.05). The scores of all items at 24 hours were significantly higher than those at the other time points, and the scores of all items gradually decreased over time ( F =227.24, 267.57, and 287.46, P <0.05). Compared with the adult norm, there were significant increases in the factor points at 24 hours and significant reductions in the factor points at 3 months ( P <0.05). Compared with those at 24 hours, the factor scores at 3 months decreased significantly ( P <0.05). Conclusion: Occupational AIDS exposure affects the mental status of related personnel, and the mental status at 24 hours after exposure is poor. Related departments should provide corresponding psychological counseling for the occupational exposure population at different exposure times.

Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study

PubMed Central

Vardy, J. L.; Dhillon, H. M.; Pond, G. R.; Renton, C.; Dodd, A.; Zhang, H.; Clarke, S. J.; Tannock, I. F.

2016-01-01

Background Fatigue is associated with cancer and chemotherapy and may be sustained. Here, we describe a prospective longitudinal study evaluating fatigue and putative mechanisms in people with colorectal cancer (CRC). Patients and methods People with localized CRC completed the Functional Assessment of Cancer Treatment-Fatigue (FACT-F) questionnaire at baseline (before chemotherapy, if given), 6, 12, and 24 months. Healthy controls (HCs) were assessed at the first three time points. Fatigue was defined by standardized FACT-F scores ≤68/100. Quality-of-life (QoL, assessed by the FACT-G questionnaire), affective, and cognitive symptoms were evaluated. Associations were sought between fatigue, baseline factors, and blood tests (including hemoglobin, cytokines, and sex hormones). Regression analyses, Fisher's exact tests, and Wilcoxon rank-sum tests assessed levels of fatigue at each time point and change in fatigue from baseline. A repeated-measures analysis investigated prognostic factors of fatigue across all time points. Results A total of 289 subjects with localized CRC (173 received chemotherapy) and 72 HCs were assessed. More CRC patients had fatigue than HCs at baseline (52% versus 26%, P < 0.001). Fatigue was increased in the chemotherapy (CTh) group at 6 months [CTh+ 70% versus CTh− 31% (P < 0.001), HCs 22%] and remained more common at 12 [CTh+ 44% versus CTh− 31% (P = 0.079)] and 24 months [CTh+ 39% versus CTh− 24% (P = 0.047)]. There was no significant difference between those not receiving chemotherapy and HCs at follow-up assessments. Fatigue was associated with poor QoL, affective and cognitive symptoms, but not consistently with cytokine levels. Predictors for sustained fatigue were baseline fatigue, treatment group, cognitive and affective symptoms, poorer QoL, and comorbidities. Conclusions CRC patients have more fatigue than HCs at baseline. Fatigue peaks immediately after adjuvant chemotherapy, but remains common for 2 years in those who receive chemotherapy. Cognitive and affective symptoms, QoL, comorbidities, chemotherapy, and baseline fatigue predict for longer term fatigue. PMID:27443634

Comparison of treatment outcomes in neck pain patients depending on the sex of the chiropractor: a prospective outcome study.

PubMed

Thöni, Janine; Peterson, Cynthia K; Kim Humphreys, B

2017-01-01

The high percentage of female chiropractic students in Switzerland suggests a future sex shift in the chiropractic profession in Switzerland. Thus the purpose of this study is to determine if male and female chiropractors achieve the same treatment outcomes in neck pain patients. Included in this prospective outcomes study were 849 patients with neck pain of any duration. Prior to the first treatment, baseline demographic data, the Bournemouth Questionnaire (BQ) and the numerical rating scale (NRS) for neck and arm pain were completed. At the follow-up time points of 1 week, 1, 3, 6 and 12 months, the Patient's Global Impression of Change (PGIC) scale to categorize the actual 'improvement' and the BQ and the NRS for neck pain were completed. The Chi-square test compared the proportion of patients reporting 'improvement' between male and female chiropractors for each time point. The unpaired Student's t-test compared the BQ and the NRS actual and change scores between patients of male and female chiropractors at all time points. Demographic factors were compared between the sexes using the Chi-square test. Proportionally more patients of female chiropractors reported 'improvement' at 1 month ( p  = 0.035) and significantly more pain reduction at 3 months ( p  = 0.040). Patients of male chiropractors presented with significant older age ( p  = 0.0001), higher levels of baseline neck pain ( p  = 0.012), a lower proportion with radiculopathy ( p  = 0.014) and less pain medication use ( p  = 0.046). Female chiropractors achieve at least equally satisfying treatment results for neck pain patients compared to male chiropractors. Female chiropractors also have a higher proportion of female patients compared to male chiropractors and patients presenting with radiculopathy and using pain medications. Not applicable for this type of study.

Acupuncture for smoking cessation.

PubMed

White, A R; Rampes, H; Ernst, E

2000-01-01

Acupuncture is promoted as a treatment for smoking cessation, and is believed to reduce withdrawal symptoms. The objective of this review is to determine the effectiveness of acupuncture in smoking cessation in comparison with: a) sham acupuncture b) other interventions c) no intervention. We searched the Cochrane Tobacco Addiction Group trials register, Medline, PsycLit, Dissertation Abstracts, Health Planning and Administration, Social SciSearch, Smoking & Health, Embase, Biological Abstracts and DRUG. Randomised trials comparing a form of acupuncture with either sham acupuncture, another intervention or no intervention for smoking cessation. We extracted data in duplicate on the type of subjects, the nature of the acupuncture and control procedures, the outcome measures, method of randomisation, and completeness of follow-up. We assessed abstinence from smoking at the earliest time-point (before 6 weeks), at six months and at one year follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing to smoke. Where appropriate, we performed meta-analysis using a fixed effects model. We identified 18 publications involving 20 comparisons. Acupuncture was not superior to sham acupuncture in smoking cessation at any time point. The odds ratio (OR) for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49); the OR after 6 months was 1.38 (95% confidence interval 0.90 to 2.11) and after 12 months 1.02 (95% confidence interval 0.72 to 1.43). Similarly, when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point. Acupuncture appeared to be superior to no intervention in the early results, but this difference was not sustained. The results with different acupuncture techniques do not show any one particular method (i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control intervention. There is no clear evidence that acupuncture is effective for smoking cessation.

Neglected foreign body infratemporal fossa, a typical presentation: a case report.

PubMed

Sajad, Mir; Kirmani, Masood A; Patigaroo, A R

2011-07-01

A 25 year old male presented to our ENT OPD with the history of hyperemic swelling left zygomatic area with a pointed pustule in the centre resembling a furuncle,which progressed into a discharging sinus, complicated by trismus. The patient had a past history of trauma in the vicinity of the left zygomatic area 4-months back with a pointed stick the tip of the stick which had got lodged in the wound at that time was removed. The diagnostic dilemma was solved as neglected foreign body infratemporal fossa.

Three percent diquafosol ophthalmic solution as an additional therapy to existing artificial tears with steroids for dry-eye patients with Sjögren's syndrome.

PubMed

Yokoi, N; Sonomura, Y; Kato, H; Komuro, A; Kinoshita, S

2015-09-01

To investigate the long-term results of 3% diquafosol ophthalmic solution as an alternative therapy to existing ophthalmic solutions, including topical immunosuppression, for the treatment of dry eye in patients with Sjögren's syndrome. This study involved 14 female dry-eye patients (mean age: 62.4 years) with Sjögren's syndrome who insufficiently responded to their current therapy. In all patients, 3% diquafosol ophthalmic solution was administered six times daily for 12 months in substitution for artificial tears and sodium hyaluronate ophthalmic solution. Their use of corticosteroid eye drops remained unchanged from that prior to the treatment with diquafosol sodium. The subjective symptoms assessed, and ocular signs including tear meniscus radius and the tear film breakup time, and ocular-surface epithelial damage score were examined at 1, 2, 3, 4, 5, 6, 9, and 12 months after initiating treatment. Among the subjective symptoms, significant improvement was obtained in dryness at 2 months post treatment, in eye fatigue at 1, 2, 3, 4, and 12 months post treatment, and in pain at 1, 2, 6, and 12 months post treatment. Difficulty in opening the eye, foreign body sensation, and redness were also significantly ameliorated at various time-points. The tear meniscus radius and the tear film breakup time were significantly improved throughout the observation period, and the corneal epithelial staining scores were significantly decreased at 3 months post treatment. In dry-eye patients with Sjögren's syndrome, treatment with 3% diquafosol ophthalmic solution improved both symptoms and signs, and that effectiveness was maintained for 12 months.

Timing of HPV vaccine intervals among United States teens with consideration to the current ACIP schedule and the WHO 2-dose schedule

PubMed Central

Cloessner, Emily A.; Stokley, Shannon; Yankey, David; Markowitz, Lauri E.

2016-01-01

Abstract The current recommendation for human papillomavirus (HPV) vaccination in the United States is for 3 doses to be administered over a 6 month period. In April 2014, the World Health Organization (WHO) recommended adoption of a 2-dose schedule, with doses spaced a minimum of 6 months apart, for teens who begin the series before age 15. We analyzed data from the 2013 National Immunization Survey-Teen to examine the timing of second and third dose receipt among US adolescents. All analyses were restricted to adolescents age 13–17 y who had adequate provider data. The Wilcoxon–Mann–Whitney test measured differences in time to receive vaccine doses among demographic and socioeconomic groups. Logistic regression identified socioeconomic characteristics associated with receiving the second dose of HPV vaccine at least 6 months after the first dose. The median time for teens to receive the second dose of HPV vaccine was 2.6 months after the first dose, and the median time to receive the third dose was 4.9 months after the second dose. Minority teens and teens living below the poverty level took significantly longer to receive doses. Among teens that initiated the HPV vaccine series before age 15 y, 28.6% received the second dose at least 6 months after the first dose. If these teens, who met the WHO criteria for up-to-date HPV vaccination, were classified as having completed the vaccination series, overall coverage in the US would increase 3.9 percentage points, with African American and Hispanic teens having the greatest increases in coverage. PMID:26587886

Timing of HPV vaccine intervals among United States teens with consideration to the current ACIP schedule and the WHO 2-dose schedule.

PubMed

Cloessner, Emily A; Stokley, Shannon; Yankey, David; Markowitz, Lauri E

2016-06-02

The current recommendation for human papillomavirus (HPV) vaccination in the United States is for 3 doses to be administered over a 6 month period. In April 2014, the World Health Organization (WHO) recommended adoption of a 2-dose schedule, with doses spaced a minimum of 6 months apart, for teens who begin the series before age 15. We analyzed data from the 2013 National Immunization Survey-Teen to examine the timing of second and third dose receipt among US adolescents. All analyses were restricted to adolescents age 13-17 y who had adequate provider data. The Wilcoxon-Mann-Whitney test measured differences in time to receive vaccine doses among demographic and socioeconomic groups. Logistic regression identified socioeconomic characteristics associated with receiving the second dose of HPV vaccine at least 6 months after the first dose. The median time for teens to receive the second dose of HPV vaccine was 2.6 months after the first dose, and the median time to receive the third dose was 4.9 months after the second dose. Minority teens and teens living below the poverty level took significantly longer to receive doses. Among teens that initiated the HPV vaccine series before age 15 y, 28.6% received the second dose at least 6 months after the first dose. If these teens, who met the WHO criteria for up-to-date HPV vaccination, were classified as having completed the vaccination series, overall coverage in the US would increase 3.9 percentage points, with African American and Hispanic teens having the greatest increases in coverage.

Incidence of Dysphagia and Serial Videofluoroscopic Swallow Study Findings After Anterior Cervical Discectomy and Fusion: A Prospective Study.

PubMed

Min, Yusun; Kim, Won-Seok; Kang, Sung Shik; Choi, Jin Man; Yeom, Jin S; Paik, Nam-Jong

2016-05-01

Prospective study. To prospectively assess the incidence of dysphagia and to present the serial changes of each finding in the videofluoroscopic swallow study (VFSS) after anterior cervical discectomy and fusion (ACDF). The reported incidence of dysphagia after ACDF has varied widely, and the serial changes of dysphagia using VFSS have not been clearly determined yet. Data of 47 patients preoperatively and at 1 week and 1 month postoperatively were used for the analyses. The Bazaz dysphagia score and VFSS were checked preoperatively and at 1 week and 1 month postoperatively. The presence of aspiration or penetration, amount of vallecular and pyriform sinus residues, functional dysphagia scale, temporal parameters of oral transit time, pharyngeal transit time, and pharyngeal delay time (PDT) were evaluated from the VFSS data. Incidences of dysphagia measured by the Bazaz dysphagia score were 83.0% at 1 week and 59.6% at 1 month after ACDF. Although the incidence of aspiration was 4.3% and the incidence of penetration was 36.2% at 1 week and 25.5% at 1 month after surgery, none of the patients had aspiration pneumonia. The number of patients with vallecular and pyriform sinus residues significantly increased after ACDF. Further, there were no statistically significant changes at all time points in terms of oral transit time, pharyngeal transit time, and pharyngeal delay time. Dysphagia is common until 1 month after ACDF. Although the incidence of aspiration or penetration in VFSS after ACDF was high, no patient had aspiration pneumonia, which may be because of the intact neurological swallowing mechanism. The typical pattern of dysphagia after ACDF included vallecular and pyriform sinuses filled with postswallow residue, which may result from soft tissue edema and weak constriction of pharyngeal muscles after ACDF.

Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy.

PubMed

Jensen, Megan E; Murphy, V E; Gibson, P G; Mattes, J; Camargo, C A

2018-01-05

Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants. Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother-infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D < 75 nmol/L (at both time-points) versus 25(OH)D ≥ 75 nmol/L (at one or both time-points). In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26-110) nmol/L at 16 weeks, and 65 (range 32-116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D < 75 nmol/L at both time-points; 21 (40%) had 25(OH)D ≥ 75 nmol/L at one or both time-points. Maternal 25(OH)D < 75 nmol/L during pregnancy was associated with a higher proportion of infants with "wheeze ever" at 12 months, compared with 25(OH)D ≥ 75 nmol/L (71 versus 43%, p = .04). Infant acute-care presentations (45 versus 13%, p = .02) and oral corticosteroid use (26 versus 4%, p = .03) due to "asthma/wheezing" were higher in the maternal group with 25(OH)D < 75 nmol/L, versus ≥75 nmol/L. Most pregnant women with asthma had low vitamin D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.

Recovery from hip fracture in eight areas of function.

PubMed

Magaziner, J; Hawkes, W; Hebel, J R; Zimmerman, S I; Fox, K M; Dolan, M; Felsenthal, G; Kenzora, J

2000-09-01

This report describes changes in eight areas of functioning after a hip fracture, identifies the point at which maximal levels of recovery are reached in each area, and evaluates the sequence of recuperation across multiple functional domains. METHODS. Community-residing hip fracture patients (n = 674) admitted to eight hospitals in Baltimore, Maryland, 1990-1991 were followed prospectively for 2 years from the time of hospitalization. Eight areas of function (i.e., upper and lower extremity physical and instrumental activities of daily living; gait and balance; social, cognitive, and affective function) were measured by personal interview and direct observation during hospitalization at 2, 6, 12, 18, and 24 months. Levels of recovery are described in each area, and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data. Most areas of functioning showed progressive lessening of dependence over the first postfracture year, with different levels of recovery and time to maximum levels observed for each area. New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3% for putting on pants to as high as 89.9% for climbing five stairs. Recuperation times were specific to area of function, ranging from approximately 4 months for depressive symptoms (3.9 months), upper extremity function (4.3 months), and cognition (4.4 months) to almost a year for lower extremity function (11.2 months). Functional disability following hip fracture is significant, patterns of recovery differ by area of function, and there appears to be an orderly sequence by which areas of function reach their maximal levels.

Lower Extremity Movement Differences Persist After Anterior Cruciate Ligament Reconstruction and When Returning to Sports.

PubMed

Butler, Robert J; Dai, Boyi; Huffman, Nikki; Garrett, William E; Queen, Robin M

2016-09-01

To examine how landing mechanics change in patients after anterior cruciate ligament reconstruction (ACL-R) between 6 months and 12 months after surgery. Case-series. Laboratory. Fifteen adolescent patients after ACL-R participated. Lower extremity three-dimensional motion analysis was conducted during a bilateral stop jump task in patients at 6 and 12 months after ACL-R. Joint kinematic and kinetic data, in addition to ground reaction forces, were collected at each time point. During the stop jump landing, the peak joint moments and the initial and peak joint motion at the ankle, knee, and hip were examined. The peak vertical ground reaction force was also examined. Interactions were observed for both the peak knee (P = 0.03) and hip extension moment (P = 0.07). However, only the hip extension moment was symmetrical level at 12 months. Statistically significant (P < 0.05) side-to-side differences existed for the ankle angle at initial contact, peak plantarflexion moment, peak hip flexion angle, and peak impact vertical ground reaction force independent of time. The findings of this study suggest that sagittal plane moments at the knee and hip demonstrate an increase in symmetry between 6 months and 1 year after ACL-R surgery, however, symmetry of the knee extension moment is not established by 12 months after surgery. The lack of change in the variables across time was unexpected. As a result, it is inappropriate to expect a change in landing mechanics solely as a result of time alone after discharge from rehabilitation.

Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair

PubMed Central

Melman, L.; Jenkins, E. D.; Hamilton, N. A.; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.

2013-01-01

Purpose To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard®Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO® (LWPP, Ethicon, http://www.ethicon.com), and GORE®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P < 0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P < 0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P = 0.001) but did not significantly change thereafter (P > 0.09). Conclusions The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P = 0.000), and tissue ingrowth increased (P = 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes. PMID:21279663

Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair.

PubMed

Melman, L; Jenkins, E D; Hamilton, N A; Bender, L C; Brodt, M D; Deeken, C R; Greco, S C; Frisella, M M; Matthews, B D

2011-08-01

To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard(®)Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO(®) (LWPP, Ethicon, http://www.ethicon.com), and GORE(®)INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test. No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P < 0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P < 0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P = 0.001) but did not significantly change thereafter (P > 0.09). The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P = 0.000), and tissue ingrowth increased (P = 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.

Study protocol to examine the effects of spaceflight and a spaceflight analog on neurocognitive performance: extent, longevity, and neural bases.

PubMed

Koppelmans, Vincent; Erdeniz, Burak; De Dios, Yiri E; Wood, Scott J; Reuter-Lorenz, Patricia A; Kofman, Igor; Bloomberg, Jacob J; Mulavara, Ajitkumar P; Seidler, Rachael D

2013-12-18

Long duration spaceflight (i.e., 22 days or longer) has been associated with changes in sensorimotor systems, resulting in difficulties that astronauts experience with posture control, locomotion, and manual control. The microgravity environment is an important causal factor for spaceflight induced sensorimotor changes. Whether spaceflight also affects other central nervous system functions such as cognition is yet largely unknown, but of importance in consideration of the health and performance of crewmembers both in- and post-flight. We are therefore conducting a controlled prospective longitudinal study to investigate the effects of spaceflight on the extent, longevity and neural bases of sensorimotor and cognitive performance changes. Here we present the protocol of our study. This study includes three groups (astronauts, bed rest subjects, ground-based control subjects) for which each the design is single group with repeated measures. The effects of spaceflight on the brain will be investigated in astronauts who will be assessed at two time points pre-, at three time points during-, and at four time points following a spaceflight mission of six months. To parse out the effect of microgravity from the overall effects of spaceflight, we investigate the effects of seventy days head-down tilted bed rest. Bed rest subjects will be assessed at two time points before-, two time points during-, and three time points post-bed rest. A third group of ground based controls will be measured at four time points to assess reliability of our measures over time. For all participants and at all time points, except in flight, measures of neurocognitive performance, fine motor control, gait, balance, structural MRI (T1, DTI), task fMRI, and functional connectivity MRI will be obtained. In flight, astronauts will complete some of the tasks that they complete pre- and post flight, including tasks measuring spatial working memory, sensorimotor adaptation, and fine motor performance. Potential changes over time and associations between cognition, motor-behavior, and brain structure and function will be analyzed. This study explores how spaceflight induced brain changes impact functional performance. This understanding could aid in the design of targeted countermeasures to mitigate the negative effects of long-duration spaceflight.

An open label comparative study of glimepiride versus repaglinide in type 2 diabetes mellitus Muslim subjects during the month of Ramadan.

PubMed

Anwar, A; Azmi, K Nor; Hamidon, B B; Khalid, B A K

2006-03-01

This study was conducted to compare the treatment efficacy between a prandial glucose regulator, repaglinide and a new sulphonylurea, glimepiride in Muslim Type 2 diabetic patients who practice Ramadan fasting. Forty-one patients, previously treated with a sulphonylurea or metformin, were divided to receive either repaglinide (n=20, preprandially three-times daily) or glimepiride (n=21, preprandially once daily) 3 months before the month of Ramadan. During Ramadan, patients modified their eating pattern to two meals daily, and the triple doses of repaglinide were redistributed to two preprandial doses. Four point blood glucose monitoring were performed weekly during the month of Ramadan and the subsequent month. Measurements of the 4-point blood glucose were significantly lower in the glimepiride group compared to the repaglinide group both during and after Ramadan. The glycaemic excursion was better in the morning for the repaglinide group and better in the afternoon and evening for the glimepiride group during the Ramadan period. There was no statistically significant difference in the incidence of hypoglycaemia between the two groups during and after Ramadan. There was no difference in the glycaemic excursion post-Ramadan. The longer duration of action of glimepiride may offer an advantage over repaglinide during the 13.5 hours of fast in Ramadan for diabetic patients.

Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint.

PubMed

Kawasaki, Kenzo; Uchio, Yuji; Adachi, Nobuo; Iwasa, Junji; Ochi, Mitsuo

2003-09-01

We demonstrate a new method in which a drilling is made from the intercondylar space, and its efficacy in treating osteochondritis dissecans (OCD) of the knee in skeletally immature patients with relatively stable lesions with an intact articular surface, in cases where there was failure of initial non-operative management. The lesions of 16 knees of 12 patients with OCD of the femoral condyles failed to heal by conservative treatment for more than 3 months (average 5-6 months) and thereafter were arthroscopically treated with drilling from not the transarticular but the intercondylar bare area without damaging the articular surface. Eight lesions involved the medial femoral condyle, and eight involved the lateral femoral condyle. The average follow-up was 16 months. All lesions healed after drilling, and the average time of healing was 4 months by X-ray and 7 months by MRI. The average Lysholm score improved from an average of 70.4 points at preoperation to an average of 97.8 points after operation. The results of the Hughston Rating Scale were similar: 10 of the 12 patients showed excellent results and the remaining two patients good results. We advocate our new and less invasive procedure of drilling from the bare area of the intercondylar space for OCD in the knee joint of skeletally immature patients who have had failure of initial non-operative management.

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal.

PubMed

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Little is known about purchasing micronutrient powders (MNP) for children 2-5 years. We describe acceptability for purchasing and price points for MNP for children 2-5 years among caregivers living in districts where free MNP are distributed for children 6-23 months. Crosssectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among sociodemographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6-23 months who had heard of MNP. Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal.

Normal orbit skeletal changes in adolescents as determined through cone-beam computed tomography.

PubMed

Lee, B; Flores-Mir, C; Lagravère, M O

2016-11-10

To determine three-dimensional spatial orbit skeletal changes in adolescents over a 19 to 24 months observation period assessed through cone-beam computed tomography (CBCT). The sample consisted of 50 adolescents aged 11 to 17. All were orthodontic patients who had two CBCTs taken with an interval of 19 to 24 months between images. The CBCTs were analyzed using the third-party software Avizo. Sixteen anatomical landmarks resulting in 24 distances were used to measure spatial structural changes of both orbits. Reliability and measurement error of all landmarks were calculated using ten CBCTs. Descriptive and t-test statistical analyses were used to determine the overall changes in the orbits. All landmarks showed excellent reliability with the largest measurement error being the Y-coordinate of the left most medial point of the temporalis grooves at 0.95 mm. The mean differences of orbital changes between time 1 and time 2 in the transverse, antero-posterior and vertical directions were 0.97, 0.36 and 0.33 mm respectively. Right to left most antero-inferior superior orbital rim distance had the greatest overall transverse change of 4.37 mm. Right most posterior point of lacrimal crest to right most postero-lateral point of the superior orbital fissure had the greatest overall antero-posterior change of 0.52 mm. Lastly, left most antero-inferior superior orbital rim to left most antero-superior inferior orbital rim had the greatest overall vertical change of 0.63 mm. The orbit skeletal changes in a period of 19-24 months in a sample of 11-17 year olds were statistically significant, but are not considered to be clinically significant. The overall average changes of orbit measurements were less than 1 mm.

Reported Prestroke Physical Activity Is Associated with Vascular Endothelial Growth Factor Expression and Good Outcomes after Stroke.

PubMed

López-Cancio, Elena; Ricciardi, Ana Clara; Sobrino, Tomás; Cortés, Jordi; de la Ossa, Natalia Pérez; Millán, Mónica; Hernández-Pérez, María; Gomis, Meritxell; Dorado, Laura; Muñoz-Narbona, Lucía; Campos, Francisco; Arenillas, Juan F; Dávalos, Antoni

2017-02-01

Physical activity (PhA) prior to stroke has been associated with good outcomes after the ischemic insult, but there is scarce data on the involved molecular mechanisms. We studied consecutive acute ischemic stroke patients admitted to a single tertiary stroke center. Prestroke PhA was evaluated with the International Physical Activity Questionnaire (metabolic equivalent of minutes/week). We studied several circulating angiogenic and neurogenic factors at different time points: vascular endothelial growth factor (VEGF), granulocyte colony-stimulating factor (G-CSF), and brain-derived neurotrophic factor (BDNF) at admission, day 7, and at 3 months. We considered good functional outcome at 3 months (modified Rankin scale  ≤ 2) as primary end point, and final infarct volume as secondary outcome. We studied 83 patients with at least 2 time point serum determinations (mean age 69.6 years, median National Institutes of Health Stroke Scale 17 at admission). Patients more physically active before stroke had a significantly higher increment of serum VEGF on the seventh day when compared to less active patients. This increment was an independent predictor of good functional outcome at 3 months and was associated with smaller infarct volume in multivariate analyses adjusted for relevant covariates. We did not find independent associations of G-CSF or BDNF levels neither with level of prestroke PhA nor with stroke outcomes. Although there are probably more molecular mechanisms by which PhA exerts its beneficial effects in stroke outcomes, our observation regarding the potential role of VEGF is plausible and in line with previous experimental studies. Further research in this field is needed. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Neuroprotection after a first episode of mania: a randomized controlled maintenance trial comparing the effects of lithium and quetiapine on grey and white matter volume

PubMed Central

Berk, M; Dandash, O; Daglas, R; Cotton, S M; Allott, K; Fornito, A; Suo, C; Klauser, P; Liberg, B; Henry, L; Macneil, C; Hasty, M; McGorry, P; Pantelis, Cs; Yücel, M

2017-01-01

Lithium and quetiapine are effective treatments for bipolar disorder, but their potential neuroprotective effects in humans remain unclear. A single blinded equivalence randomized controlled maintenance trial was conducted in a prospective cohort of first-episode mania (FEM) patients (n=26) to longitudinally compare the putative protective effects of lithium and quetapine on grey and white matter volume. A healthy control sample was also collected (n=20). Using structural MRI scans, voxel-wise grey and white matter volumes at baseline and changes over time in response to treatment were investigated. Patients were assessed at three time points (baseline, 3 and 12-month follow-up), whereas healthy controls were assessed at two time points (baseline and 12-month follow-up). Patients were randomized to lithium (serum level 0.6 mmol l−1, n=20) or quetiapine (flexibly dosed up to 800 mg per day, n=19) monotherapy. At baseline, compared with healthy control subjects, patients with FEM showed reduced grey matter in the orbitofrontal cortex, anterior cingulate, inferior frontal gyrus and cerebellum. In addition, patients had reduced internal capsule white matter volume bilaterally (t1,66>3.20, P<0.01). Longitudinally, there was a significant treatment × time effect only in the white matter of the left internal capsule (F2,112=8.54, P<0.01). Post hoc testing showed that, compared with baseline, lithium was more effective than quetiapine in slowing the progression of white matter volume reduction after 12 months (t1,24=3.76, P<0.01). Our data support the role of lithium but not quetiapine therapy in limiting white matter reduction early in the illness course after FEM. PMID:28117843

Subthalamic Nucleus Deep Brain Stimulation in Early Stage Parkinson’s Disease

PubMed Central

Charles, David; Konrad, Peter E.; Neimat, Joseph S.; Molinari, Anna L.; Tramontana, Michael G.; Finder, Stuart G.; Gill, Chandler E.; Bliton, Mark J.; Kao, Chris C.; Phibbs, Fenna T.; Hedera, Peter; Salomon, Ronald M.; Cannard, Kevin R.; Wang, Lily; Song, Yanna; Davis, Thomas L.

2014-01-01

Background Deep brain stimulation (DBS) is an effective and approved therapy for advanced Parkinson’s disease (PD), and a recent study suggests efficacy in mid-stage disease. This manuscript reports the results of a pilot trial investigating preliminary safety and tolerability of DBS in early PD. Methods Thirty subjects with idiopathic PD (Hoehn & Yahr Stage II off medication), age 50–75, on medication ≥ 6 months but < 4 years, and without motor fluctuations or dyskinesias were randomized to optimal drug therapy (ODT) (n=15) or DBS+ODT (n=15). Co-primary endpoints were the time to reach a 4-point worsening from baseline in the UPDRS-III off therapy and the change in levodopa equivalent daily dose from baseline to 24 months. Results As hypothesized, the mean UPDRS total and part III scores were not significantly different on or off therapy at 24 months. The DBS+ODT group took less medication at all time points, and this reached maximum difference at 18 months. With a few exceptions, differences in neuropsychological functioning were not significant. Two subjects in the DBS+ODT group suffered serious adverse events; remaining adverse events were mild or transient. Conclusions This study demonstrates that subjects with early stage PD will enroll in and complete trials testing invasive therapies and provides preliminary evidence that DBS is well tolerated in early PD. The results of this trial provide the data necessary to design a large, phase III, double-blind, multicenter trial investigating the safety and efficacy of DBS in early PD. PMID:24768120

Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease.

PubMed

Charles, David; Konrad, Peter E; Neimat, Joseph S; Molinari, Anna L; Tramontana, Michael G; Finder, Stuart G; Gill, Chandler E; Bliton, Mark J; Kao, Chris; Phibbs, Fenna T; Hedera, Peter; Salomon, Ronald M; Cannard, Kevin R; Wang, Lily; Song, Yanna; Davis, Thomas L

2014-07-01

Deep brain stimulation (DBS) is an effective and approved therapy for advanced Parkinson's disease (PD), and a recent study suggests efficacy in mid-stage disease. This manuscript reports the results of a pilot trial investigating preliminary safety and tolerability of DBS in early PD. Thirty subjects with idiopathic PD (Hoehn & Yahr Stage II off medication), age 50-75, on medication ≥6 months but ≤4 years, and without motor fluctuations or dyskinesias were randomized to optimal drug therapy (ODT) (n = 15) or DBS + ODT (n = 15). Co-primary endpoints were the time to reach a 4-point worsening from baseline in the UPDRS-III off therapy and the change in levodopa equivalent daily dose from baseline to 24 months. As hypothesized, the mean UPDRS total and part III scores were not significantly different on or off therapy at 24 months. Medication requirements in the DBS + ODT group were lower at all time points with a maximal difference at 18 months. With a few exceptions, differences in neuropsychological functioning were not significant. Two subjects in the DBS + ODT group suffered serious adverse events; remaining adverse events were mild or transient. This study demonstrates that subjects with early stage PD will enroll in and complete trials testing invasive therapies and provides preliminary evidence that DBS is well tolerated in early PD. The results of this trial provide the data necessary to design a large, phase III, double-blind, multicenter trial investigating the safety and efficacy of DBS in early PD. Copyright © 2014 Elsevier Ltd. All rights reserved.

Breakfast and Energy Drink Consumption in Secondary School Children: Breakfast Omission, in Isolation or in Combination with Frequent Energy Drink Use, is Associated with Stress, Anxiety, and Depression Cross-Sectionally, but not at 6-Month Follow-Up.

PubMed

Richards, Gareth; Smith, Andrew P

2016-01-01

A considerable amount of research suggests that breakfast omission and the frequent use of caffeinated energy drinks may be associated with undesirable effects, and particularly so in children and adolescents. The current paper presents cross-sectional and longitudinal data from the Cornish Academies Project to investigate the effects of consuming energy drinks and missing breakfast on stress, anxiety, and depression in a cohort of secondary school children from the South West of England. Questionnaires were administered at two time-points (spaced 6 months apart) to collect information relating to diet and lifestyle over the previous 6 months. Demographic and school data were acquired through the School Information Management System, and single-item measures of stress, anxiety, and depression were administered at the second time-point only. Associations between breakfast and energy drink consumption and stress, anxiety, and depression were investigated, and a multivariate approach was taken so that additional variance from diet, demography, and lifestyle could be controlled for statistically. Cross-sectional analyses showed that breakfast omission was consistently associated with negative outcomes, and that this was largely observed for both those who frequently consumed energy drinks and those who did not. However, cross-lag analyses showed that neither breakfast omission or energy drink consumption, alone or in combination, was predictive of stress, anxiety, or depression at 6-month follow-up. This suggests that associations between breakfast and mental health may be bi-directional rather than breakfast being the causal factor.

Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes.

PubMed

Jones, Roy W; Lebrec, Jeremie; Kahle-Wrobleski, Kristin; Dell'Agnello, Grazia; Bruno, Giuseppe; Vellas, Bruno; Argimon, Josep M; Dodel, Richard; Haro, Josep Maria; Wimo, Anders; Reed, Catherine

2017-01-01

We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.

Effect of eccentric exercise program for early tibialis posterior tendinopathy.

PubMed

Kulig, Kornelia; Lederhaus, Eric S; Reischl, Steve; Arya, Shruti; Bashford, Greg

2009-09-01

Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations (p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation (p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization.

MAOA expression predicts vulnerability for alcohol use.

PubMed

Cervera-Juanes, R; Wilhem, L J; Park, B; Lee, R; Locke, J; Helms, C; Gonzales, S; Wand, G; Jones, S R; Grant, K A; Ferguson, B

2016-04-01

The role of the monoamines dopamine (DA) and serotonin (5HT) and the monoamine-metabolizing enzyme monoamine oxidase A (MAOA) have been repeatedly implicated in studies of alcohol use and dependence. Genetic investigations of MAOA have yielded conflicting associations between a common polymorphism (MAOA-LPR) and risk for alcohol abuse. The present study provides direct comparison of tissue-specific MAOA expression and the level of alcohol consumption. We analyzed rhesus macaque MAOA (rhMAOA) expression in blood from males before and after 12 months of alcohol self-administration. In addition, nucleus accumbens core (NAc core) and cerebrospinal fluid (CSF) were collected from alcohol access and control (no alcohol access) subjects at the 12-month time point for comparison. The rhMAOA expression level in the blood of alcohol-naive subjects was negatively correlated with subsequent alcohol consumption level. The mRNA expression was independent of rhMAOA-LPR genotype and global promoter methylation. After 12 months of alcohol use, blood rhMAOA expression had decreased in an alcohol dose-dependent manner. Also after 12 months, rhMAOA expression in the NAc core was significantly lower in the heavy drinkers, as compared with control subjects. The CSF measured higher levels of DA and lower DOPAC/DA ratios among the heavy drinkers at the same time point. These results provide novel evidence that blood MAOA expression predicts alcohol consumption and that heavy alcohol use is linked to low MAOA expression in both the blood and NAc core. Together, the findings suggest a mechanistic link between dampened MAOA expression, elevated DA and alcohol abuse.

Partial recovery of hemiparesis following hemispherectomy in infant monkeys.

PubMed

Burke, Mark W; Zangenehpour, Shahin; Ptito, Maurice

2010-01-22

Hemiparesis, unilateral weakness or partial paralysis, is a common outcome following hemispherectomy in humans. We use the non-human primate as an invaluable translational model for our understanding of developmental plasticity in response to hemispherectomy. Three infant vervet monkeys (Chlorocebus sabeus) underwent hemispherectomy at a median age of 9 weeks and two additional monkeys at 48 months. Gross motor assessment was conducted in a large open field that contained a horizontal bar spanning the width of the cage. Subjects were assessed yearly following surgery in infantile lesions for a period of 3 years. Adult-lesioned subjects were assessed 40 months following surgery. Shortly after surgery both infant and adult-lesioned subjects were unable to move the contralateral side of their body, but all subjects were able to walk within 6 months following surgery. At each time point the lower limb gait was normal in infant-lesioned subjects with no apparent limp or dragging, however the upper limb demonstrated significant impairment. Horizontal bar crossing was significantly impaired during the first 24 months following surgery. Adult-lesioned subjects also displayed upper limb movement impairments similar to infant-lesioned subjects. In addition the adult-lesioned subjects displayed a noticeable lower limb limp, which was not observed in the infant-lesioned group. Both groups at each time point showed a propensity for ipsiversive turning. The upper limb gait impairment and horizontal bar crossing of lesioned subjects are reminiscent of hemiparesis seen in hemisperectomized humans with the young-lesioned subjects showing a greater propensity for recovery. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Developmental Programming: Impact of Prenatal Testosterone Excess on Insulin Sensitivity, Adiposity, and Free Fatty Acid Profile in Postpubertal Female Sheep

PubMed Central

Veiga-Lopez, A.; Moeller, J.; Patel, D.; Ye, W.; Pease, A.; Kinns, J.

2013-01-01

Prenatal T excess causes reproductive and metabolic disruptions including insulin resistance, attributes of women with polycystic ovary syndrome. This study tested whether increases in visceral adiposity, adipocyte size, and total free fatty acids underlie the insulin resistance seen in prenatal T-treated female sheep. At approximately 16 months of age, insulin resistance and adipose tissue partitioning were determined via hyperinsulinemic euglycemic clamp and computed tomography, respectively, in control and prenatal T-treated females. Three months later, adipocyte size and free fatty acid composition were determined. Results revealed that at the postpubertal time points tested, insulin sensitivity was increased, visceral adiposity and adipocyte size in both the sc and the visceral compartments were reduced, and circulating palmitic acid was increased in prenatal T-treated females relative to controls. In parallel studies, 20-month-old prenatal T-treated females tended to have increased basal insulin to glucose ratio. Relative to earlier findings of reduced insulin sensitivity of prenatal T-treated females during early life and adulthood, these findings of increased insulin sensitivity and reduced adiposity postpubertally are suggestive of a period of developmental adaptation. The disruption observed in free fatty acid metabolism a few months later correspond to a time point when the insulin sensitivity indices of prenatal T-treated animals appear to shift toward insulin resistance. In summary, current findings of improved insulin sensitivity and reduced visceral adiposity in postpubertal prenatal T-treated sheep relative to our earlier findings of reduced insulin sensitivity during early postnatal life and adulthood are indicative of a period of developmental adaptation. PMID:23525243

Active Idiotypic Vaccination Versus Control Immunotherapy for Follicular Lymphoma

PubMed Central

Levy, Ronald; Ganjoo, Kristen N.; Leonard, John P.; Vose, Julie M.; Flinn, Ian W.; Ambinder, Richard F.; Connors, Joseph M.; Berinstein, Neil L.; Belch, Andrew R.; Bartlett, Nancy L.; Nichols, Craig; Emmanouilides, Christos E.; Timmerman, John M.; Gregory, Stephanie A.; Link, Brian K.; Inwards, David J.; Freedman, Arnold S.; Matous, Jeffrey V.; Robertson, Michael J.; Kunkel, Lori A.; Ingolia, Diane E.; Gentles, Andrew J.; Liu, Chih Long; Tibshirani, Robert; Alizadeh, Ash A.; Denney, Dan W.

2014-01-01

Purpose Idiotypes (Ids), the unique portions of tumor immunoglobulins, can serve as targets for passive and active immunotherapies for lymphoma. We performed a multicenter, randomized trial comparing a specific vaccine (MyVax), comprising Id chemically coupled to keyhole limpet hemocyanin (KLH) plus granulocyte macrophage colony-stimulating factor (GM-CSF) to a control immunotherapy with KLH plus GM-CSF. Patients and Methods Patients with previously untreated advanced-stage follicular lymphoma (FL) received eight cycles of chemotherapy with cyclophosphamide, vincristine, and prednisone. Those achieving sustained partial or complete remission (n = 287 [44%]) were randomly assigned at a ratio of 2:1 to receive one injection per month for 7 months of MyVax or control immunotherapy. Anti-Id antibody responses (humoral immune responses [IRs]) were measured before each immunization. The primary end point was progression-free survival (PFS). Secondary end points included IR and time to subsequent antilymphoma therapy. Results At a median follow-up of 58 months, no significant difference was observed in either PFS or time to next therapy between the two arms. In the MyVax group (n = 195), anti-Id IRs were observed in 41% of patients, with a median PFS of 40 months, significantly exceeding the median PFS observed in patients without such Id-induced IRs and in those receiving control immunotherapy. Conclusion This trial failed to demonstrate clinical benefit of specific immunotherapy. The subset of vaccinated patients mounting specific anti-Id responses had superior outcomes. Whether this reflects a therapeutic benefit or is a marker for more favorable underlying prognosis requires further study. PMID:24799467

Randomization to plant-based dietary approaches leads to larger short-term improvements in Dietary Inflammatory Index scores and macronutrient intake compared with diets that contain meat.

PubMed

Turner-McGrievy, Gabrielle M; Wirth, Michael D; Shivappa, Nitin; Wingard, Ellen E; Fayad, Raja; Wilcox, Sara; Frongillo, Edward A; Hébert, James R

2015-02-01

Studies have examined nutrient differences among people following different plant-based diets. However, all of these studies have been observational. The aim of the present study was to examine differences in nutrient intake and Dietary Inflammatory Index (DII) scores among overweight and obese (body mass index 25.0-49.9 kg/m(2)) adults randomized to receive dietary instruction on a vegan (n = 12), vegetarian (n = 13), pescovegetarian (n = 13), semivegetarian (n = 13), or omnivorous (n = 12) diet during a 6-month randomized controlled trial. Nutrient intake, nutrient adequacy, and DII score were assessed via two 24-hour dietary recalls (Automated Self-Administered 24-Hour Dietary Recall) at baseline and at 2 and 6 months. Differences in nutrient intake and the DII were examined using general linear models with follow-up tests at each time point. We hypothesized that individuals randomized to the vegan diet would have lower DII scores and greater improvements in fiber, carbohydrate, fat, saturated fat, and cholesterol at both 2 and 6 months as compared with the other 4 diets. Participants randomized to the vegan diet had significantly greater changes in most macronutrients at both time points, including fat and saturated fat, as well as cholesterol and, at 2 months, fiber, as compared with most of the other diet groups (Ps < .05). Vegan, vegetarian, and pescovegetarian participants all saw significant improvements in the DII score as compared with semivegetarian participants at 2 months (Ps < .05) with no differences at 6 months. Given the greater impact on macronutrients and the DII during the short term, finding ways to provide support for adoption and maintenance of plant-based dietary approaches, such as vegan and vegetarian diets, should be given consideration. Copyright © 2015 Elsevier Inc. All rights reserved.

The Discoloration effect of White Mineral Trioxide Aggregate (WMTA), Calcium Enriched Mixture (CEM), and Portland Cement (PC) on Human Teeth.

PubMed

Salem-Milani, Amin; Ghasemi, Saeede; Rahimi, Saeed; Ardalan-Abdollahi, Amir; Asghari-Jafarabadi, Mohammad

2017-12-01

The aim of this study was to evaluate the discoloration induced by CEM cement, Portland cement (PC) and MTA mixed with propylene glycol (MTA-PG) in comparison to White MTA. Ninety extracted premolar and canine teeth were resected 2 mm below the CEJ. The coronal part of crown was prepared with peeso reamer and Gates-Glidden drills, and the specimens were randomly divided into 4 experimental (n=20) and one control (n=10) groups. The tooth crowns in experimental groups 1 to 4 were filled with White MTA, PC, CEM cement and MTA-PG, respectively; and in group 5, the teeth were kept empty. After incubation, digital photographs of teeth were acquired at 4 time points (before, immediately after placing the materials, 3 and 6 months afterwards). Images were transferred to Adobe Photoshop CS4 and CIE L*a*b color space was used for tooth shade assessment. One-Way ANOVA and One-Sample t-test were used to compare discoloration of teeth between groups. Significant statistical discoloration was only observed in the cervical one third of all groups at each time points (except between 3 and 6 months). Tooth discoloration was greatest in PC and lower in MTA and MTA-PG at the end of 6 months. The tooth discoloration between immediately and 3 months after placing the materials had significant difference only between MTA and PC; and also the tooth discoloration between immediately and 6 months after placing the materials was observed only between PC and MTA, and PC and MTA-PG. All of the experimental biomaterials caused tooth discoloration after 6 months, of those, PC had the most and MTA and MTA-PG had the least discoloration effect. Key words: Mineral trioxide aggregate (MTA). Calcium enriched mixture (CEM). Propylene glycol. Portland cement.

Approaches for quantifying energy intake and %calorie restriction during calorie restriction interventions in humans: the multicenter CALERIE study.

PubMed

Racette, Susan B; Das, Sai Krupa; Bhapkar, Manjushri; Hadley, Evan C; Roberts, Susan B; Ravussin, Eric; Pieper, Carl; DeLany, James P; Kraus, William E; Rochon, James; Redman, Leanne M

2012-02-15

Calorie restriction (CR) is a component of most weight loss interventions and a potential strategy to slow aging. Accurate determination of energy intake and %CR is critical when interpreting the results of CR interventions; this is most accurately achieved using the doubly labeled water method to quantify total energy expenditure (TEE). However, the costs and analytical requirements of this method preclude its repeated use in many clinical trials. Our aims were to determine 1) the optimal TEE assessment time points for quantifying average energy intake and %CR during long-term CR interventions and 2) the optimal approach for quantifying short-term changes in body energy stores to determine energy intake and %CR during 2-wk DLW periods. Adults randomized to a CR intervention in the multicenter CALERIE study underwent measurements of TEE by doubly labeled water and body composition at baseline and months 1, 3, and 6. Average %CR achieved during the intervention was 24.9 ± 8.7%, which was computed using an approach that included four TEE assessment time points (i.e., TEE(baseline, months 1, 3, and 6)) plus the 6-mo change in body composition. Approaches that included fewer TEE assessments yielded %CR values of 23.4 ± 9.0 (TEE(baseline,) months 3 and 6), 25.0 ± 8.7 (TEE(baseline,) months 1 and 6), and 20.9 ± 7.1% (TEE(baseline, month 6)); the latter approach differed significantly from approach 1 (P < 0.001). TEE declined 9.6 ± 9.9% within 2-4 wk of CR beginning and then stabilized. Regression of daily home weights provided the most reliable estimate of short-term change in energy stores. In summary, optimal quantification of energy intake and %CR during weight loss necessitates a TEE measurement within the first month of CR to capture the rapid reduction in TEE.

Approaches for quantifying energy intake and %calorie restriction during calorie restriction interventions in humans: the multicenter CALERIE study

PubMed Central

Das, Sai Krupa; Bhapkar, Manjushri; Hadley, Evan C.; Roberts, Susan B.; Ravussin, Eric; Pieper, Carl; DeLany, James P.; Kraus, William E.; Rochon, James; Redman, Leanne M.

2012-01-01

Calorie restriction (CR) is a component of most weight loss interventions and a potential strategy to slow aging. Accurate determination of energy intake and %CR is critical when interpreting the results of CR interventions; this is most accurately achieved using the doubly labeled water method to quantify total energy expenditure (TEE). However, the costs and analytical requirements of this method preclude its repeated use in many clinical trials. Our aims were to determine 1) the optimal TEE assessment time points for quantifying average energy intake and %CR during long-term CR interventions and 2) the optimal approach for quantifying short-term changes in body energy stores to determine energy intake and %CR during 2-wk DLW periods. Adults randomized to a CR intervention in the multicenter CALERIE study underwent measurements of TEE by doubly labeled water and body composition at baseline and months 1, 3, and 6. Average %CR achieved during the intervention was 24.9 ± 8.7%, which was computed using an approach that included four TEE assessment time points (i.e., TEEbaseline, months 1, 3, and 6) plus the 6-mo change in body composition. Approaches that included fewer TEE assessments yielded %CR values of 23.4 ± 9.0 (TEEbaseline, months 3 and 6), 25.0 ± 8.7 (TEEbaseline, months 1 and 6), and 20.9 ± 7.1% (TEEbaseline, month 6); the latter approach differed significantly from approach 1 (P < 0.001). TEE declined 9.6 ± 9.9% within 2–4 wk of CR beginning and then stabilized. Regression of daily home weights provided the most reliable estimate of short-term change in energy stores. In summary, optimal quantification of energy intake and %CR during weight loss necessitates a TEE measurement within the first month of CR to capture the rapid reduction in TEE. PMID:22127229

Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.

PubMed

Thomas, Jeffrey L; Wilk, Joshua E; Riviere, Lyndon A; McGurk, Dennis; Castro, Carl A; Hoge, Charles W

2010-06-01

A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with postdeployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression. However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse, or aggressive behavior as comorbid factors occurring with PTSD and depression. To (1) examine the prevalence rates of depression and PTSD using several case definitions including functional impairment, (2) determine the comorbidity of alcohol misuse or aggressive behaviors with depression or PTSD, and (3) compare rates between Active Component and National Guard soldiers at the 3- and 12-month time points following their deployment to Iraq. Population-based, cross-sectional study. United States Army posts and National Guard armories. A total of 18 305 US Army soldiers from 4 Active Component and 2 National Guard infantry brigade combat teams. Between 2004 and 2007, anonymous mental health surveys were collected at 3 and 12 months following deployment. Current PTSD, depression, functional impairment, alcohol misuse, and aggressive behavior. Prevalence rates for PTSD or depression with serious functional impairment ranged between 8.5% and 14.0%, with some impairment between 23.2% and 31.1%. Alcohol misuse or aggressive behavior comorbidity was present in approximately half of the cases. Rates remained stable for the Active Component soldiers but increased across all case definitions from the 3- to 12-month time point for National Guard soldiers. The prevalence rates of PTSD and depression after returning from combat ranged from 9% to 31% depending on the level of functional impairment reported. The high comorbidity with alcohol misuse and aggression highlights the need for comprehensive postdeployment screening. Persistent or increased prevalence rates at 12 months compared with 3 months postdeployment illustrate the persistent effects of war zone service and provide important data to guide postdeployment care.

A Chronic Longitudinal Characterization of Neurobehavioral and Neuropathological Cognitive Impairment in a Mouse Model of Gulf War Agent Exposure

PubMed Central

Zakirova, Zuchra; Crynen, Gogce; Hassan, Samira; Abdullah, Laila; Horne, Lauren; Mathura, Venkatarajan; Crawford, Fiona; Ait-Ghezala, Ghania

2016-01-01

Gulf War Illness (GWI) is a chronic multisymptom illness with a central nervous system component that includes memory impairment as well as neurological and musculoskeletal deficits. Previous studies have shown that in the First Persian Gulf War conflict (1990–1991) exposure to Gulf War (GW) agents, such as pyridostigmine bromide (PB) and permethrin (PER), were key contributors to the etiology of GWI. For this study, we used our previously established mouse model of GW agent exposure (10 days PB+PER) and undertook an extensive lifelong neurobehavioral characterization of the mice from 11 days to 22.5 months post exposure in order to address the persistence and chronicity of effects suffered by the current GWI patient population, 24 years post-exposure. Mice were evaluated using a battery of neurobehavioral testing paradigms, including Open Field Test (OFT), Elevated Plus Maze (EPM), Three Chamber Testing, Radial Arm Water Maze (RAWM), and Barnes Maze (BM) Test. We also carried out neuropathological analyses at 22.5 months post exposure to GW agents after the final behavioral testing. Our results demonstrate that PB+PER exposed mice exhibit neurobehavioral deficits beginning at the 13 months post exposure time point and continuing trends through the 22.5 month post exposure time point. Furthermore, neuropathological changes, including an increase in GFAP staining in the cerebral cortices of exposed mice, were noted 22.5 months post exposure. Thus, the persistent neuroinflammation evident in our model presents a platform with which to identify novel biological pathways, correlating with emergent outcomes that may be amenable to therapeutic targeting. Furthermore, in this work we confirmed our previous findings that GW agent exposure causes neuropathological changes, and have presented novel data which demonstrate increased disinhibition, and lack of social preference in PB+PER exposed mice at 13 months after exposure. We also extended upon our previous work to cover the lifespan of the laboratory mouse using a battery of neurobehavioral techniques. PMID:26793076

A suicide education programme for nurses to educate the family caregivers of suicidal individuals: a longitudinal study.

PubMed

Sun, Fan-Ko; Chiang, Chun-Ying; Yu, Pei-Jane; Lin, Ching-Hsing

2013-10-01

Family members lack the ability to care for suicidal relatives. Nurses have a responsibility to improve family members' ability to care for their suicidal relatives. The aims of this study were to design a suicide education programme for nurses to educate family caregivers and to evaluate the longitudinal (12 months after the educational programme) effects of a suicide care education programme on the ability of families to care for suicidal relatives. A randomised controlled trial was conducted. The study population (n=61) was composed of the family caregivers of suicidal individuals. Several caregivers (n=26) were randomly allocated to an experimental group who attended a two-hour suicide care education programme, and the other caregivers (n=35) represented a control group who did not attend the education programme. All of the participants were given a questionnaire at baseline, 3 months, and 12 months during the period from 2009 to 2011. The results of the longitudinal effects of the suicide care education programme demonstrated that there were statistically significant differences after the educational programme as compared to before the programme with regard to "seeking assistance from resources" and the ability to care for those who were once suicidal. The longitudinal results of both groups showed that there was a significant difference in terms of "caring ability" at 12 months. The results of a multiple linear regression analysis indicated that evaluations performed at the three-month time point were able to effectively predict success in "seeking assistance from resources", "caring ability"; caring ability was also significantly improved among those who engaged in the educational programme at the 12-month time point. The suicide care education programme had long-term effects for family caregivers caring for their suicidal relatives. Nurses could employ this suicide care education programme to improve the ability of family caregivers to care for their suicidal relatives. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Infant Growth after Preterm Birth and Mental Health in Young Adulthood.

PubMed

Sammallahti, Sara; Lahti, Marius; Pyhälä, Riikka; Lahti, Jari; Pesonen, Anu-Katriina; Heinonen, Kati; Hovi, Petteri; Eriksson, Johan G; Strang-Karlsson, Sonja; Järvenpää, Anna-Liisa; Andersson, Sture; Kajantie, Eero; Räikkönen, Katri

2015-01-01

Faster growth after preterm birth benefits long-term cognitive functioning. Whether these benefits extend to mental health remains largely unknown. We examined if faster growth in infancy is associated with better self-reported mental health in young adults born preterm at very low birth weight (VLBW) (< 1500 g). As young adults, participants of the Helsinki Study of Very Low Birth Weight Adults self-reported symptoms of depression and attention deficit/hyperactivity disorder (ADHD) (n = 157) and other psychiatric problems (n = 104). As main predictors of mental health outcomes in linear regression models, we used infant weight, length, and head circumference at birth, term, and 12 months of corrected age, and growth between these time points. Growth data were collected from records and measures at term and at 12 months of corrected age were interpolated. Additionally, we examined the moderating effects of intrauterine growth restriction. Size at birth, term, or 12 months of corrected age, or growth between these time points were not associated with mental health outcomes (p-values >0.05). Intrauterine growth restriction did not systematically moderate any associations. Despite the high variability in early growth of VLBW infants, the previously described association between slow growth in infancy and poorer cognitive functioning in later life is not reflected in symptoms of depression, ADHD, and other psychiatric problems. This suggests that the development of cognitive and psychiatric problems may have dissimilar critical periods in VLBW infants.

Potential of a Sports Club-Based Exercise Program for Improving Physical Activity in Type 2 Diabetes Mellitus.

PubMed

Lackinger, Christian; Haider, Sandra; Kosi, Lana; Harreiter, Juergen; Winhofer, Yvonne; Kautzky-Willer, Alexandra

2015-09-01

Although the infrastructure of Austrians' sports clubs is well developed, exercise classes for people suffering from type II diabetes mellitus (T2DM) do not exist. This feasibility study evaluates factors for participating in target group specific exercise courses (TGSEC) and changes in physical activity. This intervention study was performed in 22 communities of Austria. Initial TGSEC were offered to T2DM patients over 2 months. Participants were surveyed at 4 time points with a questionnaire: before the program, 2, 6 and 12 months after the initial questionnaire. 881 patients aged 59.0 (SD: 9.6) years took part in TGSEC. At baseline a lack of suitable exercise groups prevented 51% from being active. 58% were encouraged by the medical sector. After 12 months the weekly time spent on exercise training was increased from 1.40 (SD: 2.55) hours to 2.15 (SD: 3.00) hours (P < .001). The dropout rate during the first 2 months was 12.9%. The rate of return for the 12 months questionnaire was 42%. TGSEC provided by sports clubs attract people suffering from T2DM and effectively enhance physical activity.

Immunisation coverage, 2012.

PubMed

Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

2014-09-30

This, the 6th annual immunisation coverage report, documents trends during 2012 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data, and National Human Papillomavirus (HPV) Vaccination Program Register data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP) and coverage in adolescents and adults. The proportion of Australian children 'fully vaccinated' at 12, 24 and 60 months of age was 91.7%, 92.5% and 91.2%, respectively. For vaccines available on the NIP but not assessed during 2012 for 'fully vaccinated' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.6%) and varicella at 24 months (84.4%). Although 'fully vaccinated' coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied, reaching a 15 percentage point differential in South Australia but only a 0.4 percentage point differential in the Northern Territory. Overall, Indigenous coverage at 24 months of age exceeded that at 12 months of age nationally and for all jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully vaccinated' coverage estimates for vaccinations due by 60 months of age for Indigenous children exceeded 90% at 91% in 2012. Unlike in 2011, at 60 months of age, there was no dramatic variation in coverage between Indigenous and non-Indigenous children for individual jurisdictions. As previously documented, vaccines recommended for Indigenous children only, hepatitis A and pneumococcal vaccine, had suboptimal coverage at 60.1% and 73.1%, respectively, although there was a considerable improvement in coverage from 2011, 57.7% and 68.2% respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved substantially between 2011 (19%) and 2012 (38%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children worsened at the 60-month age milestone from 2011 (from 1.8 to 5.4 percentage points) and remained the same for the 12 and 24-month age milestones. By late 2012, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in all but 1 jurisdiction and greater than 70% for New South Wales, the Australian Capital Territory and Tasmania. Further, by late 2012, the percentage of children who received the 4th dose of DTPa vaccine dose at less than 4 years of age was greater than 30% in 3 jurisdictions. The percentage of children whose parents officially objected to vaccination in Australia was 1.7% and this figure varied by jurisdiction. However, there is a further 2.1% of children whose parents don't officially object but whose children have no vaccines recorded on the ACIR. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was similar to 2011 at 71% but was substantially lower for the catch up program for females outside school (44%-69%), although this was an improvement from 2011.

Web-based tool for dynamic functional outcome after acute ischemic stroke and comparison with existing models.

PubMed

Ji, Ruijun; Du, Wanliang; Shen, Haipeng; Pan, Yuesong; Wang, Penglian; Liu, Gaifen; Wang, Yilong; Li, Hao; Zhao, Xingquan; Wang, Yongjun

2014-11-25

Acute ischemic stroke (AIS) is one of the leading causes of death and adult disability worldwide. In the present study, we aimed to develop a web-based risk model for predicting dynamic functional status at discharge, 3-month, 6-month, and 1-year after acute ischemic stroke (Dynamic Functional Status after Acute Ischemic Stroke, DFS-AIS). The DFS-AIS was developed based on the China National Stroke Registry (CNSR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Good functional outcome was defined as modified Rankin Scale (mRS) score ≤ 2 at discharge, 3-month, 6-month, and 1-year after AIS, respectively. Independent predictors of each outcome measure were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and plot of observed and predicted risk were used to assess model discrimination and calibration. A total of 12,026 patients were included and the median age was 67 (interquartile range: 57-75). The proportion of patients with good functional outcome at discharge, 3-month, 6-month, and 1-year after AIS was 67.9%, 66.5%, 66.9% and 66.9%, respectively. Age, gender, medical history of diabetes mellitus, stroke or transient ischemic attack, current smoking and atrial fibrillation, pre-stroke dependence, pre-stroke statins using, admission National Institutes of Health Stroke Scale score, admission blood glucose were identified as independent predictors of functional outcome at different time points after AIS. The DFS-AIS was developed from sets of predictors of mRS ≤ 2 at different time points following AIS. The DFS-AIS demonstrated good discrimination in the derivation and validation cohorts (AUROC range: 0.837-0.845). Plots of observed versus predicted likelihood showed excellent calibration in the derivation and validation cohorts (all r = 0.99, P < 0.001). When compared to 8 existing models, the DFS-AIS showed significantly better discrimination for good functional outcome and mortality at discharge, 3-month, 6-month, and 1-year after AIS (all P < 0.0001). The DFS-AIS is a valid risk model to predict functional outcome at discharge, 3-month, 6-month, and 1-year after AIS.

Predictors of moderate to severe fatigue 12 months following admission to hospital for burn: Results from the Burns Registry of Australia and New Zealand (BRANZ) Long Term Outcomes project.

PubMed

Gabbe, Belinda J; Cleland, Heather; Watterson, Dina; Schrale, Rebecca; McRae, Sally; Taggart, Susan; Darton, Anne; Wood, Fiona; Edgar, Dale W

2016-12-01

Fatigue has been identified as an outcome of concern following burn but is rarely captured in outcomes studies. We aimed to: (i) describe the prevalence, and predictors, of moderate to severe fatigue in the first 12 months following burn, and (ii) establish the association between fatigue and health-related quality of life and work outcomes. Adult burns patients, admitted >24h, were recruited from five BRANZ sites. Participants were followed-up at 1-, 6-, and 12-months after injury using the Brief Fatigue Inventory (BFI), 36-item Short Form Health Survey (SF-36) and the Sickness Impact Profile (SIP)-work scale. Moderate to severe fatigue was defined as a global BFI score of 4-10. Multivariable mixed effects regression modelling was used to identify demographic, socioeconomic, burn size and severity predictors of moderate/severe fatigue at follow-up. The mean±SD age of the 328 participants was 42.1±16.7years, 70% were male, 47% were flame burns, and the mean±SD %TBSA was 8.7±11.2. The prevalence of moderate/severe fatigue decreased from 37% at 1-month, to 32% at 6-months and 26% at 12-months. The adjusted odds of moderate/severe fatigue were 2.62 (95% CI: 1.27, 5.42) times higher for women compared to men, and 2.64 (95% CI: 1.03, 6.79) times higher in patients with a %TBSA≥20. Compared to patients in major cities, the adjusted odds of reporting moderate/severe fatigue were 2.48 fold higher (95% CI: 1.17, 5.24) for patients residing in inner regional areas, and 3.60 fold (95% CI: 1.43, 9.05) higher for patients living in remote/very remote areas. At each time point, the physical and mental health summary scores, and each sub-scale score, of the SF-36 were significantly lower in patients reporting moderate/severe fatigue. Patients experiencing moderate to severe fatigue reported higher work-related disability on the SIP work scale at each time point after injury. More than a quarter of participants reported moderate to severe fatigue on the BFI at 12-months and fatigue was strongly associated with poorer health-related quality of life and greater work-related disability. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Six-month Longitudinal Comparison of a Portable Tablet Perimeter With the Humphrey Field Analyzer.

PubMed

Prea, Selwyn Marc; Kong, Yu Xiang George; Mehta, Aditi; He, Mingguang; Crowston, Jonathan G; Gupta, Vinay; Martin, Keith R; Vingrys, Algis J

2018-06-01

To establish the medium-term repeatability of the iPad perimetry app Melbourne Rapid Fields (MRF) compared to Humphrey Field Analyzer (HFA) 24-2 SITA-standard and SITA-fast programs. Multicenter longitudinal observational clinical study. Sixty patients (stable glaucoma/ocular hypertension/glaucoma suspects) were recruited into a 6-month longitudinal clinical study with visits planned at baseline and at 2, 4, and 6 months. At each visit patients undertook visual field assessment using the MRF perimetry application and either HFA SITA-fast (n = 21) or SITA-standard (n = 39). The primary outcome measure was the association and repeatability of mean deviation (MD) for the MRF and HFA tests. Secondary measures were the point-wise threshold and repeatability for each test, as well as test time. MRF was similar to SITA-fast in speed and significantly faster than SITA-standard (MRF 4.6 ± 0.1 minutes vs SITA-fast 4.3 ± 0.2 minutes vs SITA-standard 6.2 ± 0.1 minutes, P < .001). Intraclass correlation coefficients (ICC) between MRF and SITA-fast for MD at the 4 visits ranged from 0.71 to 0.88. ICC values between MRF and SITA-standard for MD ranged from 0.81 to 0.90. Repeatability of MRF MD outcomes was excellent, with ICC for baseline and the 6-month visit being 0.98 (95% confidence interval: 0.96-0.99). In comparison, ICC at 6-month retest for SITA-fast was 0.95 and SITA-standard 0.93. Fewer points changed with the MRF, although for those that did, the MRF gave greater point-wise variability than did the SITA tests. MRF correlated strongly with HFA across 4 visits over a 6-month period, and has good test-retest reliability. MRF is suitable for monitoring visual fields in settings where conventional perimetry is not readily accessible. Copyright © 2018 Elsevier Inc. All rights reserved.

The Impact of School Gardening on Cree Children's Knowledge and Attitudes toward Vegetables and Fruit.

PubMed

Hanbazaza, Mahitab A; Triador, Lucila; Ball, Geoff D C; Farmer, Anna; Maximova, Katerina; Alexander First Nation; Willows, Noreen D

2015-09-01

School-based interventions may increase children's preferences for vegetables and fruit (V&F). This Canadian study measured changes in Indigenous First Nations schoolchildren's V&F knowledge, preferences, and home consumption following the implementation of a gardening and V&F snack program. At baseline, 7 months, and 18 months, children in grades 1-6 (i) listed at least 5 V&F they knew, (ii) tasted and indicated their preferences towards 9 vegetables and 8 fruit using a 6-point Likert scale, and (iii) indicated their home consumption of 17 V&F. At all 3 time points, 56.8% (n = 66/116) of children provided data. Children listed a greater number of V&F at 18 months (4.9 ± 0.1) than at baseline (4.5 ± 1.0) or 7 months (4.7 ± .07) (F(1.6,105.6) = 6.225, P < 0.05). Vegetable preferences became more positive between baseline (37.9 ± 9.3) and 7 months (39.9 ± 9.2), but returned to baseline levels at 18 months (37.3 ± 8.7) (F(1.6,105.8) = 4.581, P < 0.05). Fruit preferences at 18 months (42.7 ± 3.0) were greater than at baseline (41.1 ± 4.3) and at 7 months (41.9 ± 5.1) (F(1.7,113.3) = 3.409, P < 0.05). No change in V&F consumption occurred at home. Despite improvements in V&F knowledge and preferences, home consumption of V&F did not occur. Complementing school-based programs with home-based components may be needed to influence V&F intake of children.

Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes.

PubMed

Kiuchi, Márcio Galindo; E Silva, Gustavo Ramalho; Paz, Luis Marcelo Rodrigues; Chen, Shaojie; Souto, Gladyston Luiz Lima

2016-11-01

Polymorphic premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, the relevance of sympathetic activation in patients with ventricular arrhythmias was reported, and this finding suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden. We evaluated the effectiveness of the renal sympathetic denervation (RSD) in comparison to antiarrhythmic pharmacologic therapy in reducing polymorphic PVCs refractory to medication therapy and cardiac parameters assessed by 24-h Holter monitoring and cardiac magnetic resonance (CRM), respectively, in patients with structurally normal heart. Thirty-four patients were included in this study, 14 served as control, and 20 were treated with an ablation cardiac catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. All the patients included had polymorphic PVCs and structurally normal heart. Data were obtained at baseline at the 12th month of follow-up (sixth month after RSD or adjustment of antiarrhythmic dosage). In RSD group, we observed a significant decrease in the number of polymorphic PVCs from baseline 36,091 ± 3327 to 3, 6, 7 (first month after RSD, without drugs), and 12 months (sixth month after RSD, without drugs) of follow-up, 31,009 ± 3251, 20,411 ± 3820, 7701 ± 1549, and 1274 ± 749, respectively, in all patients, P < 0.0001 to all the comparisons between the mean of each time point with the mean of every other time point. No changes in mean 24-h ABPM and renal function in both groups were observed at 12th month of follow-up. However, 24-h Holter mean heart rate decreased in control group at 12th month of follow-up, which did not happen with the RSD group. At the sixth month post-RSD in comparison to baseline, a significant reduction in the number of polymorphic PVCs (∆ = -34,817 ± 3590, P < 0.0001) was observed, as well as, in CRM parameters such as left ventricular mass/body surface area (∆ = -5.4 ± 2.1 g/m 2 , P < 0.0001) and left ventricular ejection fraction (∆ = +3.0 ± 1.8 %, P < 0.0001). In comparison to control group at the same time point, these findings were statistically superior in RSD group (P > 0.05). A significant correlation was found between the Δ number of polymorphic PVCs at the sixth month (r = -0.6723, P = 0.0012) after the RSD and the total number of RSD ablated spots. Polymorphic PVCs refractory to medication therapy may be modifiable by RSD in patients without structural heart disease. Although encouraging, our data are preliminary and need to be validated in a large population and in long term.

Post-extraction mesio-distal gap reduction assessment by confocal laser scanning microscopy - a clinical 3-month follow-up study.

PubMed

García-Herraiz, Ariadna; Silvestre, Francisco Javier; Leiva-García, Rafael; Crespo-Abril, Fortunato; García-Antón, José

2017-05-01

The aim of this 3-month follow-up study is to quantify the reduction in the mesio-distal gap dimension (MDGD) that occurs after tooth extraction through image analysis of three-dimensional images obtained with the confocal laser scanning microscopy (CLSM) technique. Following tooth extraction, impressions of 79 patients 1 month and 72 patients 3 months after tooth extraction were obtained. Cast models were processed by CLSM, and MDGD changes between time points were measured. The mean mesio-distal gap reduction 1 month after tooth extraction was 343.4 μm and 3 months after tooth extraction was 672.3 μm. The daily mean gap reduction rate during the first term (between baseline and 1 month post-extraction measurements) was 10.3 μm/day and during the second term (between 1 and 3 months) was 5.4 μm/day. The mesio-distal gap reduction is higher during the first month following the extraction and continues in time, but to a lesser extent. When the inter-dental contacts were absent, the mesio-distal gap reduction is lower. When a molar tooth is extracted or the distal tooth to the edentulous space does not occlude with an antagonist, the mesio-distal gap reduction is larger. The consideration of mesio-distal gap dimension changes can help improve dental treatment planning. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Postpartum Intimate Partner Violence and Health Risks Among Young Mothers in the United States: A Prospective Study

PubMed Central

Ickovics, Jeannette; Lewis, Jessica B.; Magriples, Urania; Kershaw, Trace S.

2014-01-01

The study assessed the relationship between postpartum intimate partner violence (IPV) and postpartum health risks among young mothers over time. Data were collected from 2001 to 2005 on young women aged 14–25 attending obstetrics and gynecology clinics in two US cities. Postpartum IPV (i.e., emotional, physical, sexual) was assessed at 6 and 12 months after childbirth (n = 734). Four types of postpartum IPV patterns were examined: emerged IPV, dissipated IPV, repeated IPV, and no IPV. Emerged IPV occurred at 12 months postpartum, not 6 months postpartum. Dissipated IPV occurred at 6 months postpartum, not 12 months postpartum. Repeated IPV was reported at 6 months and 12 months postpartum. Postpartum health risks studied at both time points were perceived stress, depression, fear of condom negotiation, condom use, infant sleeping problems, and parental stress. Repeated measures analysis of covariance was used. The proportion of young mothers reporting IPV after childbirth increased from 17.9 % at 6 months postpartum to 25.3 % at 12 months postpartum (P < 0.001). Emerged and/or repeated postpartum IPV were associated with increased perceived stress, depression, fear of condom negotiation, and infant sleeping problems as well as decreased condom use (P < 0.05). Dissipated postpartum IPV was associated with decreased depression (P < 0.05). IPV screening and prevention programs for young mothers may reduce health risks observed in this group during the postpartum period. PMID:24562504

The effects of cancer on older workers in the English labour market.

PubMed

Candon, David

2015-07-01

The continued rise in overall cancer survival rates has ignited a field of research which examines the effect that cancer has on survivors' employment. Previous estimates of the effect of cancer on labour market outcomes, using U.S. data, show significant reductions in employment in the first 6 months after diagnosis. However, this impact has been found to dissipate after 12 and 18 months. I use data from the English Longitudinal Study of Ageing and find that, in England, where there is a more generous welfare support system, not only does cancer have a negative impact in the first 6-month period following diagnosis, but also in the second 6-month period. I estimate that, in the second 6-month period after diagnosis, respondents with cancer are 12.2% points less likely to work and work 4.2 fewer hours a week when compared to matched, healthy controls. This suggests that the negative effects from cancer can persist for longer than the six months identified previously. These results have implications for government policy and employers, because it increases the length of time that survivors may be on government supported sick pay, and the expected time that workers will be absent from work due to illness. Copyright © 2015 Elsevier B.V. All rights reserved.

Estimation of Enterococci Input from Bathers and Animals on A Recreational Beach Using Camera Images

PubMed Central

D, Wang John; M, Solo-Gabriele Helena; M, Abdelzaher Amir; E, Fleming Lora

2010-01-01

Enterococci, are used nationwide as a water quality indicator of marine recreational beaches. Prior research has demonstrated that enterococci inputs to the study beach site (located in Miami, FL) are dominated by non-point sources (including humans and animals). We have estimated their respective source functions by developing a counting methodology for individuals to better understand their non-point source load impacts. The method utilizes camera images of the beach taken at regular time intervals to determine the number of people and animal visitors. The developed method translates raw image counts for weekdays and weekend days into daily and monthly visitation rates. Enterococci source functions were computed from the observed number of unique individuals for average days of each month of the year, and from average load contributions for humans and for animals. Results indicate that dogs represent the larger source of enterococci relative to humans and birds. PMID:20381094

Ultrasensitive prostate specific antigen assay following laparoscopic radical prostatectomy--an outcome measure for defining the learning curve.

PubMed

Viney, R; Gommersall, L; Zeif, J; Hayne, D; Shah, Z H; Doherty, A

2009-07-01

Radical retropubic prostatectomy (RRP) performed laparoscopically is a popular treatment with curative intent for organ-confined prostate cancer. After surgery, prostate specific antigen (PSA) levels drop to low levels which can be measured with ultrasensitive assays. This has been described in the literature for open RRP but not for laparoscopic RRP. This paper describes PSA changes in the first 300 consecutive patients undergoing non-robotic laparoscopic RRP by a single surgeon. To use ultrasensitive PSA (uPSA) assays to measure a PSA nadir in patients having laparoscopic radical prostatectomy below levels recorded by standard assays. The aim was to use uPSA nadir at 3 months' post-prostatectomy as an early surrogate end-point of oncological outcome. In so doing, laparoscopic oncological outcomes could then be compared with published results from other open radical prostatectomy series with similar end-points. Furthermore, this end-point could be used in the assessment of the surgeon's learning curve. Prospective, comprehensive, demographic, clinical, biochemical and operative data were collected from all patients undergoing non-robotic laparoscopic RRP. We present data from the first 300 consecutive patients undergoing laparoscopic RRP by a single surgeon. uPSA was measured every 3 months post surgery. Median follow-up was 29 months (minimum 3 months). The likelihood of reaching a uPSA of < or = 0.01 ng/ml at 3 months is 73% for the first 100 patients. This is statistically lower when compared with 83% (P < 0.05) for the second 100 patients and 80% for the third 100 patients (P < 0.05). Overall, 84% of patients with pT2 disease and 66% patients with pT3 disease had a uPSA of < or = 0.01 ng/ml at 3 months. Pre-operative PSA, PSA density and Gleason score were not correlated with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months. Positive margins correlate with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months but operative time and tumour volume do not (P < 0.05). Attempt at nerve sparing had no adverse effect on achieving a uPSA of < or = 0.01 ng/ml at 3 months. uPSA can be used as an early end-point in the analysis of oncological outcomes after radical prostatectomy. It is one of many measures that can be used in calculating a surgeon's learning curve for laparoscopic radical prostatectomy and in bench-marking performance. With experience, a surgeon can achieve in excess of an 80% chance of obtaining a uPSA nadir of < or = 0.01 ng/ml at 3 months after laparoscopic RRP for a British population. This is equivalent to most published open series.

Cognitive flexibility and changes in hopelessness across time: A moderation hypothesis.

PubMed

Yu, Junhong; Lee, Tatia M C

2017-01-01

Prior literature has suggested that cognitive flexibility is implicated in the feeling of hopelessness. However, studies on the nature of their relationship have been scarce. This study posits a moderation hypothesis on the relationship between cognitive flexibility and hopelessness. A total of 78 elderly participants (M age  = 70, SD = 6.1) were administered a self-report measure of hopelessness across two time points approximately 10 months apart and a measure of cognitive flexibility. We hypothesized that baseline hopelessness scores would moderate the relationship between cognitive flexibility and hopelessness scores 10 months later. Specifically, among the high baseline hopelessness group, we predicted that cognitively flexible participants would report lower hopelessness scores 10 months later. However, for the low baseline hopelessness group, cognitive flexibility would be unrelated to hopelessness scores 10 months later. The results of a bootstrapped moderation analysis controlling for age, sex, education, and general cognitive status supported our moderation hypothesis and predictions. These findings reveal the complex nature of the relationship between cognitive flexibility and hopelessness. The implications of these findings in the wider clinical context were discussed.

Rapid recovery from aphasia after infarction of Wernicke's area.

PubMed

Yagata, Stephanie A; Yen, Melodie; McCarron, Angelica; Bautista, Alexa; Lamair-Orosco, Genevieve; Wilson, Stephen M

2017-01-01

Aphasia following infarction of Wernicke's area typically resolves to some extent over time. The nature of this recovery process and its time course have not been characterized in detail, especially in the acute/subacute period. The goal of this study was to document recovery after infarction of Wernicke's area in detail in the first 3 months after stroke. Specifically, we aimed to address two questions about language recovery. First, which impaired language domains improve over time, and which do not? Second, what is the time course of recovery? We used quantitative analysis of connected speech and a brief aphasia battery to document language recovery in two individuals with aphasia following infarction of the posterior superior temporal gyrus. Speech samples were acquired daily between 2 and 16 days post stroke, and also at 1 month and 3 months. Speech samples were transcribed and coded using the CHAT system, in order to quantify multiple language domains. A brief aphasia battery was also administered at a subset of five time points during the 3 months. Both patients showed substantial recovery of language function over this time period. Most, but not all, language domains showed improvements, including fluency, lexical access, phonological retrieval and encoding, and syntactic complexity. The time course of recovery was logarithmic, with the greatest gains taking place early in the course of recovery. There is considerable potential for amelioration of language deficits when damage is relatively circumscribed to the posterior superior temporal gyrus. Quantitative analysis of connected speech samples proved to be an effective, albeit time-consuming, approach to tracking day-by-day recovery in the acute/subacute post-stroke period.

D-Dimer Levels before HIV Seroconversion Remain Elevated Even after Viral Suppression and Are Associated with an Increased Risk of Non-AIDS Events.

PubMed

Freiberg, Matthew S; Bebu, Ionut; Tracy, Russell; So-Armah, Kaku; Okulicz, Jason; Ganesan, Anuradha; Armstrong, Adam; O'Bryan, Thomas; Rimland, David; Justice, Amy C; Agan, Brian K

2016-01-01

The mechanism underlying the excess risk of non-AIDS diseases among HIV infected people is unclear. HIV associated inflammation/hypercoagulability likely plays a role. While antiretroviral therapy (ART) may return this process to pre-HIV levels, this has not been directly demonstrated. We analyzed data/specimens on 249 HIV+ participants from the US Military HIV Natural History Study, a prospective, multicenter observational cohort of >5600 active duty military personnel and beneficiaries living with HIV. We used stored blood specimens to measure D-dimer and Interleukin-6 (IL-6) at three time points: pre-HIV seroconversion, ≥6 months post-HIV seroconversion but prior to ART initiation, and ≥6 months post-ART with documented HIV viral suppression on two successive evaluations. We evaluated the changes in biomarker levels between time points, and the association between these biomarker changes and future non-AIDS events. During a median follow-up of 3.7 years, there were 28 incident non-AIDS diseases. At ART initiation, the median CD4 count was 361cells/mm3; median duration of documented HIV infection 392 days; median time on ART was 354 days. Adjusted mean percent increase in D-dimer levels from pre-seroconversion to post-ART was 75.1% (95% confidence interval 24.6-148.0, p = 0.002). This increase in D-dimer was associated with a significant 22% increase risk of future non-AIDS events (p = 0.03). Changes in IL-6 levels across time points were small and not associated with future non-AIDS events. In conclusion, ART initiation and HIV viral suppression does not eliminate HIV associated elevation in D-dimer levels. This residual pathology is associated with an increased risk of future non-AIDS diseases.

HYC-24L Demonstrates Greater Effectiveness With Less Pain Than CPM-22.5 for Treatment of Perioral Lines in a Randomized Controlled Trial.

PubMed

Butterwick, Kimberly; Marmur, Ellen; Narurkar, Vic; Cox, Sue Ellen; Joseph, John H; Sadick, Neil S; Tedaldi, Ruth; Wheeler, Sarah; Kolodziejczyk, Julia K; Gallagher, Conor J

2015-12-01

This trial compares the effectiveness and safety of HYC-24L (Juvéderm Ultra XC; Allergan plc, Dublin, Ireland) (24 mg/mL of hyaluronic acid, 0.3% lidocaine) and CPM-22.5 (Belotero Balance; Merz Aesthetics, Raleigh, NC) (22.5 mg/mL of hyaluronic acid) for the treatment of perioral lines. Men and women aged 35 years or older with moderate-to-severe perioral lines were recruited for this randomized controlled, rater-blinded, 2-arm trial. The primary endpoint was a comparison of rater-assessed responder rates by the validated 4-point Perioral Lines Severity Scale at Month 6; responders were those who showed a ≥1 point improvement. A secondary endpoint was subject-assessed change in perioral lines measured by the Global Assessment of Change Scale. A total of 136 subjects received treatment and 132 completed the trial (mean age: 58 ± 8 years). Total volume injected was 1.18 mL (HYC-24L) and 1.32 mL (CPM-22.5). At Month 6, a significantly greater proportion of HYC-24L subjects responded to treatment (87%) than CPM-22.5 subjects (72%) (p < .04). At all time points, HYC-24L subjects reported significantly greater improvement in their perioral lines than CPM-22.5 subjects, with the greatest difference at Month 6. No unexpected adverse events occurred. HYC-24L subjects showed a higher response rate and a greater improvement in their perioral lines than CPM-22.5 subjects for up to 6 months.

Theory-Based Predictors of Follow-Up Exercise Behavior After A Supervised Exercise Intervention in Older Breast Cancer Survivors

PubMed Central

Loprinzi, Paul D.; Cardinal, Bradley J.; Si, Qi; Bennett, Jill A.; Winters-Stone, Kerri

2014-01-01

Purpose Supervised exercise interventions can elicit numerous positive health outcomes in older breast cancer survivors. However, to maintain these benefits, regular exercise needs to be maintained long after the supervised program. This may be difficult, as in this transitional period (i.e., time period immediately following a supervised exercise program), breast cancer survivors are in the absence of on-site direct supervision from a trained exercise specialist. The purpose of the present study was to identify key determinants of regular exercise participation during a 6-month follow-up period after a 12-month supervised exercise program among women aged 65+ years who had completed adjuvant treatment for breast cancer. Methods At the conclusion of a supervised exercise program, and 6-months later, 69 breast cancer survivors completed surveys examining their exercise behavior and key constructs from the Transtheoretical Model. Results After adjusting for weight status and physical activity at the transition point, breast cancer survivors with higher self-efficacy at the point of transition were more likely to be active 6-months after leaving the supervised exercise program (OR [95% CI]: 1.10 [1.01–1.18]). Similarly, breast cancer survivors with higher behavioral processes of change use at the point of transition were more likely to be active (OR [95% CI]: 1.13 [1.02–1.26]). Conclusion These findings suggest that self-efficacy and the behavioral processes of change, in particular, play an important role in exercise participation during the transition from a supervised to a home-based program among older breast cancer survivors. PMID:22252545

Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients

PubMed Central

Winterstein, Andrew P.; McGuine, Timothy A.; Carr, Kathleen E.; Hetzel, Scott J.

2013-01-01

Background: Knee injury among young, active female patients remains a public health issue. Clinicians are called upon to pay greater attention to patient-oriented outcomes to evaluate the impact of these injuries. Little agreement exists on which outcome measures are best, and clinicians cite several barriers to their use. Single Assessment Numerical Evaluation (SANE) may provide meaningful outcome information while lessening the time burden associated with other patient-oriented measures. Hypothesis: The SANE and International Knee Documentation Committee (IKDC) scores would be strongly correlated in a cohort of young active female patients with knee injuries from preinjury through 1-year follow-up and that a minimal clinically important difference (MCID) could be calculated for the SANE score. Study Design: Observational prospective cohort. Methods: Two hundred sixty-three subjects completed SANE and IKDC at preinjury by recall, time of injury, and 3, 6, and 12 months postinjury. Pearson correlation coefficients were used to assess the association between SANE and IKDC. Repeated-measures analysis of variance was used to determine differences in SANE and IKDC over time. MCID was calculated for SANE using IKDC MCID as an anchor. Results: Moderate to strong correlations were seen between SANE and IKDC (0.65-0.83). SANE, on average, was 2.7 (95% confidence interval, 1.5-3.9; P < 0.00) units greater than IKDC over all time points. MCID for the SANE was calculated as 7 for a 6-month follow-up and 19 for a 12-month follow-up. Conclusion: SANE scores were moderately to strongly correlated to IKDC scores across all time points. Reported MCID values for the SANE should be utilized to measure meaningful changes over time for young, active female patients with knee injuries. Clinical Relevance: Providing clinicians with patient-oriented outcome measures that can be obtained with little clinician and patient burden may allow for greater acceptance and use of outcome measures in clinical settings. PMID:24427427

Adequacy and change in nutrient and food intakes with aging in a seven-year cohort study in elderly women.

PubMed

Zhu, K; Devine, A; Suleska, A; Tan, C Y; Toh, C Z J; Kerr, D; Prince, R L

2010-11-01

As women age total dietary intake falls which may increase the risk of dietary deficiencies in some individuals. The aims of this study were to investigate the changes in nutrient and dietary intakes that occurred with aging in a seven-year longitudinal study of elderly Australian women and to evaluate the adequacy of their dietary intakes. Longitudinal population based study on health with ageing. 911 free-living elderly women aged 70-85 years at baseline from a cohort of 1500 elderly women. At baseline, 60 and 84 months, self-reported Food Frequency Questionnaires (FFQ) and demographics were collected and anthropometry measured. During the 84 month subjects lost height (1.8 cm) and body weight (1.9 kg). Intakes of energy and macronutrients carbohydrate, fat and protein declined significantly over the 84 months. Mean energy derived from saturated fat was above, whereas energy derived from carbohydrate was below, recommended levels of intake at all time points. Intakes of vitamins and minerals all declined with age and subjects had suboptimal intakes of folate, vitamin E and calcium at all time points. The serve sizes for potato and meat and the consumption of milk, bread and variety of vegetables declined significantly over time reflecting changes in nutrient intake. Ageing is associated with reduced food intake resulting in inadequate intakes in energy, and some nutrients. Nutrition policy for elderly women should include advice to maintain or increase intakes of carbohydrate, milk, vegetables and fruit whilst continuing to reduce fat intake.

The Effects of Preliteracy Knowledge, Schooling, and Summer Vacation on Literacy Acquisition

ERIC Educational Resources Information Center

Tiruchittampalam, Shanthi; Nicholson, Tom; Levin, Joel R.; Ferron, John M.

2018-01-01

What causes the literacy gap and can schools compensate for it? The authors investigated 3 drivers of the gap: preliteracy knowledge, schooling, and the summer vacation. Longitudinal literacy data over 5 time points were collected on 126 five-year-olds attending higher or lower socioeconomic status (SES) schools during their first 15 months of…

76 FR 59458 - Stone Harbor Emerging Markets Income Fund, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-26

... market price and its net asset value per common share (``NAV'')) and the relationship between such Fund's... the market price of such Fund's common shares at a particular point in time or a fixed monthly... person (``financial intermediary'') holds common shares issued by the Fund in nominee name, or otherwise...

77 FR 26052 - Invesco Total Property Market Income Fund, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... price of such Fund's common shares at a particular point in time, or a fixed percentage of NAV at a... broker, dealer, bank or other person (``financial intermediary'') holds common shares issued by a Fund in... outstanding common shares as frequently as monthly in any one taxable year, and as frequently as distributions...

Dementia in Adults with Mental Retardation: Assessment at a Single Point in Time

ERIC Educational Resources Information Center

Silverman, Wayne; Schupf, Nicole; Zigman, Warren; Devenny, Darlynne; Miezejeski, Charles; Schubert, Romaine; Ryan, Robert

2004-01-01

Dementia status of 273 adults with mental retardation was rated based upon two extensive evaluations conducted 18 months apart. Overall, 184 individuals did not have dementia, 33 had possible or definite dementia, and 66 had findings suggesting uncertain or questionable status. These ratings were compared to binary classifications (dementia vs. no…

Mother and Infant Talk about Mental States Relates to Desire Language and Emotion Understanding

ERIC Educational Resources Information Center

Taumoepeau, Mele; Ruffman, Ted

2006-01-01

This study assessed the relation between mother mental state language and child desire language and emotion understanding in 15--24-month-olds. At both times point, mothers described pictures to their infants and mother talk was coded for mental and nonmental state language. Children were administered 2 emotion understanding tasks and their mental…

Social Support, Needs, and Stress in Urban Families with Children Enrolled in an Early Intervention Program.

ERIC Educational Resources Information Center

Baxter, Abigail; Kahn, James V.

1999-01-01

This study investigated the needs, supports, and stresses of 37 families of children enrolled in an urban early intervention program at program start and 12 months later. At both assessment points, caregivers reported food, shelter, transportation, medical, information, personal time needs, and feelings of stress. Significant differences in scores…

Arm and Hand Movement in Children Suspected of Having Autism Spectrum Disorder

ERIC Educational Resources Information Center

Braddock, Barbara A.; Hilton, Jane C.

2016-01-01

The aim of this study was to describe arm and hand movement in children suspected of having autism spectrum disorder (ASD; age range 29-43 months). A videotaped retrospective review of five children with symptoms of ASD during "Communication Temptation Tasks" was completed at two time points (pre-testing and 6 weeks later). Categories of…

Interpersonal Sensitivity, Romantic Stress, and the Prediction of Depression: A Study of Inner-City, Minority Adolescent Girls

ERIC Educational Resources Information Center

Rizzo, Christie J.; Daley, Shannon E.; Gunderson, Brent H.

2006-01-01

The role of interpersonal sensitivity in the relation between romantic stress and depression was examined in 55 adolescent girls from an inner-city high school. Depression, interpersonal sensitivity, and chronic and episodic romantic stress were measured at two time points, 6 months apart. Interpersonal sensitivity was found to moderate the…

Wage Differentials by Field of Study--The Case of German University Graduates

ERIC Educational Resources Information Center

Grave, Barbara S.; Goerlitz, Katja

2012-01-01

Using data on German university graduates, this paper analyzes wage differentials by field of study at labor market entry and five to six years later. At both points of time, graduates from arts/humanities have lower average monthly wages compared to other fields. Blinder-Oaxaca decompositions show that these wage differentials can be explained…

Classroom Goal Structures and HIV and Pregnancy Prevention Education in Rural High School Health Classrooms

ERIC Educational Resources Information Center

Anderman, Eric M.; Cupp, Pamela K.; Lane, Derek R.; Zimmerman, Rick; Gray, DeLeon L.; O'Connell, Ann

2011-01-01

Over 5,000 adolescents enrolled in required rural high school health courses reported their perceptions of mastery and extrinsic goal structures in their health classrooms. Data were collected from all students at three time points (prior to HIV and pregnancy instruction, 3 months after instruction, and 1 year after instruction). Results indicated…

40 CFR 463.32 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... for the finishing water processes at a point source times the following pollutant concentrations: Subpart C [Finishing water] Concentration used to calculate BPT effluent limitations Pollutant or pollutant property Maximum for any 1 day (mg/l) Maximum for monthly average (mg/l) TSS 130 37 pH (1) (1) 1...

40 CFR 463.32 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... finishing water processes at a point source times the following pollutant concentrations: Subpart C [Finishing water] Concentration used to calculate BPT effluent limitations Pollutant or pollutant property Maximum for any 1 day (mg/l) Maximum for monthly average (mg/l) TSS 130 37 pH (1) (1) 1 Within the range...

40 CFR 463.32 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... for the finishing water processes at a point source times the following pollutant concentrations: Subpart C [Finishing water] Concentration used to calculate BPT effluent limitations Pollutant or pollutant property Maximum for any 1 day (mg/l) Maximum for monthly average (mg/l) TSS 130 37 pH (1) (1) 1...

40 CFR 463.32 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... for the finishing water processes at a point source times the following pollutant concentrations: Subpart C [Finishing water] Concentration used to calculate BPT effluent limitations Pollutant or pollutant property Maximum for any 1 day (mg/l) Maximum for monthly average (mg/l) TSS 130 37 pH (1) (1) 1...

Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study.

PubMed

Zhou, Yang; Li, Zili; Wang, Xiaoxia; Zou, Bingshuang; Zhou, Yanheng

2016-02-01

In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion. Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery. Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups. Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Feasibility of a school reintegration programme for children with acute lymphoblastic leukaemia.

PubMed

Annett, R D; Erickson, S J

2009-07-01

Despite children with acute lymphoblastic leukaemia missing a significant amount of school, little empirical literature guides the optimal content, setting and timing of a school reintegration programme. We examined the feasibility of a 4-month school reintegration intervention by: (1) developing collaboration with a community-based advocacy organisation; (2) developing intervention modules and observable end points; and (3) determining how the study achieved recruitment expectations. Eight families with children aged 6-12 years diagnosed with acute lymphoblastic leukaemia and parents were enrolled in the study. An experienced advocate implemented a series of eight modules over a 4-month period (twice per month) with the families. Participants completed pre-post measures. Successful collaboration with the advocacy organisation and the development of an intervention module series were achieved. Recruitment aims proved more difficult: enrolment was extended when recruitment for the original 1- to 6-month post-diagnosis window proved difficult. The advocate was able to complete between three and seven of the modules (mean = 5.2, standard deviation = 1.5). Families preferred clinic-based intervention. Challenges faced and lessons learned include: (1) advocacy organisations may be useful resources for school reintegration interventions; (2) school reintegration interventions must be flexibly applied; and (3) measurement end points constructed to gauge programme effectiveness.

Predictors of posttreatment drinking outcomes in patients with alcohol dependence.

PubMed

Flórez, Gerardo; Saiz, Pilar A; García-Portilla, Paz; De Cos, Francisco J; Dapía, Sonia; Alvarez, Sandra; Nogueiras, Luis; Bobes, Julio

2015-01-01

This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors. A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment. Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes. The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.

Loving-kindness meditation and the broaden-and-build theory of positive emotions among veterans with posttraumatic stress disorder.

PubMed

Kearney, David J; McManus, Carolyn; Malte, Carol A; Martinez, Michelle E; Felleman, Benjamin; Simpson, Tracy L

2014-12-01

Loving-kindness meditation (LKM) is a practice intended to enhance feelings of kindness and compassion for self and others. To assess whether participation in a 12-week course of LKM for veterans with posttraumatic stress disorder (PTSD) is associated with improved positive emotions, decentering, and personal resources. In an open-pilot trial, veterans were assessed at baseline, after the course, and 3 months later. Effect sizes were calculated from baseline to each follow-up point for each construct of interest. Measures were chosen as an initial investigation of the broaden-and-build theory of positive emotions. A total of 42 veterans with active PTSD (40% female) participated. Emotions, decentering, psychological wellbeing including autonomy, environmental mastery, personal growth, positive relations, purpose in life, self-acceptance, and sense of social support were measured at each time point. Significant increases in unactivated pleasant (d=0.73), but not activated pleasant, emotions were found over time. Activated and unactivated unpleasant emotions decreased over time (d=-0.69 and -0.53, respectively). There were also increases in environmental mastery (d=0.61), personal growth (d=0.54), purpose in life (d=0.71), self-acceptance (d=0.68), and decentering (d=0.96) at 3-month follow-up. Overall, positive emotions increased, and enhancement of personal resources occurred over time. Further investigation of LKM for PTSD is warranted.

Tumor DNA in cerebral spinal fluid reflects clinical course in a patient with melanoma leptomeningeal brain metastases

PubMed Central

Li, Yingmei; Pan, Wenying; Connolly, Ian D.; Reddy, Sunil; Nagpal, Seema

2017-01-01

Cerebral spinal fluid (CSF) from brain tumor patients contains tumor cellular and cell-free DNA (cfDNA), which provides a less-invasive and routinely accessible method to obtain tumor genomic information. In this report, we used droplet digital PCR to test mutant tumor DNA in CSF of a patient to monitor the treatment response of metastatic melanoma leptomeningeal disease (LMD). The primary melanoma was known to have a BRAFV600E mutation, and the patient was treated with whole brain radiotherapy and BRAF inhibitors. We collected 9 CSF samples over 6 months. The mutant cfDNA fraction gradually decreased from 53 % (time of diagnosis) to 0 (time of symptom alleviation) over the first 6 time points. Three months after clinical improvement, the patient returned with severe symptoms and the mutant cfDNA was again detected in CSF at high levels. The mutant DNA fraction corresponded well with the patient’s clinical response. We used whole exome sequencing to examine the mutation profiles of the LMD tumor DNA in CSF before therapeutic response and after disease relapse, and discovered a canonical cancer mutation PTENR130* at both time points. The cellular and cfDNA revealed similar mutation profiles, suggesting cfDNA is representative of LMD cells. This study demonstrates the potential of using cellular or cfDNA in CSF to monitor treatment response for LMD. PMID:26961773

Differences in Cognitive Outcomes After ECT Depending on BDNF and COMT Polymorphisms.

PubMed

Bennett, Daniel Mark; Currie, James; Fernie, Gordon; Perrin, Jennifer S; Reid, Ian C

2016-12-01

The study aimed to explore cognitive outcomes after electroconvulsive therapy (ECT) depending on which version of common single nucleotide polymorphisms the patient expressed for brain-derived neurotrophic factor (BDNF) and catechol-O-methyltransferase (COMT). A total of 87 patients from the clinical ECT service in Aberdeen, Scotland, were included in the study. Cognitive function testing (using Spatial Recognition Memory task from the Cambridge Neuropsychological Test Automated Battery and Mini-Mental State Examination) and mood ratings (Montgomery-Åsberg Depression Rating Scale) were performed before ECT, after 4 treatments, at the end of ECT and 1 and 3 months after the end of treatment. These scores were compared depending on BDNF and COMT variant at each time point using the Student t test and using a time series generalized least squares random effects model. No differences were found between the val and met versions of the BDNF or COMT polymorphism in either cognitive or mood outcomes at any time point during ECT treatment or up to 3 months of follow-up. This study did not detect significant differences in cognitive or mood outcomes between patients who have the val66val or met versions of the BDNF polymorphism. Our results suggest that these polymorphisms will not be helpful in clinical practice for predicting cognitive outcomes after ECT.

Goserelin with chemotherapy to preserve ovarian function in pre-menopausal women with early breast cancer: menstruation and pregnancy outcomes.

PubMed

Wong, M; O'Neill, S; Walsh, G; Smith, I E

2013-01-01

Premature ovarian failure and infertility following chemotherapy in early breast cancer (EBC) are major concerns for young women. The role of gonadotrophin-releasing hormone (GnRH) agonists with chemotherapy in EBC in reducing the incidence of chemotherapy-induced early menopause remains uncertain, and long-term data on the recovery of fertility are sparse. We report an audit of our experience with the GnRH agonist, goserelin (Zoladex®), used with chemotherapy to preserve ovarian function and maintain fertility. Pre-menopausal women were given goserelin subcutaneously every 28 days during chemotherapy, starting 0-14 days before treatment. The main clinical end point was recovery of menstruation after chemotherapy. The other end points were rate of successful conception and median time to recovery of menses. About 84% of 125 women recovered menstruation with the median time to recovery of 6 months (1-43 months), including 76% of 71 patients aged over 35. Of the 42 patients who attempted pregnancy, 71% (n=30) managed to achieve pregnancies. At the time of analysis, there were 42 pregnancies and 30 healthy deliveries. The GnRH agonist, goserelin, given with chemotherapy for EBC is associated with a low risk of long-term chemotherapy-induced amenorrhoea and a high chance of pregnancy. Further randomised trials are needed.

Gravitational lensing, time delay, and gamma-ray bursts

NASA Technical Reports Server (NTRS)

Mao, Shude

1992-01-01

The probability distributions of time delay in gravitational lensing by point masses and isolated galaxies (modeled as singular isothermal spheres) are studied. For point lenses (all with the same mass) the probability distribution is broad, and with a peak at delta(t) of about 50 S; for singular isothermal spheres, the probability distribution is a rapidly decreasing function with increasing time delay, with a median delta(t) equals about 1/h month, and its behavior depends sensitively on the luminosity function of galaxies. The present simplified calculation is particularly relevant to the gamma-ray bursts if they are of cosmological origin. The frequency of 'recurrent' bursts due to gravitational lensing by galaxies is probably between 0.05 and 0.4 percent. Gravitational lensing can be used as a test of the cosmological origin of gamma-ray bursts.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction.

PubMed

Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-Shal, Ehab A; Al-Sebai, Ibrahim; Negm, Mohame

2016-01-01

The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 - 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction

PubMed Central

Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-shal, Ehab A.; Al-Sebai, Ibrahim; Negm, Mohame

2016-01-01

Background: The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective: To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Methods: Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. Results: In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Conclusion: Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure. PMID:27347245

Helping Seniors Plan for Posthospital Discharge Needs Before a Hospitalization Occurs: Results from the Randomized Control Trial of PlanYourLifespan.org.

PubMed

Lindquist, Lee A; Ramirez-Zohfeld, Vanessa; Sunkara, Priya D; Forcucci, Chris; Campbell, Dianne S; Mitzen, Phyllis; Ciolino, Jody D; Kricke, Gayle; Seltzer, Anne; Ramirez, Ana V; Cameron, Kenzie A

2017-11-01

Investigate the effect of PlanYourLifespan.org (PYL) on knowledge of posthospital discharge options. Multisite randomized controlled trial. Nonhospitalized adults, aged =65 years, living in urban, suburban, and rural areas of Texas, Illinois, and Indiana. PYL is a national, publicly available tool that provides education on posthospital therapy choices and local home-based resources. Participants completed an in-person baseline survey, followed by exposure to intervention or attention control (AC) websites, then 1-month and 3-month telephone surveys. The primary knowledge outcome was measured with 6 items (possible 0-6 points) pertaining to hospital discharge needs. Among 385 participants randomized, mean age was 71.9 years (standard deviation 5.6) and 79.5% of participants were female. At 1 month, the intervention group had a 0.6 point change (standard deviation = 1.6) versus the AC group who had a -0.1 point change in knowledge score. Linear mixed modeling results suggest sex, health literacy level, level of education, income, and history of high blood pressure/kidney disease were significant predictors of knowledge over time. Controlling for these variables, treatment effect remained significant (P < 0.0001). Seniors who used PYL demonstrated an increased understanding of posthospitalization and home services compared to the control group. © 2017 Society of Hospital Medicine

Development of Pointing Gestures in Children With Typical and Delayed Language Acquisition.

PubMed

Lüke, Carina; Ritterfeld, Ute; Grimminger, Angela; Liszkowski, Ulf; Rohlfing, Katharina J

2017-11-09

This longitudinal study compared the development of hand and index-finger pointing in children with typical language development (TD) and children with language delay (LD). First, we examined whether the number and the form of pointing gestures during the second year of life are potential indicators of later LD. Second, we analyzed the influence of caregivers' gestural and verbal input on children's communicative development. Thirty children with TD and 10 children with LD were observed together with their primary caregivers in a seminatural setting in 5 sessions between the ages of 12 and 21 months. Language skills were assessed at 24 months. Compared with children with TD, children with LD used fewer index-finger points at 12 and 14 months but more pointing gestures in total at 21 months. There were no significant differences in verbal or gestural input between caregivers of children with or without LD. Using more index-finger points at the beginning of the second year of life is associated with TD, whereas using more pointing gestures at the end of the second year of life is associated with delayed acquisition. Neither the verbal nor gestural input of caregivers accounted for differences in children's skills.

17 CFR 1.34 - Monthly record, “point balance”.

Code of Federal Regulations, 2010 CFR

2010-04-01

... REGULATIONS UNDER THE COMMODITY EXCHANGE ACT Recordkeeping § 1.34 Monthly record, “point balance”. (a) Each... statement commonly known as a “point balance,” which accrues or brings to the official closing price, or... contracts long and short in the customers' accounts are in balance with those in the carrying futures...

17 CFR 1.34 - Monthly record, “point balance”.

Code of Federal Regulations, 2011 CFR

2011-04-01

... REGULATIONS UNDER THE COMMODITY EXCHANGE ACT Recordkeeping § 1.34 Monthly record, “point balance”. (a) Each... statement commonly known as a “point balance,” which accrues or brings to the official closing price, or... contracts long and short in the customers' accounts are in balance with those in the carrying futures...

When Do Infants Begin to Follow a Point?

ERIC Educational Resources Information Center

Bertenthal, Bennett I.; Boyer, Ty W.; Harding, Samuel

2014-01-01

Infants' understanding of a pointing gesture represents a major milestone in their communicative development. The current consensus is that infants are not capable of following a pointing gesture until 9-12 months of age. In this article, we present evidence from 4- and 6-month-old infants challenging this conclusion. Infants were tested with…

Resuscitation skills after Helping Babies Breathe training: a comparison of varying practice frequency and impact on retention of skills in different types of providers.

PubMed

Tabangin, M E; Josyula, S; Taylor, K K; Vasquez, J C; Kamath-Rayne, B D

2018-05-01

Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.

Political skill: A proactive inhibitor of workplace aggression exposure and an active buffer of the aggression-strain relationship.

PubMed

Zhou, Zhiqing E; Yang, Liu-Qin; Spector, Paul E

2015-10-01

In the current study we examined the role of 4 dimensions of political skill (social astuteness, interpersonal influence, networking ability, and apparent sincerity) in predicting subsequent workplace aggression exposure based on the proactive coping framework. Further, we investigated their buffering effects on the negative outcomes of experienced workplace aggression based on the transactional stress model. Data were collected from nurses at 3 time points: before graduation (Time 1, n = 346), approximately 6 months after graduation (Time 2, n = 214), and approximately 12 months after graduation (Time 3, n = 161). Results showed that Time 1 interpersonal influence and apparent sincerity predicted subsequent physical aggression exposure. Exposure to physical and/or psychological workplace aggression was related to increased anger and musculoskeletal injury, and decreased job satisfaction and career commitment. Further, all dimensions of political skill but networking ability buffered some negative effects of physical aggression, and all dimensions but social astuteness buffered some negative effects of psychological aggression. (c) 2015 APA, all rights reserved).

Health-related behaviours after 1 year of renal transplantation.

PubMed

Costa-Requena, Gema; Cantarell, MªCarmen; Moreso, Francesc J; Parramon, Gemma; Seron, Daniel

2017-03-01

Health-related behaviours and psychological distress were examined after kidney transplantation. Patients were evaluated at 1 month, 6 months and 1 year after transplantation. Participants completed the Healthy Behaviours Questionnaire and the Hospital Anxiety and Depression Scale. No significant differences in Healthy Behaviours Questionnaire's total score and psychological comorbidity were observed at three time points. However, there was an increase in drug-consumer habits ( p < 0.05) and a reduction in sedentary lifestyle ( p < 0.05) at 6 months and 1 year. Moreover, at 1 year, post-transplant had increased the harmful health habits ( p < 0.05). In regression analysis, anxiety symptoms were significant predictors of Healthy Behaviours Questionnaire change at a year post-transplantation.

Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.

PubMed

Metz, Luanne M; Li, David K B; Traboulsee, Anthony L; Duquette, Pierre; Eliasziw, Misha; Cerchiaro, Graziela; Greenfield, Jamie; Riddehough, Andrew; Yeung, Michael; Kremenchutzky, Marcelo; Vorobeychik, Galina; Freedman, Mark S; Bhan, Virender; Blevins, Gregg; Marriott, James J; Grand'Maison, Francois; Lee, Liesly; Thibault, Manon; Hill, Michael D; Yong, V Wee

2017-06-01

On the basis of encouraging preliminary results, we conducted a randomized, controlled trial to determine whether minocycline reduces the risk of conversion from a first demyelinating event (also known as a clinically isolated syndrome) to multiple sclerosis. During the period from January 2009 through July 2013, we randomly assigned participants who had had their first demyelinating symptoms within the previous 180 days to receive either 100 mg of minocycline, administered orally twice daily, or placebo. Administration of minocycline or placebo was continued until a diagnosis of multiple sclerosis was established or until 24 months after randomization, whichever came first. The primary outcome was conversion to multiple sclerosis (diagnosed on the basis of the 2005 McDonald criteria) within 6 months after randomization. Secondary outcomes included conversion to multiple sclerosis within 24 months after randomization and changes on magnetic resonance imaging (MRI) at 6 months and 24 months (change in lesion volume on T 2 -weighted MRI, cumulative number of new lesions enhanced on T 1 -weighted MRI ["enhancing lesions"], and cumulative combined number of unique lesions [new enhancing lesions on T 1 -weighted MRI plus new and newly enlarged lesions on T 2 -weighted MRI]). A total of 142 eligible participants underwent randomization at 12 Canadian multiple sclerosis clinics; 72 participants were assigned to the minocycline group and 70 to the placebo group. The mean age of the participants was 35.8 years, and 68.3% were women. The unadjusted risk of conversion to multiple sclerosis within 6 months after randomization was 61.0% in the placebo group and 33.4% in the minocycline group, a difference of 27.6 percentage points (95% confidence interval [CI], 11.4 to 43.9; P=0.001). After adjustment for the number of enhancing lesions at baseline, the difference in the risk of conversion to multiple sclerosis within 6 months after randomization was 18.5 percentage points (95% CI, 3.7 to 33.3; P=0.01); the unadjusted risk difference was not significant at the 24-month secondary outcome time point (P=0.06). All secondary MRI outcomes favored minocycline over placebo at 6 months but not at 24 months. Trial withdrawals and adverse events of rash, dizziness, and dental discoloration were more frequent among participants who received minocycline than among those who received placebo. The risk of conversion from a clinically isolated syndrome to multiple sclerosis was significantly lower with minocycline than with placebo over 6 months but not over 24 months. (Funded by the Multiple Sclerosis Society of Canada; ClinicalTrials.gov number, NCT00666887 .).

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction.

PubMed

Polly, David W; Swofford, John; Whang, Peter G; Frank, Clay J; Glaser, John A; Limoni, Robert P; Cher, Daniel J; Wine, Kathryn D; Sembrano, Jonathan N

2016-01-01

Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation.

Evidence of early ultrastructural photoreceptor abnormalities in light-induced retinal degeneration using spectral domain optical coherence tomography.

PubMed

Aziz, Mehak K; Ni, Aiguo; Esserman, Denise A; Chavala, Sai H

2014-07-01

To study spatiotemporal in vivo changes in retinal morphology and quantify thickness of retinal layers in a mouse model of light-induced retinal degeneration using spectral domain optical coherence tomography (SD-OCT). BALB/c mice were exposed to 5000 lux of constant light for 3 h. SD-OCT images were taken 3 h, 24 h, 3 days, 1 week and 1 month after light exposure and were compared with histology at the same time points. SD-OCT images were also taken at 0, 1 and 2 h after light exposure in order to analyse retinal changes at the earliest time points. The thickness of retinal layers was measured using the Bioptigen software InVivoVue Diver. SD-OCT demonstrated progressive outer retinal thinning. 3 h after light exposure, the outer nuclear layer converted from hyporeflective to hyper-reflective. At 24 h, outer retinal bands and nuclear layer demonstrated similar levels of hyper-reflectivity. Significant variations in outer retinal thickness, vitreous opacities and retinal detachments occurred within days of injury. Thinning of the retina was observed at 1 month after injury. It was also determined that outer nuclear layer changes precede photoreceptor segment structure disintegration and the greatest change in segment structure occurs between 1 and 2 h after light exposure. Longitudinal SD-OCT reveals intraretinal changes that cannot be observed by histopathology at early time points in the light injury model. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of a levonorgestrel-releasing intrauterine system for treating endometrial hyperplasia in patients with polycystic ovary syndrome.

PubMed

Lin, Min; Xu, XiaoWen; Wang, Yi; Hu, Yue; Zhao, Yu

2014-01-01

To evaluate the use of a levonorgestrel-releasing intrauterine system (LNG-IUS) for treating endometrial hyperplasia in patients with polycystic ovary syndrome (PCOS). LNG-IUSs were inserted in 60 PCOS patients with simple (40 cases), irregular (12 cases), or complex (8 cases) endometrial hyperplasia. Follow-ups were performed at 3, 6, 12, and 24 months after insertion. At each time point, changes in menstruation, hemoglobin level, and endometrial thickness and pathology were recorded. Menstrual changes were assessed with the Pictorial Blood Assessment Chart. Hemoglobin levels were measured by the Blood Routine Test. Endometrial thickness was determined by transvaginal ultrasound. Endometrial pathology was defined as simple, irregular, or complex endometrial hyperplasia by a pathologist after curettage. Outcomes at each time point were compared to baseline (pre-insertion) measurements by Student's t test or ANOVA (for multiple comparisons) with the post hoc Dunnett's test. Differences with a p < 0.05 were considered statistically significant. At all time points after LNG-IUS insertion and in all patients, menstrual blood loss was decreased and hemoglobin level was increased significantly compared to pre-insertion levels. The endometrial thickness was significantly reduced in all groups after 12 months. Most patients showed transformation of the endometrial pathology, with complete disappearance of simple and irregular cases of endometrial hyperplasia and a decreased number of complex endometrial hyperplasia cases. LNG-IUS is an effective, safe, nonsurgical, and atraumatic approach with few side effects for the treatment of endometrial hyperplasia in patients with PCOS. © 2014 S. Karger AG, Basel.

Tibial Tuberosity Anteromedialization for Patellofemoral Chondral Disease: Prognostic Factors.

PubMed

Rosso, Federica; Rossi, Roberto; Governale, Giorgio; Marmotti, Antongiulio; Cherubini, Valeria; Cottino, Umberto; Bonasia, Davide Edoardo

2017-06-01

Tibial tuberosity anteromedialization (TTA) is a well-established treatment option for patellofemoral chondral disease that is resistant to nonoperative treatment. However, the prognostic factors of this procedure are unknown. To analyze the prognostic factors correlated with the midterm outcomes of TTA for patellofemoral chondral disease and determine the survivorship. Case series; Level of evidence, 4. Indications of TTA for chondral disease included skeletal maturity, age <65 years, 7 points (34.6% of knees) in the multiple regression model was associated with age >45 years (odds ratio [OR], 10.4; 95% CI, 2.0-55.0) and increased femoral anteversion (OR, 7.9; 95% CI, 1.4-44.1). A Kujala score of <80 points (61.5% of knees) was associated with age >45 years (OR, 12.0; 95% CI, 2.6-56.2) and foot pronation (OR, 5.1; 95% CI, 1.3-20.4). Patient satisfaction of <7 of 10 points (32.1% of knees) was associated with positive postoperative patellofemoral crepitus (OR, 3.6; 95% CI, 1.1-11.7). The Kaplan-Meier survivorship of TTA with dissatisfaction (<5/10 points) as an end point was 94% at 43 months, 88% at 77 months, and 77% at 108 months. Overall, good outcomes and survivorship (77% at 108 months) were obtained in this case series. However, 25.6% of the patients would not undergo the surgery again. Increased age, increased femoral anteversion, foot pronation, and postoperative patellofemoral crepitus were identified as negative prognostic factors.

Comparing methods to combine functional loss and mortality in clinical trials for amyotrophic lateral sclerosis

PubMed Central

van Eijk, Ruben PA; Eijkemans, Marinus JC; Rizopoulos, Dimitris

2018-01-01

Objective Amyotrophic lateral sclerosis (ALS) clinical trials based on single end points only partially capture the full treatment effect when both function and mortality are affected, and may falsely dismiss efficacious drugs as futile. We aimed to investigate the statistical properties of several strategies for the simultaneous analysis of function and mortality in ALS clinical trials. Methods Based on the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database, we simulated longitudinal patterns of functional decline, defined by the revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R) and conditional survival time. Different treatment scenarios with varying effect sizes were simulated with follow-up ranging from 12 to 18 months. We considered the following analytical strategies: 1) Cox model; 2) linear mixed effects (LME) model; 3) omnibus test based on Cox and LME models; 4) composite time-to-6-point decrease or death; 5) combined assessment of function and survival (CAFS); and 6) test based on joint modeling framework. For each analytical strategy, we calculated the empirical power and sample size. Results Both Cox and LME models have increased false-negative rates when treatment exclusively affects either function or survival. The joint model has superior power compared to other strategies. The composite end point increases false-negative rates among all treatment scenarios. To detect a 15% reduction in ALSFRS-R decline and 34% decline in hazard with 80% power after 18 months, the Cox model requires 524 patients, the LME model 794 patients, the omnibus test 526 patients, the composite end point 1,274 patients, the CAFS 576 patients and the joint model 464 patients. Conclusion Joint models have superior statistical power to analyze simultaneous effects on survival and function and may circumvent pitfalls encountered by other end points. Optimizing trial end points is essential, as selecting suboptimal outcomes may disguise important treatment clues. PMID:29593436

Reliability of Interaural Time Difference-Based Localization Training in Elderly Individuals with Speech-in-Noise Perception Disorder.

PubMed

Delphi, Maryam; Lotfi, M-Yones; Moossavi, Abdollah; Bakhshi, Enayatollah; Banimostafa, Maryam

2017-09-01

Previous studies have shown that interaural-time-difference (ITD) training can improve localization ability. Surprisingly little is, however, known about localization training vis-à-vis speech perception in noise based on interaural time difference in the envelope (ITD ENV). We sought to investigate the reliability of an ITD ENV-based training program in speech-in-noise perception among elderly individuals with normal hearing and speech-in-noise disorder. The present interventional study was performed during 2016. Sixteen elderly men between 55 and 65 years of age with the clinical diagnosis of normal hearing up to 2000 Hz and speech-in-noise perception disorder participated in this study. The training localization program was based on changes in ITD ENV. In order to evaluate the reliability of the training program, we performed speech-in-noise tests before the training program, immediately afterward, and then at 2 months' follow-up. The reliability of the training program was analyzed using the Friedman test and the SPSS software. Significant statistical differences were shown in the mean scores of speech-in-noise perception between the 3 time points (P=0.001). The results also indicated no difference in the mean scores of speech-in-noise perception between the 2 time points of immediately after the training program and 2 months' follow-up (P=0.212). The present study showed the reliability of an ITD ENV-based localization training in elderly individuals with speech-in-noise perception disorder.

Timing of infant feeding in relation to childhood asthma and allergic diseases.

PubMed

Nwaru, Bright I; Takkinen, Hanna-Mari; Niemelä, Onni; Kaila, Minna; Erkkola, Maijaliisa; Ahonen, Suvi; Haapala, Anna-Maija; Kenward, Michael G; Pekkanen, Juha; Lahesmaa, Riitta; Kere, Juha; Simell, Olli; Veijola, Riitta; Ilonen, Jorma; Hyöty, Heikki; Knip, Mikael; Virtanen, Suvi M

2013-01-01

Emerging evidence questions current recommendations on the timing of infant feeding for the prevention of childhood allergies. The evidence for asthma is inconclusive. We sought to investigate the associations between the duration of breast-feeding and timing of introduction of complementary foods and the development of asthma and allergies by the age of 5 years. Data were analyzed for 3781 consecutively born children. The dietary exposures were categorized into thirds and analyzed as time-dependent variables. Asthma, allergic rhinitis, and atopic eczema end points were assessed by using the International Study of Asthma and Allergies in Childhood questionnaire, whereas IgE antibodies were analyzed from serum samples at the age of 5 years. Cox proportional hazard and logistic regressions were used for the analyses. The median duration of exclusive and total breast-feeding was 1.4 months (interquartile range, 0.2-3.5 months) and 7.0 months (interquartile range, 4.0-11.0 months), respectively. Total breast-feeding of 9.5 months or less was associated with an increased risk of nonatopic asthma. Introduction of wheat, rye, oats, or barley at 5 to 5.5 months was inversely associated with asthma and allergic rhinitis, whereas introduction of other cereals at less than 4.5 months increased the risk of atopic eczema. Introduction of egg at 11 months or less was inversely associated with asthma, allergic rhinitis, and atopic sensitization, whereas introduction of fish at 9 months or less was inversely associated with allergic rhinitis and atopic sensitization. Early introduction of wheat, rye, oats, and barley cereals; fish; and egg (respective to the timing of introduction of each food) seems to decrease the risk of asthma, allergic rhinitis, and atopic sensitization in childhood. Longer duration of total breast-feeding, rather than its exclusivity, was protective against the development of nonatopic but not atopic asthma, suggesting a potential differing effect of breast-feeding on different asthma phenotypes. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Effects of a 12-month task-specific balance training on the balance status of stroke survivors with and without cognitive impairments in Selected Hospitals in Nnewi, Anambra State, Nigeria.

PubMed

Okonkwo, Uchenna Prosper; Ibeneme, Sam Chidi; Ihegihu, Ebere Yvonne; Egwuonwu, Afamefuna Victor; Ezema, Charles Ikechukwu; Maruf, Fatai Adesina

2018-05-02

Stroke results in varying levels of physical disabilities that may adversely impact balance with increased tendency to falls. This may intensify with cognitive impairments (CI), and impede functional recovery. Therefore, task-specific balance training (TSBT), which presents versatile task-specific training options that matches varied individual needs, was explored as a beneficial rehabilitation regime for stroke survivors with and without CI. It was hypothesized that there will be no significant difference in the balance control measures in stroke survivors with and without CI after a 12-month TSBT. To determine if TSBT will have comparable beneficial effects on the balance control status of sub-acute ischemic stroke survivors with CI and without CI. One hundred of 143 available sub-acute first ever ischemic stroke survivors were recruited using convenience sampling technique in a quasi-experimental study. They were later assigned into the cognitive impaired group (CIG) and non-cognitive impaired group (NCIG), respectively, based on the baseline presence or absence of CI, after screening with the mini-mental examination (MMSE) tool. With the help of four trained research assistants, TSBT was applied to each group, thrice times a week, 60 mins per session, for 12 months. Their balance was measured as Bergs Balance scores (BBS) at baseline, 4th, 8th, and 12th month intervals. Data were analyzed statistically using Kruskal Wallis test, and repeated measure ANOVA, at p < 0.05.  There was significant improvement across time points in the balance control of CIG with large effect size of 0.69 after 12 months of TSBT. There was also significant improvement across time points in the balance control of NCIG with large effect size of 0.544 after 12 months of TSBT. There was no significant difference between the improvement in CIG and NCIG after 8th and 12th months of TSBT.  Within the groups, a 12-month TSBT intervention significantly improved balance control, respectively, but with broader effects in the CIG than NCIG. Importantly, though between-group comparison at baseline revealed significantly impaired balance control in the CIG than NCIG, these differences were not significant at the 8th month and non-existent at the 12th month of TSBT intervention. These results underscore the robustness of TSBT to evenly address specific balance deficits of stroke survivors with and without CI within a long-term rehabilitation plan as was hypothesized.

Dynamic Balance Deficits 6 Months Following First-Time Acute Lateral Ankle Sprain: A Laboratory Analysis.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2015-08-01

Controlled laboratory study. To utilize kinematic and stabilometric measures to compare dynamic balance during performance of the Star Excursion Balance Test between persons 6 months following first-time lateral ankle sprain (LAS) and a noninjured control group. Biomechanical evaluation of dynamic balance in persons following first-time LAS during performance of the Star Excursion Balance Test could provide insight into the mechanisms by which individuals proceed to recover fully or develop chronic ankle instability. Sagittal plane kinematics of the lower extremity and the center-of-pressure path during the performance of the anterior, posterolateral, and posteromedial reach directions of the Star Excursion Balance Test were obtained from 69 participants 6 months following first-time acute LAS and from a control group of 20 noninjured participants. Compared to the control group, the LAS group displayed lower normalized reach distances in all 3 reach directions on the injured and noninjured limbs, with the largest observed effect size in the posterolateral direction (P = .001, ηp(2) = 0.07). The performance impairment was associated with less hip and knee flexion and ankle dorsiflexion at the point of maximum reach (P<.02), and coincided with less complexity of the center-of-pressure path (P<.05). Participants with a 6-month history of LAS exhibit a persistence of deficits previously established in the acute phase of injury.

Maternal abuse history, postpartum depression, and parenting: links with preschoolers' internalizing problems.

PubMed

Madigan, Sheri; Wade, Mark; Plamondon, Andre; Jenkins, Jennifer

2015-01-01

The current study examined a temporal cascade linking mothers' history of abuse with their children's internalizing difficulties through proximal processes such as maternal postnatal depressive symptoms and responsive parenting. Participants consisted of 490 mother-child dyads assessed at three time points when children were, on average, 2 months old at Time 1 (T1), 18 months at Time 2 (T2), and 36 months at Time 3 (T3). Maternal abuse history and depressive symptoms were assessed via questionnaires at T1. Observations of responsive parenting were collected at T2 and were coded using a validated coding scheme. Children's internalizing difficulties were assessed in the preschool period using averaged parental reports. Path analysis revealed that maternal physical abuse was associated with depressive symptoms postnatally, which were in turn associated with children's internalizing behavior at 36 months of age. We also found that the association between physical abuse history and responsive parenting operated indirectly through maternal depressive symptoms. These findings remained after controlling for covariates including socioeconomic status, child gender, and age. After accounting for physical abuse history, sexual abuse history was not associated with child internalizing problems either directly or indirectly through maternal depressive symptoms and/or parenting behavior. Thus, mothers' physical abuse history is a risk factor for relatively poor mental health, which is itself predictive of both later parenting behavior and children's internalizing problems. © 2015 Michigan Association for Infant Mental Health.

On the reliability of the holographic method for measurement of soft tissue modifications during periodontal therapy

NASA Astrophysics Data System (ADS)

Stratul, Stefan-Ioan; Sinescu, Cosmin; Negrutiu, Meda; de Sabata, Aldo; Rominu, Mihai; Ogodescu, Alexandru; Rusu, Darian

2014-01-01

Holographic evaluations count among recent measurement tools in orthodontics and prosthodontics. This research introduces holography as an assessment method of 3D variations of gingival retractions. The retraction of gingiva on frontal regions of 5 patients with periodontitis was measured in six points and was evaluated by holographic methods using a He-Ne laser device (1mV, Superlum, Carrigtwohill, Ireland) inside a holographic bank of 200 x 100cm. Impressions were taken during first visit and cast models were manufactured. Six months after the end of periodontal treatment, clinical measurements were repeated and the hologram of the first model was superimposed on a final model cast, by using reference points, while maintaining the optical geometric perimeters. The retractions were evaluated 3D in every point using a dedicated software (Sigma Scan Pro,Systat Software, SanJose, CA, USA). The Wilcoxon test was used to compare the mean recession changes between baseline and six months after treatment, and between values in vivo and the values on hologram. No statistically significant differences between values in vivo and on the hologram were found. In conclusion, holography provides a valuable tool for assessing gingival retractions on virtual models. The data can be stored, reproduced, transmitted and compared at a later time point with accuracy.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

PubMed

Honma, Katsuaki; Sakai, Ritsuko; Takeshima, Akiko; Shimamori, Yoshimitsu; Hayase, Yukitoshi

2004-10-01

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

Longitudinal analysis of the behavioral phenotype in a novel transgenic rat model of early stages of Alzheimer's disease.

PubMed

Galeano, Pablo; Martino Adami, Pamela V; Do Carmo, Sonia; Blanco, Eduardo; Rotondaro, Cecilia; Capani, Francisco; Castaño, Eduardo M; Cuello, A Claudio; Morelli, Laura

2014-01-01

Intraneuronal accumulation of amyloid β (iAβ) has been linked to mild cognitive impairment that may precede Alzheimer's disease (AD) onset. This neuropathological trait was recently mimicked in a novel animal model of AD, the hemizygous transgenic McGill-R-Thy1-APP (Tg(+/-)) rat. The characterization of the behavioral phenotypes in this animal model could provide a baseline of efficacy for earlier therapeutic interventions. The aim of the present study was to undertake a longitudinal study of Aβ accumulation and a comprehensive behavioral evaluation of this transgenic rat model. We assessed exploratory activity, anxiety-related behaviors, recognition memory, working memory, spatial learning and reference memory at 3, 6, and 12 months of age. In parallel, we measured Aβ by ELISA, Western blots and semiquantitative immunohistochemistry in hippocampal samples. SDS-soluble Aβ peptide accumulated at low levels (~9 pg/mg) without differences among ages. However, Western blots showed SDS-resistant Aβ oligomers (~30 kDa) at 6 and 12 months, but not at 3 months. When compared to wild-type (WT), male Tg(+/-) rats exhibited a spatial reference memory deficit in the Morris Water Maze (MWM) as early as 3 months of age, which persisted at 6 and 12 months. In addition, Tg(+/-) rats displayed a working memory impairment in the Y-maze and higher anxiety levels in the Open Field (OF) at 6 and 12 months of age, but not at 3 months. Exploratory activity in the OF was similar to that of WT at all-time points. Spatial learning in the MWM and the recognition memory, as assessed by the Novel Object Recognition Test, were unimpaired at any time point. The data from the present study demonstrate that the hemizygous transgenic McGill-R-Thy1-APP rat has a wide array of behavioral and cognitive impairments from young adulthood to middle-age. The low Aβ burden and early emotional and cognitive deficits in this transgenic rat model supports its potential use for drug discovery purposes in early AD.

Longitudinal analysis of the behavioral phenotype in a novel transgenic rat model of early stages of Alzheimer's disease

PubMed Central

Galeano, Pablo; Martino Adami, Pamela V.; Do Carmo, Sonia; Blanco, Eduardo; Rotondaro, Cecilia; Capani, Francisco; Castaño, Eduardo M.; Cuello, A. Claudio; Morelli, Laura

2014-01-01

Intraneuronal accumulation of amyloid β (iAβ) has been linked to mild cognitive impairment that may precede Alzheimer's disease (AD) onset. This neuropathological trait was recently mimicked in a novel animal model of AD, the hemizygous transgenic McGill-R-Thy1-APP (Tg+/−) rat. The characterization of the behavioral phenotypes in this animal model could provide a baseline of efficacy for earlier therapeutic interventions. The aim of the present study was to undertake a longitudinal study of Aβ accumulation and a comprehensive behavioral evaluation of this transgenic rat model. We assessed exploratory activity, anxiety-related behaviors, recognition memory, working memory, spatial learning and reference memory at 3, 6, and 12 months of age. In parallel, we measured Aβ by ELISA, Western blots and semiquantitative immunohistochemistry in hippocampal samples. SDS-soluble Aβ peptide accumulated at low levels (~9 pg/mg) without differences among ages. However, Western blots showed SDS-resistant Aβ oligomers (~30 kDa) at 6 and 12 months, but not at 3 months. When compared to wild-type (WT), male Tg+/− rats exhibited a spatial reference memory deficit in the Morris Water Maze (MWM) as early as 3 months of age, which persisted at 6 and 12 months. In addition, Tg+/− rats displayed a working memory impairment in the Y-maze and higher anxiety levels in the Open Field (OF) at 6 and 12 months of age, but not at 3 months. Exploratory activity in the OF was similar to that of WT at all-time points. Spatial learning in the MWM and the recognition memory, as assessed by the Novel Object Recognition Test, were unimpaired at any time point. The data from the present study demonstrate that the hemizygous transgenic McGill-R-Thy1-APP rat has a wide array of behavioral and cognitive impairments from young adulthood to middle-age. The low Aβ burden and early emotional and cognitive deficits in this transgenic rat model supports its potential use for drug discovery purposes in early AD. PMID:25278855

Randomized Phase II Study of Carboplatin and Paclitaxel With Either Linifanib or Placebo for Advanced Nonsquamous Non–Small-Cell Lung Cancer

PubMed Central

Ramalingam, Suresh S.; Shtivelband, Mikhail; Soo, Ross A.; Barrios, Carlos H.; Makhson, Anatoly; Segalla, José G.M.; Pittman, Kenneth B.; Kolman, Petr; Pereira, Jose R.; Srkalovic, Gordan; Belani, Chandra P.; Axelrod, Rita; Owonikoko, Taofeek K.; Qin, Qin; Qian, Jiang; McKeegan, Evelyn M.; Devanarayan, Viswanath; McKee, Mark D.; Ricker, Justin L.; Carlson, Dawn M.; Gorbunova, Vera A.

2015-01-01

Purpose Linifanib, a potent, selective inhibitor of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) receptors, has single-agent activity in non–small-cell lung cancer (NSCLC). We evaluated linifanib with carboplatin and paclitaxel as first-line therapy of advanced nonsquamous NSCLC. Patients and Methods Patients with stage IIIB/IV nonsquamous NSCLC were randomly assigned to 3-week cycles of carboplatin (area under the curve 6) and paclitaxel (200 mg/m2) with daily placebo (arm A), linifanib 7.5 mg (arm B), or linifanib 12.5 mg (arm C). The primary end point was progression-free survival (PFS); secondary efficacy end points included overall survival (OS) and objective response rate. Results One hundred thirty-eight patients were randomly assigned (median age, 61 years; 57% men; 84% smokers). Median PFS times were 5.4 months (95% CI, 4.2 to 5.7 months) in arm A (n = 47), 8.3 months (95% CI, 4.2 to 10.8 months) in arm B (n = 44), and 7.3 months (95% CI, 4.6 to 10.8 months) in arm C (n = 47). Hazard ratios (HRs) for PFS were 0.51 for arm B versus A (P = .022) and 0.64 for arm C versus A (P = .118). Median OS times were 11.3, 11.4, and 13.0 months in arms A, B, and C, respectively. HRs for OS were 1.08 for arm B versus A (P = .779) and 0.88 for arm C versus A (P = .650). Both linifanib doses were associated with increased toxicity, including a higher incidence of adverse events known to be associated with VEGF/PDGF inhibition. Baseline plasma carcinoembryonic antigen/cytokeratin 19 fragments biomarker signature was associated with PFS improvement and a trend toward OS improvement with linifanib 12.5 mg. Conclusion Addition of linifanib to chemotherapy significantly improved PFS (arm B), with a modest trend for survival benefit (arm C) and increased toxicity reflective of known VEGF/PDGF inhibitory effects. PMID:25559798

Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts.

PubMed

Oladeji, Lasun O; Stannard, James P; Cook, Cristi R; Kfuri, Mauricio; Crist, Brett D; Smith, Matthew J; Cook, James L

2017-10-01

Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. Cohort study; Level of evidence, 3. A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly ( P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly ( P = .017) less in the BMC group at 6 weeks and 3 months, with no significant difference at 6 months after surgery. When combining the groups to examine the influence of smoking on graft integration, nonsmokers had significantly ( P = .007) higher graft integration scores at 6 months. Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.

Changes and tracking of fruit, vegetables and sugar-sweetened beverages intake from 18 months to 7 years in the Norwegian Mother and Child Cohort Study.

PubMed

Bjelland, Mona; Brantsæter, Anne Lise; Haugen, Margaretha; Meltzer, Helle Margrete; Nystad, Wenche; Andersen, Lene Frost

2013-08-30

A few studies have investigated tracking of dietary patterns or nutrient intake in pre-school children, but no studies have been identified examining tracking of sugar-sweetened beverages (SSB), fruit and vegetable intakes in early childhood (1-7 year olds). The purpose of this study was to investigate changes and tracking of intakes of fruit, vegetables and SSB, and association between maternal education and dietary tracking, from 18 months to 7 years of age. Longitudinal data from the nation-wide Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health were used, including 9025 children participating at three time points (18 months, 36 months and 7 years). Frequencies of fruit, vegetables and SSB were assessed by questionnaire. Slightly different questions were used at each time point to collect information about intake. Maternal education was categorized into ≤ 12 years, 13-16 years, ≥ 17 years. Cross-tabulation, Spearman's rho and multinomial logistic regression were used for assessing change, tracking and differences by maternal education. Analyses by gender indicated largest changes for intake of fruit and SSB from age 18 months to 7 years. Fair to moderate tracking coefficients (Spearman's rho = 0.23-0.46) for intake of fruit, vegetables and SSB were found and children assigned to low, medium and high frequency of consumption at 18 months continued to be in the same group at age 36 months and 7 years. Children of mothers with low education consumed fruit and vegetables less often and SSB more often compared to children of mothers with high education at 18 months of age. Children with higher educated mothers had lower odds for increasing fruit intake or decreasing SSB intake, compared to children with lower educated mothers showing a stable intake. The tracking coefficients for intakes were fair to moderate and differences in intakes according to maternal education were found already at age 18 months. This suggests that promotion of healthy dietary behaviours at an early age is important to prevent unfavourable dietary behaviours later in childhood. Moreover, it seems important to target mothers in nutrition interventions for improving dietary habits among children.

Predictive and construct validity of the Bayley Scales of Infant Development and the Wechsler Preschool and Primary Scale of Intelligence with the Taiwan Birth Cohort Study instrument.

PubMed

Lung, For-Wey; Chen, Po-Fei; Shu, Bih-Ching

2012-08-01

This study aimed to investigate the concurrent validity of the parent-report Taiwan Birth Cohort Study Developmental Instrument (TBCS-DI) with the Bayley Scales of Infant Development-Second Edition (BSID-II) and the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) at 6, 18, 36, and 60 months. 100 children were recruited at 6 months, 88 children followed-up at 18 months, 71 at 36 months, and 53 at 60 months. Longitudinally, the parent-report TBCS-DI, with the professional psychological assessments of the BSID-II and the WPPSI-R showed predictive validity. Looking at each time point in cross section, at 6 and 18 months the TBCS-DI had good concurrent validity with the BSID-II, and at 36 and 60 months the TBCS-DI was correlated only with the motor and performance domains of the BSID-II and WPPSI-R. With further investigation, the TBCS-DI may be used both in research and in clinical settings.

Language development at 18 months is related to multimodal communicative strategies at 12 months.

PubMed

Igualada, Alfonso; Bosch, Laura; Prieto, Pilar

2015-05-01

The present study investigated the degree to which an infants' use of simultaneous gesture-speech combinations during controlled social interactions predicts later language development. Nineteen infants participated in a declarative pointing task involving three different social conditions: two experimental conditions (a) available, when the adult was visually attending to the infant but did not attend to the object of reference jointly with the child, and (b) unavailable, when the adult was not visually attending to neither the infant nor the object; and (c) a baseline condition, when the adult jointly engaged with the infant's object of reference. At 12 months of age measures related to infants' speech-only productions, pointing-only gestures, and simultaneous pointing-speech combinations were obtained in each of the three social conditions. Each child's lexical and grammatical output was assessed at 18 months of age through parental report. Results revealed a significant interaction between social condition and type of communicative production. Specifically, only simultaneous pointing-speech combinations increased in frequency during the available condition compared to baseline, while no differences were found for speech-only and pointing-only productions. Moreover, simultaneous pointing-speech combinations in the available condition at 12 months positively correlated with lexical and grammatical development at 18 months of age. The ability to selectively use this multimodal communicative strategy to engage the adult in joint attention by drawing his attention toward an unseen event or object reveals 12-month-olds' clear understanding of referential cues that are relevant for language development. This strategy to successfully initiate and maintain joint attention is related to language development as it increases learning opportunities from social interactions. Copyright © 2015 Elsevier Inc. All rights reserved.

Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes.

PubMed

Cacchio, Angelo; Rompe, Jan D; Furia, John P; Susi, Piero; Santilli, Valter; De Paulis, Fosco

2011-01-01

Chronic proximal hamstring tendinopathy is an overuse syndrome that is usually managed by nonoperative methods. Shockwave therapy has proved to be effective in many tendinopathies. Shockwave therapy may be more effective than other nonoperative treatments for chronic proximal hamstring tendinopathy. Randomized controlled clinical study; Level of evidence, 1. Forty professional athletes with chronic proximal hamstring tendinopathy were enrolled between February 1, 2004, and September 30, 2006. Patients were randomly assigned to receive either shockwave therapy, consisting of 2500 impulses per session at a 0.18 mJ/mm² energy flux density without anesthesia, for 4 weeks (SWT group, n = 20), or traditional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, physiotherapy, and an exercise program for hamstring muscles (TCT group, n = 20). Patients were evaluated before treatment, and 1 week and 3, 6, and 12 months after the end of treatment. The visual analog scale (VAS) score for pain and Nirschl phase rating scale (NPRS) were used as primary outcome measures. The patients were observed for a mean of 10.7 months (range, 1-12 months). Six patients were lost to follow-up because they underwent a surgical intervention: 3 (all in TCT group) were lost at 3 months; 2 (1 in each group), at 6 months; and 1 (in the TCT group), at 12 months. Primary follow-up was at 3 months after the beginning of treatment. The VAS scores in the SWT and TCT groups were 7 points before treatment (P = .84), and 2 points and 5 points, respectively, 3 months after treatment (P < .001). The NPRS scores in the SWT and TCT groups were 5 points in either group before treatment (P = .48), and 2 points and 6 points, respectively, 3 months after treatment (P < .001). At 3 months after treatment, 17 of the 20 patients (85%) in the SWT group and 2 of the 20 patients (10%) in the TCT group achieved a reduction of at least 50% in pain (P < .001). There were no serious complications in the SWT group. Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.

The impact of a community-led program promoting weight loss and healthy living in Aboriginal communities: the New South Wales Knockout Health Challenge.

PubMed

Passmore, Erin; Shepherd, Brooke; Milat, Andrew; Maher, Louise; Hennessey, Kiel; Havrlant, Rachael; Maxwell, Michelle; Hodge, Wendy; Christian, Fiona; Richards, Justin; Mitchell, Jo

2017-12-13

Aboriginal people in Australia experience significant health burden from chronic disease. There has been limited research to identify effective healthy lifestyle programs to address risk factors for chronic disease among Aboriginal people. The Knockout Health Challenge is a community-led healthy lifestyle program for Aboriginal communities across New South Wales, Australia. An evaluation of the 2013 Knockout Health Challenge was undertaken. Participants' self-reported physical activity and diet were measured at four time points - at the start and end of the Challenge (via paper form), and 5 and 9 months after the Challenge (via telephone survey). Participants' weight was measured objectively at the start and end of the Challenge, and self-reported (via telephone survey) 5 and 9 months after the Challenge. Changes in body composition, physical activity and diet between time points were analysed using linear mixed models. As part of the telephone survey participants were also asked to identify other impacts of the Challenge; these were analysed descriptively (quantitative items) and thematically (qualitative items). A total of 586 people registered in 22 teams to participate in the Challenge. The mean weight at the start was 98.54kg (SD 22.4), and 94% of participants were overweight or obese. Among participants who provided data at all four time points (n=122), the mean weight loss from the start to the end of the Challenge was 2.3kg (95%CI -3.0 to -1.9, p<0.001), and from the start to 9 months after the Challenge was 2.3kg (95%CI -3.3 to -1.3, p<0.001). Body mass index decreased by an average of 0.9kg/m 2 (95%CI -1.0 to -0.7, p<0.001) from the start to the end of the Challenge, and 0.8kg/m 2 (95%CI -1.2 to -0.4, p<0.001) 9 months after. At the end of the Challenge, participants reported they were more physically active and had increased fruit and vegetable consumption compared with the start of the Challenge, and identified a range of other positive impacts. The Challenge was effective in reducing weight and promoting healthy lifestyles among Aboriginal people across New South Wales, and has potential to contribute to closing the health gap between Aboriginal and non-Aboriginal people.

Detecting Behavioral Deficits in Rats After Traumatic Brain Injury

PubMed Central

Parsley, Margaret A.; Guptarak, Jutatip; Spratt, Heidi; Sell, Stacy L.

2018-01-01

With the increasing incidence of traumatic brain injury (TBI) in both civilian and military populations, TBI is now considered a chronic disease; however, few studies have investigated the long-term effects of injury in rodent models of TBI. Shown here are behavioral measures that are well-established in TBI research for times early after injury, such as two weeks, until two months. Some of these methods have previously been used at later times after injury, up to one year, but by very few laboratories. The methods demonstrated here are a short neurological assessment to test reflexes, a Beam-Balance to test balance, a Beam-Walk to test balance and motor coordination, and a working memory version of the Morris water maze that can be sensitive to deficits in reference memory. Male rats were handled and pre-trained to neurological, balance, and motor coordination tests prior to receiving parasagittal fluid percussion injury (FPI) or sham injury. Rats can be tested on the short neurological assessment (neuroscore), the beam-balance, and the Beam-Walk multiple times, while testing on the water maze can only be done once. This difference is because rats can remember the task, thus confounding the results if repeated testing is attempted in the same animal. When testing from one to three days after injury, significant differences are detected in all three non-cognitive tasks. However, differences in the Beam-Walk task were not detectable at later time points (after 3 months). Deficits were detected at 3 months in the Beam-Balance and at 6 months in the neuroscore. Deficits in working memory were detected out to 12 months after injury, and a deficit in a reference memory first appeared at 12 months. Thus, standard behavioral tests can be useful measures of persistent behavioral deficits after FPI. PMID:29443022

Workload and Marital Satisfaction over Time: Testing Lagged Spillover and Crossover Effects during the Newlywed Years.

PubMed

Lavner, Justin A; Clark, Malissa A

2017-08-01

Although many studies have found that higher workloads covary with lower levels of marital satisfaction, the question of whether workloads may also predict changes in marital satisfaction over time has been overlooked. To address this question, we investigated the lagged association between own and partner workload and marital satisfaction using eight waves of data collected every 6 months over the first four years of marriage from 172 heterosexual couples. Significant crossover, but not spillover, effects were found, indicating that partners of individuals with higher workloads at one time point experience greater declines in marital satisfaction by the following time point compared to the partners of individuals with lower workloads. These effects were not moderated by gender or parental status. These findings suggest that higher partner workloads can prove deleterious for relationship functioning over time and call for increased attention to the long-term effects of spillover and crossover from work to marital functioning.

Phase III, Randomized, Double-Blind, Multicenter Trial Comparing Orteronel (TAK-700) Plus Prednisone With Placebo Plus Prednisone in Patients With Metastatic Castration-Resistant Prostate Cancer That Has Progressed During or After Docetaxel-Based Therapy: ELM-PC 5

PubMed Central

Fizazi, Karim; Jones, Robert; Oudard, Stephane; Efstathiou, Eleni; Saad, Fred; de Wit, Ronald; De Bono, Johann; Cruz, Felipe Melo; Fountzilas, George; Ulys, Albertas; Carcano, Flavio; Agarwal, Neeraj; Agus, David; Bellmunt, Joaquim; Petrylak, Daniel P.; Lee, Shih-Yuan; Webb, Iain J.; Tejura, Bindu; Borgstein, Niels; Dreicer, Robert

2015-01-01

Purpose Orteronel (TAK-700) is an investigational, nonsteroidal, reversible, selective 17,20-lyase inhibitor. This study examined orteronel in patients with metastatic castration-resistant prostate cancer that progressed after docetaxel therapy. Patients and Methods In our study, 1,099 men were randomly assigned in a 2:1 schedule to receive orteronel 400 mg plus prednisone 5 mg twice daily or placebo plus prednisone 5 mg twice daily, stratified by region (Europe, North America [NA], and non-Europe/NA) and Brief Pain Inventory–Short Form worst pain score. Primary end point was overall survival (OS). Key secondary end points (radiographic progression-free survival [rPFS], ≥ 50% decrease of prostate-specific antigen [PSA50], and pain response at 12 weeks) were to undergo statistical testing only if the primary end point analysis was significant. Results The study was unblinded after crossing a prespecified OS futility boundary. The median OS was 17.0 months versus 15.2 months with orteronel-prednisone versus placebo-prednisone (hazard ratio [HR], 0.886; 95% CI, 0.739 to 1.062; P = .190). Improved rPFS was observed with orteronel-prednisone (median, 8.3 v 5.7 months; HR, 0.760; 95% CI, 0.653 to 0.885; P < .001). Orteronel-prednisone showed advantages over placebo-prednisone in PSA50 rate (25% v 10%, P < .001) and time to PSA progression (median, 5.5 v 2.9 months, P < .001) but not pain response rate (12% v 9%; P = .128). Adverse events (all grades) were generally more frequent with orteronel-prednisone, including nausea (42% v 26%), vomiting (36% v 17%), fatigue (29% v 23%), and increased amylase (14% v 2%). Conclusion Our study did not meet the primary end point of OS. Longer rPFS and a higher PSA50 rate with orteronel-prednisone indicate antitumor activity. PMID:25624429

Alpha emitter radium-223 and survival in metastatic prostate cancer.

PubMed

Parker, C; Nilsson, S; Heinrich, D; Helle, S I; O'Sullivan, J M; Fosså, S D; Chodacki, A; Wiechno, P; Logue, J; Seke, M; Widmark, A; Johannessen, D C; Hoskin, P; Bottomley, D; James, N D; Solberg, A; Syndikus, I; Kliment, J; Wedel, S; Boehmer, S; Dall'Oglio, M; Franzén, L; Coleman, R; Vogelzang, N J; O'Bryan-Tear, C G; Staudacher, K; Garcia-Vargas, J; Shan, M; Bruland, Ø S; Sartor, O

2013-07-18

Radium-223 dichloride (radium-223), an alpha emitter, selectively targets bone metastases with alpha particles. We assessed the efficacy and safety of radium-223 as compared with placebo, in addition to the best standard of care, in men with castration-resistant prostate cancer and bone metastases. In our phase 3, randomized, double-blind, placebo-controlled study, we randomly assigned 921 patients who had received, were not eligible to receive, or declined docetaxel, in a 2:1 ratio, to receive six injections of radium-223 (at a dose of 50 kBq per kilogram of body weight intravenously) or matching placebo; one injection was administered every 4 weeks. In addition, all patients received the best standard of care. The primary end point was overall survival. The main secondary efficacy end points included time to the first symptomatic skeletal event and various biochemical end points. A prespecified interim analysis, conducted when 314 deaths had occurred, assessed the effect of radium-223 versus placebo on survival. An updated analysis, when 528 deaths had occurred, was performed before crossover from placebo to radium-223. At the interim analysis, which involved 809 patients, radium-223, as compared with placebo, significantly improved overall survival (median, 14.0 months vs. 11.2 months; hazard ratio, 0.70; 95% confidence interval [CI], 0.55 to 0.88; two-sided P=0.002). The updated analysis involving 921 patients confirmed the radium-223 survival benefit (median, 14.9 months vs. 11.3 months; hazard ratio, 0.70; 95% CI, 0.58 to 0.83; P<0.001). Assessments of all main secondary efficacy end points also showed a benefit of radium-233 as compared with placebo. Radium-223 was associated with low myelosuppression rates and fewer adverse events. In this study, which was terminated for efficacy at the prespecified interim analysis, radium-223 improved overall survival. (Funded by Algeta and Bayer HealthCare Pharmaceuticals; ALSYMPCA ClinicalTrials.gov number, NCT00699751.).

Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke.

PubMed

Liu, Ning; Cadilhac, Dominique A; Andrew, Nadine E; Zeng, Lingxia; Li, Zongfang; Li, Jin; Li, Yan; Yu, Xuewen; Mi, Baibing; Li, Zhe; Xu, Honghai; Chen, Yangjing; Wang, Juan; Yao, Wanxia; Li, Kuo; Yan, Feng; Wang, Jue

2014-12-01

Mechanisms, acute management, and outcomes for patients who experience intracerebral hemorrhage may differ from patients with ischemic stroke. Studies of very early rehabilitation have been mainly undertaken in patients with ischemic stroke, and it is unknown if benefits apply to those with intracerebral hemorrhage. We hypothesized that early rehabilitation, within 48 hours of stroke, would improve survival and functional outcomes in patients with intracerebral hemorrhage. This was a multicenter, randomized controlled study, with blinded assessment of outcome at 3 and 6 months. Eligible patients were randomized to receive standard care or standard care plus early rehabilitation. Primary outcome includes survival. Secondary outcomes includes health-related quality of life using the 36-item Short Form Questionnaire, function measured with the modified Barthel Index, and anxiety measured with the Zung Self-Rated Anxiety Scale. Two hundred forty-three of 326 patients were randomized (mean age, 59 years; 56% men). At 6 months, patients receiving standard care were more likely to have died (adjusted hazard ratio, 4.44; 95% confidence interval [CI], 1.24-15.87); for morbidity outcomes, a 6-point difference in the Physical Component Summary score of the 36-item Short Form Questionnaire (95% CI, 4.2-8.7), a 7-point difference for the Mental Component Summary score (95% CI, 4.5-9.5), a 13-point difference in Modified Barthel Index scores (95% CI, 6.8-18.3), and a 6-point difference in Self-Rating Anxiety Scale scores (95% CI, 4.4-8.3) was reported in favor of the intervention groups. For the first time, we have shown that commencing rehabilitation within 48 hours of intracerebral hemorrhage improves survival and functional outcomes at 6 months after stroke in hospitalized patients in China. http://www.chictr.org/en. Unique identifier: ChiCTR-TRC-13004039. © 2014 American Heart Association, Inc.

Development and transfer of vocabulary knowledge in Spanish-speaking language minority preschool children.

PubMed

Goodrich, J Marc; Lonigan, Christopher J; Kleuver, Cherie G; Farver, Joann M

2016-09-01

In this study we evaluated the predictive validity of conceptual scoring. Two independent samples of Spanish-speaking language minority preschoolers (Sample 1: N = 96, mean age = 54·51 months, 54·3% male; Sample 2: N = 116, mean age = 60·70 months, 56·0% male) completed measures of receptive, expressive, and definitional vocabulary in their first (L1) and second (L2) languages at two time points approximately 9-12 months apart. We examined whether unique L1 and L2 vocabulary at time 1 predicted later L2 and L1 vocabulary, respectively. Results indicated that unique L1 vocabulary did not predict later L2 vocabulary after controlling for initial L2 vocabulary. An identical pattern of results emerged for L1 vocabulary outcomes. We also examined whether children acquired translational equivalents for words known in one language but not the other. Results indicated that children acquired translational equivalents, providing partial support for the transfer of vocabulary knowledge across languages.

SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction

PubMed Central

Bagheri, Shirin; Hansson, Emma; Manjer, Jonas; Troëng, Thomas; Brorson, Håkan

2017-01-01

Abstracts Background: Arm lymphedema after breast cancer surgery affects women both from physical and psychological points of view. Lymphedema leads to adipose tissue deposition. Liposuction and controlled compression therapy (CCT) reduces the lymphedema completely. Methods and Results: Sixty female patients with arm lymphedema were followed for a 1-year period after surgery. The 36-item short-form health survey (SF-36) was used to assess health-related quality of life (HRQoL). Patients completed the SF-36 questionnaire before liposuction, and after 1, 3, 6, and 12 months. Preoperative excess arm volume was 1365 ± 73 mL. Complete reduction was achieved after 3 months and was sustained during follow-up. The adipose tissue volume removed at surgery was 1373 ± 56 mL. One month after liposuction, better scores were found in mental health. After 3 months, an increase in physical functioning, bodily pain, and vitality was detected. After 1 year, an increase was also seen for social functioning. The physical component score was higher at 3 months and thereafter, while the mental component score was improved at 3 and 12 months. Compared with SF-36 norm data for the Swedish population, only physical functioning showed lower values than the norm at baseline. After liposuction, general health, bodily pain, vitality, mental health, and social functioning showed higher values at various time points. Conclusions: Liposuction of arm lymphedema in combination with CCT improves patients HRQoL as measured with SF-36. The treatment seems to target and improve both the physical and mental health domains. PMID:28135120

SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction.

PubMed

Hoffner, Mattias; Bagheri, Shirin; Hansson, Emma; Manjer, Jonas; Troëng, Thomas; Brorson, Håkan

2017-03-01

Abstracts Background: Arm lymphedema after breast cancer surgery affects women both from physical and psychological points of view. Lymphedema leads to adipose tissue deposition. Liposuction and controlled compression therapy (CCT) reduces the lymphedema completely. Sixty female patients with arm lymphedema were followed for a 1-year period after surgery. The 36-item short-form health survey (SF-36) was used to assess health-related quality of life (HRQoL). Patients completed the SF-36 questionnaire before liposuction, and after 1, 3, 6, and 12 months. Preoperative excess arm volume was 1365 ± 73 mL. Complete reduction was achieved after 3 months and was sustained during follow-up. The adipose tissue volume removed at surgery was 1373 ± 56 mL. One month after liposuction, better scores were found in mental health. After 3 months, an increase in physical functioning, bodily pain, and vitality was detected. After 1 year, an increase was also seen for social functioning. The physical component score was higher at 3 months and thereafter, while the mental component score was improved at 3 and 12 months. Compared with SF-36 norm data for the Swedish population, only physical functioning showed lower values than the norm at baseline. After liposuction, general health, bodily pain, vitality, mental health, and social functioning showed higher values at various time points. Liposuction of arm lymphedema in combination with CCT improves patients HRQoL as measured with SF-36. The treatment seems to target and improve both the physical and mental health domains.

Early Implantation of Primary Prevention Implantable Cardioverter Defibrillators for Patients with Newly Diagnosed Severe Nonischemic Cardiomyopathy.

PubMed

Voskoboinik, Aleksandr; Bloom, Jason; Taylor, Andrew; Mariani, Justin

2016-09-01

Primary prevention implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients with severe systolic dysfunction. Current guidelines suggest a 3- to 6-month waiting period before implantation. We retrospectively studied 29 consecutive patients with newly diagnosed nonischemic cardiomyopathy (NICM) who underwent primary prevention ICD implantation within 6 months of diagnosis between January 2008 and April 2014. Cardiac MRI (CMR) evaluated left ventricular ejection fraction (LVEF) and regional fibrosis preimplant. The primary end point was "failure to qualify for an ICD at 12 months postimplant," either due to LVEF ≥ 35% or deterioration necessitating mechanical support or transplantation, without appropriate ICD therapy. Secondary end points were appropriate and inappropriate ICD therapy. Baseline mean age was 44.2 ± 14.8 years and median LVEF 16.4%. Median time from diagnosis to implant was 32 days. At 12 months, 17 patients (58.6%) no longer qualified for an ICD, mainly due to LVEF improvement. At follow-up (mean 32.0 ± 20.6 months), three patients received appropriate therapy (one for ventricular fibrillation). All three had CMR late gadolinium enhancement (LGE) and nonsustained ventricular tachycardia (NSVT) preimplant. Cardiac resynchronization at implant predicted LVEF improvement. Early appropriate therapy, particularly for ventricular fibrillation, is infrequent for patients with very severe NICM who have ICDs implanted within 6 months of diagnosis. The majority of these patients would not qualify for an ICD at 12 months postinsertion. In the absence of a multimodality risk score, early ICD insertion should only be considered in selected cases (presence of LGE and NSVT). Wearable cardioverter defibrillators may have a role as a bridge to ICD decision. © 2016 Wiley Periodicals, Inc.

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal

PubMed Central

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Background and Objective Little is known about purchasing micronutrient powders (MNP) for children 2–5 years. We describe acceptability for purchasing and price points for MNP for children 2–5 years among caregivers living in districts where free MNP are distributed for children 6–23 months. Methods and Study Design Cross-sectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among socio-demographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6–23 months who had heard of MNP. Results Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Conclusions Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal. PMID:28049270

Multi-modal magnetic resonance imaging in the acute and sub-acute phase of mild traumatic brain injury: can we see the difference?

PubMed

Toth, Arnold; Kovacs, Noemi; Perlaki, Gabor; Orsi, Gergely; Aradi, Mihaly; Komaromy, Hedvig; Ezer, Erzsebet; Bukovics, Peter; Farkas, Orsolya; Janszky, Jozsef; Doczi, Tamas; Buki, Andras; Schwarcz, Attila

2013-01-01

Advanced magnetic resonance imaging (MRI) methods were shown to be able to detect the subtle structural consequences of mild traumatic brain injury (mTBI). The objective of this study was to investigate the acute structural alterations and recovery after mTBI, using diffusion tensor imaging (DTI) to reveal axonal pathology, volumetric analysis, and susceptibility weighted imaging (SWI) to detect microhemorrhage. Fourteen patients with mTBI who had computed tomography with negative results underwent MRI within 3 days and 1 month after injury. High resolution T1-weighted imaging, DTI, and SWI, were performed at both time points. A control group of 14 matched volunteers were also examined following the same imaging protocol and time interval. Tract-Based Spatial Statistics (TBSS) were performed on DTI data to reveal group differences. T1-weighted images were fed into Freesurfer volumetric analysis. TBSS showed fractional anisotropy (FA) to be significantly (corrected p<0.05) lower, and mean diffusivity (MD) to be higher in the mTBI group in several white matter tracts (FA=40,737; MD=39,078 voxels) compared with controls at 72 hours after injury and still 1month later for FA. Longitudinal analysis revealed significant change (i.e., normalization) of FA and MD over 1 month dominantly in the left hemisphere (FA=3408; MD=7450 voxels). A significant (p<0.05) decrease in cortical volumes (mean 1%) and increase in ventricular volumes (mean 3.4%) appeared at 1 month after injury in the mTBI group. SWI did not reveal microhemorrhage in our patients. Our findings present dynamic micro- and macrostructural changes occurring in the acute to sub-acute phase in mTBI, in very mildly injured patients lacking microhemorrhage detectable by SWI. These results underscore the importance of strictly defined image acquisition time points when performing MRI studies on patients with mTBI.

EFFECTS OF TRANSDERMAL TESTOSTERONE TREATMENT ON INFLAMMATORY MARKERS IN ELDERLY MEN

PubMed Central

Maggio, Marcello; Snyder, Peter J.; De Vita, Francesca; Ceda, Gian Paolo; Milaneschi, Yuri; Lauretani, Fulvio; Luci, Michele; Cattabiani, Chiara; Peachey, Helen; Valenti, Giorgio; Cappola, Anne R; Longo, Dan L.; Ferrucci, Luigi

2016-01-01

Objective During the aging process in men testosterone (T) levels progressively fall and inflammatory biomarkers increase. Although a relationship between these two phenomena has been tested in previous clinical trials, there is inconclusive evidence about the potential anti-inflammatory action of T. Methods A total of 108 healthy men >65 years with serum T concentration <475 ng/dL were recruited by direct mailings to alumni of the University of Pennsylvania and Temple University, and randomized to 60-cm2 T or placebo patch for 36-months. Ninety-six subjects completed the trial. Information and stored serum specimens from this trial were used to test the hypothesis of T inhibitory effect on inflammation. 70 men (42 in the T group) who had banked specimens available for assays of T, C-reactive protein (CRP), Tumor necrosis factor (TNF)-alpha, soluble TNF-alpha receptor-1 (TNFR1), interleukin-6 (IL-6) and soluble IL-6 receptors (sIL6r and sgp130) at multiple time points, were evaluated. Results The mean age ± SD at baseline was 71.8 ± 4.9 years. Testosterone replacement therapy for 36 months did not induce a significant decrease in inflammatory markers. A trend toward a significant increase was observed in the placebo group for TNF-alpha (p=0.03) and sgp130 (p=0.01). Significant differences, in estimated means of TNFR1 (but not of other inflammatory markers), with lower levels in T group, were observed at 36 month-time point. In T-treated subjects we found an almost significant treatment-time interaction term TNFR1 (p=0.02) independent of total body fat content assessed by DXA. No serious adverse effect was observed. Conclusions Transdermal T treatment of older men for 36 months is not associated with significant changes in inflammatory markers. PMID:25100359

Effects of transdermal testosterone treatment on inflammatory markers in elderly males.

PubMed

Maggio, Marcello; Snyder, Peter J; De Vita, Francesca; Ceda, Gian Paolo; Milaneschi, Yuri; Lauretani, Fulvio; Luci, Michele; Cattabiani, Chiara; Peachey, Helen; Valenti, Giorgio; Cappola, Anne R; Longo, Dan L; Ferrucci, Luigi

2014-11-01

During the male aging process, testosterone (T) levels progressively fall and inflammatory biomarkers increase. Although a relationship between these 2 phenomena has been tested in previous clinical trials, there is inconclusive evidence about the potential anti-inflammatory action of T. A total of 108 healthy males >65 years with serum T concentration <475 ng/dL were recruited by direct mailings to alumni of the University of Pennsylvania and Temple University and randomized to 60-cm2 T or a placebo patch for 36 months. Ninety-six subjects completed the trial. Information and stored serum specimens from this trial were used to test the hypothesis of the inhibitory effect of T on inflammation. We evaluated 70 males (42 in the T group) who had banked specimens from multiple time points available for assays of T, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, soluble TNF-α receptor-1 (TNFR1), interleukin-6 (IL-6), and soluble IL-6 receptors (sIL6r and sgp130). The mean age ± SD at baseline was 71.8 ± 4.9 years. Testosterone replacement therapy for 36 months did not induce significant decreases in inflammatory markers. A trend toward a significant increase was observed in the placebo group for TNF-α (P = .03) and sgp130 (P = .01). Significant differences in estimated means of TNFR1 (but not other inflammatory markers), with lower levels in the T group, were observed at the 36-month time point. In T-treated subjects we found an almost significant treatment x time interaction term TNFR1 (P = .02) independent of total body fat content as assessed by dual energy X-ray absorptiometry (DXA). No serious adverse effect was observed. Transdermal T treatment of older males for 36 months is not associated with significant changes in inflammatory markers.

The addition of a tension night splint to a structured home rehabilitation programme in patients with chronic plantar fasciitis does not lead to significant additional benefits in either pain, function or flexibility: a single-blinded randomised controlled trial

PubMed Central

2017-01-01

Objective To identify any improvements in pain or function in patients with chronic plantar fasciitis following the use of a tension night splint (TNS). Methods Single-blinded randomised controlled trial, with participants split evenly between intervention group (TNS + home exercise programme/HEP) and control group (HEP only). Follow-up at 3 months, with interim data at 6 weeks. Results 40 patients recruited. Mean age 52.1 years, 33% male, mean body mass index 30.8 kg/m2, mean duration of symptoms of 25 months. Improvement in self-reported ‘average pain' in the intervention group from 6.8/10 at baseline to 5.6/10 at 6 weeks, and 5.3/10 at 3 months (both clinically and statistically significant at both time points), compared with control group of 7.1/10 at baseline to 6.2/10 at 6 weeks and 5.6/10 at 3 months (significant only at 3 months). Improvements in self-reported ‘worst pain', ‘pain walking' and ‘pain first thing in the morning' in both groups at all time periods. Improvements were seen in revised Foot Function Index at all time points in both groups, but limited changes seen in flexibility and no significant changes in anxiety or depression Hospital Anxiety and Depression Scale domains or sleep quality in either group. However, no differences were seen between the outcomes seen in the two groups for the majority of the measures studied. Conclusions Improvements in pain and some functional measures seen in both groups, with few, if any, differences seen in outcomes between the intervention group compared with the control group. However, ongoing pain symptoms were reported in both groups, suggesting that ‘help' rather than ‘cure' was obtained for the majority. There is a possibility of earlier benefit seen in the intervention group compared with the control group, but data are unclear and further work may be needed. Trial registration number ClinicalTrials.gov: NCT02546115; results. PMID:29259809

A 12-month phase 3 study of pasireotide in Cushing's disease.

PubMed

Colao, Annamaria; Petersenn, Stephan; Newell-Price, John; Findling, James W; Gu, Feng; Maldonado, Mario; Schoenherr, Ulrike; Mills, David; Salgado, Luiz Roberto; Biller, Beverly M K

2012-03-08

Cushing's disease is associated with high morbidity and mortality. Pasireotide, a potential therapy, has a unique, broad somatostatin-receptor-binding profile, with high binding affinity for somatostatin-receptor subtype 5. In this double-blind, phase 3 study, we randomly assigned 162 adults with Cushing's disease and a urinary free cortisol level of at least 1.5 times the upper limit of the normal range to receive subcutaneous pasireotide at a dose of 600 μg (82 patients) or 900 μg (80 patients) twice daily. Patients with urinary free cortisol not exceeding 2 times the upper limit of the normal range and not exceeding the baseline level at month 3 continued to receive their randomly assigned dose; all others received an additional 300 μg twice daily. The primary end point was a urinary free cortisol level at or below the upper limit of the normal range at month 6 without an increased dose. Open-label treatment continued through month 12. Twelve of the 82 patients in the 600-μg group and 21 of the 80 patients in the 900-μg group met the primary end point. The median urinary free cortisol level decreased by approximately 50% by month 2 and remained stable in both groups. A normal urinary free cortisol level was achieved more frequently in patients with baseline levels not exceeding 5 times the upper limit of the normal range than in patients with higher baseline levels. Serum and salivary cortisol and plasma corticotropin levels decreased, and clinical signs and symptoms of Cushing's disease diminished. Pasireotide was associated with hyperglycemia-related adverse events in 118 of 162 patients; other adverse events were similar to those associated with other somatostatin analogues. Despite declines in cortisol levels, blood glucose and glycated hemoglobin levels increased soon after treatment initiation and then stabilized; treatment with a glucose-lowering medication was initiated in 74 of 162 patients. The significant decrease in cortisol levels in patients with Cushing's disease who received pasireotide supports its potential use as a targeted treatment for corticotropin-secreting pituitary adenomas. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT00434148.).

Arbovirus models to provide practical management tools for mosquito control and disease prevention in the Northern Territory, Australia.

PubMed

Jacups, Susan P; Whelan, Peter I; Harley, David

2011-03-01

Ross River virus (RRV) causes the most common human arbovirus disease in Australia. Although the disease is nonfatal, the associated arthritis and postinfection fatigue can be debilitating for many months, impacting on workforce participation. We sought to create an early-warning system to notify of approaching RRV disease outbreak conditions for major townships in the Northern Territory. By applying a logistic regression model to meteorologic factors, including rainfall, a postestimation analysis of sensitivity and specificity can create rainfall cut-points. These rainfall cut-points indicate the rainfall level above which previous epidemic conditions have occurred. Furthermore, rainfall cut-points indirectly adjust for vertebrate host data from the agile wallaby (Macropus agilis) as the life cycle of the agile wallaby is intricately meshed with the wet season. Once generated, cut-points can thus be used prospectively to allow timely implementation of larval survey and control measures and public health warnings to preemptively reduce RRV disease incidence. Cut-points are location specific and have the capacity to replace previously used models, which require data management and input, and rarely provide timely notification for vector control requirements and public health warnings. These methods can be adapted for use elsewhere.

From Death Metal to R&B? Consistency of Music Preferences among Dutch Adolescents and Young Adults

ERIC Educational Resources Information Center

Mulder, Juul; Ter Bogt, Tom F. M.; Raaijmakers, Quinten A. W.; Gabhainn, Saoirse Nic; Sikkema, Paul

2010-01-01

The structure of music preferences has been investigated extensively. However, development of music preferences in terms of consistency of music taste is as yet understudied. In this study, intra-individual consistency of music taste was assessed among Dutch adolescents and young adults over three points in time in a 21-month period. An…

Physical Activity on Medical Prescription: A Qualitative Study of Factors Influencing Take-Up and Adherence in Chronically Ill Patients

ERIC Educational Resources Information Center

Gasparini, William; Knobé, Sandrine; Didierjean, Romaine

2015-01-01

Objective: This study sought to determine the effects of an innovative public health programme offering physical and sports activities on medical prescription to chronically ill patients. Method: Semi-structured interviews were conducted with programme participants at two time points: at the start of their activity (n?=?33) and 3?months after the…

Validity of body mass index as a measurement of adiposity in infancy

USDA-ARS?s Scientific Manuscript database

To assess the validity of body mass index (BMI) and age- and sex-standardized BMI z-score (BMIZ) as surrogates for adiposity (body fat percentage [BF%], fat mass, and fat mass index [kg/m2]) at 3 time points in infancy (1, 4, and 7 months) and to assess the extent to which the change in BMIZ represe...

The Relationship between Parenting Stress and Behavior Problems of Children with Autistic Spectrum Disorders

ERIC Educational Resources Information Center

Osborne, Lisa A.; Reed, Phil

2009-01-01

Two 9- to 10-month-Iong studies (N = 137) examined the interaction between parenting stress and behavior problems in children with autistic spectrum disorders (ASDs). Study 1 focused on very young children, and Study 2 employed a wider range of child ages; both studies assessed these factors at 2 points in time. The researchers noted a strong…

Value-Added Predictors of Expressive and Receptive Language Growth in Initially Nonverbal Preschoolers with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Yoder, Paul; Watson, Linda R.; Lambert, Warren

2015-01-01

Eighty-seven preschoolers with autism spectrum disorders who were initially nonverbal (under 6 words in language sample and under 21 parent-reported words said) were assessed at five time points over 16 months. Statistical models that accounted for the intercorrelation among nine theoretically- and empirically-motivated predictors, as well as two…

Child and Parent Report of Parenting as Predictors of Substance Use and Suspensions from School

ERIC Educational Resources Information Center

Fleming, Charles B.; Mason, W. Alex; Thompson, Ronald W.; Haggerty, Kevin P.; Gross, Thomas J.

2016-01-01

This study examined how child and parent reports of parenting were related to early adolescent substance use and school suspensions. Data were from two time points 6 months apart on 321 families with an eighth-grade student attending one of five schools in the Pacific Northwest. Child- and parent-report measures of family management practices were…

The Changing Role of Mothers' Verbal and Nonverbal Behavior in Children's Language Acquisition

ERIC Educational Resources Information Center

Poulain, Tanja; Brauer, Jens

2018-01-01

This study explores the developmental change of mother-child interactions in order to investigate which aspects of maternal behavior affect children's speech production. To this end, the interactions between 79 German-speaking mothers and their two- or five-year-old children were observed at two time points (12 months apart) and in two interactive…

The Incidence of Posttraumatic Stress Disorder After Floods: A Meta-Analysis.

PubMed

Chen, Long; Liu, Aizhong

2015-06-01

This study analyzes the incidence of posttraumatic stress disorder (PTSD) among flood victims, between different flood intensities, and between different time points after a flood. A search of several electronic literature databases was conducted to collect data on the incidence of PTSD after a flood. Loney criteria for research quality were used to evaluate the quality of selected search results. The combined incidence of PTSD was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted on different trauma intensities and different time points after a flood. Sensitivity analysis was performed to evaluate the impact of research quality. Fourteen articles were included in this meta-analysis, including a total of 40 600 flood victims; 3862 victims were diagnosed with PTSD. The combined incidence of PTSD was 15.74%. The subgroup analyses showed that the incidence of PTSD in victims who experienced severe and moderate flood intensity was higher than that in victims who experienced mild flood intensity. The incidence of PTSD was lower at 6 or more months after a flood (11.45%) than within 6 months (16.01%) of a flood. In conclusion, the incidence of PTSD among floods of different trauma intensities was statistically significant.