Patients were included from @ HD centers .


Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan , @mg daily .


Target systolic blood pressure ( BP ) was @mm Hg .


Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume .


Secondary outcomes were change in albuminuria , renin-angiotensin II-aldosterone hormone plasma levels , and time to anuria .


Of @ patients randomly assigned ( @ patients in each group ) , @ completed @ year of treatment .


The placebo and irbesartan groups were comparable at baseline in terms of sex balance ( @ vs @ men ) , mean age ( @ vs @ years ) , median HD vintage ( @ vs @ days ) , mean HD time ( @ vs @h/wk ) , median urine volume ( @ vs @ L/d ) , and mean GFR ( @ vs @ mL/min/@ @ m ( @ ) ) .


The target BP level was reached in both groups and BP did not differ significantly between groups over time .


Adverse-event rates were similar .


GFR declined by a mean of @ ( @ % CI , @-@ @ ) and @ ( @ % CI , @-@ @ ) mL/min/@ @ m ( @ ) per year in the placebo and irbesartan groups , respectively .


Mean difference ( baseline values minus value at @ months ) between groups was-@ @ ( @ % CI,-@ @ to @ ) .


In each group , @ patients became anuric .


GFR decline rates were lower than expected , reducing the power .


At equal BP levels , we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during @ year of treatment in HD patients .


Irbesartan treatment was used safely in the studied population .


Short interpregnancy intervals are associated with adverse perinatal outcomes .


Increased postpartum use of long-acting reversible contraception ( LARC ) could reduce short interpregnancy intervals .


Therefore , the primary objective of our study was to evaluate if a postpartum educational script about LARC ( LARC script ) could increase postpartum LARC utilization at the @-week postpartum visit .


We completed a randomized controlled trial ( @:@ ) of @ postpartum women in Raleigh , North Carolina .


Women were recruited from the postpartum unit and randomized to receive ( intervention ) or not receive ( control ) the LARC script prior to hospital discharge .


We conducted follow-up phone interviews to assess LARC use after their @-week postpartum visit .


We used Pearson 's chi-squared test to compare LARC use between arms .


Between May @ and January @ , @ women were randomized to each arm .


Three hundred sixty-nine women ( @ % ) in each arm were successfully contacted after their @-week postpartum visit .


LARC use was reported by @ % and @ % of women in the intervention and control arms , respectively ( p = @ ) .


The LARC script did not increase LARC utilization at the @-week postpartum visit .


Future studies should evaluate interventions that address both educational and systematic barriers to postpartum LARC uptake .


Use of a postpartum educational script focused on the intrauterine device and contraceptive implant did not increase their utilization after the @-week postpartum visit .


Future studies should evaluate interventions that address both educational and systematic barriers to postpartum contraceptive uptake .


Although depression is a risk and prognostic factor for cardiovascular disease ( CVD ) , depression trials involving cardiac patients have not observed the anticipated cardiovascular benefits .


To test our hypothesis that depression treatment delivered before clinical CVD onset reduces risk of CVD events , we conducted an @-year follow-up study of the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) randomized controlled trial .


Participants were @ primary care patients @ years or older with major depression or dysthymia who were randomized to a @-month collaborative care program involving antidepressants and psychotherapy ( @ without and @ with baseline CVD ) or usual care ( @ without and @ with baseline CVD ) .


Hard CVD events ( fatal/nonfatal ) were identified using electronic medical record and Medicare/Medicaid data .


A total of @ patients ( @ % ) had a hard CVD event .


As hypothesized , the treatment baseline CVD interaction was significant ( p = @ ) .


IMPACT patients without baseline CVD had a @ % lower risk of an event than did usual care patients ( @ % versus @ % , hazard ratio = @ , @ % confidence interval = @-@ @ ) .


The number needed to treat to prevent one event for @ years was @ .


The likelihood of an event did not differ between IMPACT and usual care patients with baseline CVD ( @ % versus @ % , hazard ratio = @ , @ % confidence interval , @-@ @ ) .


Collaborative depression care delivered before CVD onset halved the excess risk of hard CVD events among older , depressed patients .


Our findings raise the possibility that the IMPACT intervention could be used as a CVD primary prevention strategy .


Preeclampsia is a unique disease of pregnancy .


Delivery via caesarean section is the most important way of terminating the pregnancy and treating preeclampsia .


Perioperative fluid therapy is performed to maintain the circulatory volume and reduce tissue edema .


This study evaluated the effects of hypertonic sodium chloride hydroxyethyl starch @ ( HSH@ ) as perioperative fluid therapy for preeclampsia patients .


Forty preeclamptic women were randomly divided into two groups : the Ringer 's solution group and the HSH@ group .


Their ECG , HR , MAP , and SPO@ were monitored .


Their MVP and HR were recorded at five , eight , and ten minutes after anesthesia induction and at the end of the caesarean section .


The corresponding volume of infusion , blood loss , and urine output during the operation were also recorded .


Venous samples were collected before HSH@ infusion and @ min after infusion to measure the plasma concentrations of ET , TXB@ , @-keto-PGF@ , and ANP via a radioimmunoassay .


HSH@ infusion significantly decreased the plasma ET levels ( p < @ ) , significantly changed the plasma ANP and TXB@ levels ( p < @ ) , and significantly increased the plasma @-keto-PGF@ levels ( p < @ ) in the experimental group compared with those before infusion .


The plasma levels of ET , ANP , TXB@ , and @-keto-PGF@ did not significantly change in the control group .


Compared with T@ , MAP decreased significantly at T@ , T@ , T@ , and T@ within groups ( p < @ ) and between the two groups .


MAP significantly changed at T@ , T@ , T@ , and T@ ( p < @ ) .


HR did not significant change at T@ , T@ , T@ , T@ , and T@ within or between groups .


Volume of infusion and urine volume significantly differed between groups ( p < @ ) .


Low-dose HSH@ lowers the plasma levels of vasoconstrictor substances ( ET and TXB@ ) and increases the levels of vasodilator substances ( @-keto-PGF@ and ANP ) during preeclampsia .


It effectively maintains and stabilizes the circulating blood volume , increasing renal blood flow , which improves renal function and increases urine output .


To compare percutaneous nephrostomy ( PCN ) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria ( OCA ) and post-renal acute renal failure ( ARF ) due to bilateral ureteric calculi , to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage , decrease complications and facilitate the subsequent definitive clearance of stones , as this comparison is lacking in the literature .


A series of @ children aged @ years presenting with OCA and ARF due to bilateral ureteric calculi were included from March @ to September @ at Cairo University Pediatric Hospital in this randomised comparative study .


Patients with grade @-@ hydronephrosis , fever or pyonephrosis were excluded .


No patient had any contraindication for either method of drainage .


Stable patients ( or patients stabilised by dialysis ) were randomised ( non-blinded , block randomisation , sealed envelope method ) into PCN-tube or bilateral JJ-stent groups ( @ patients for each group ) .


Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance .


We used @-@ F JJ stents or @-@ F PCN tubes .


The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions .


Both groups were compared for operative and imaging times , complications , and the period required for a return to normal serum creatinine levels .


The secondary outcomes included the number of subsequent interventions needed for clearance of stones .


Additional analysis was done for factors affecting outcome within each group .


All presented patients completed the study with intention-to-treat analysis .


There was no significant difference between the PCN-tube and JJ-stent groups for the operative and imaging times , period for return to a normal creatinine level and failure of insertion .


There were significantly more complications in the PCN-tube group .


The stone size ( > @cm ) was the only factor affecting the rates of mucosal complications , operative time and failure of insertion in the JJ-stent group .


The degree of hydronephrosis significantly affected the operative time for PCN-tube insertion .


Grade @ hydronephrosis was associated with all cases of insertion failure in the PCN-tube group .


The total number of subsequent interventions needed to clear stones was significantly higher in the PCN-tube group , especially in patients with bilateral stones destined for chemolytic dissolution ( alkalinisation ) or extracorporeal shockwave lithotripsy ( ESWL ) .


We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL , as this will lower the total number of subsequent interventions needed to clear the stones .


This is also true for stones destined for ureteroscopy ( URS ) , as JJ-stent insertion will facilitate subsequent URS due to previous ureteric stenting .


Mild hydronephrosis will prolong the operative time for PCN-tube insertion and may increase the incidence of insertion failure .


We recommend the use of PCN tube if the stone size is > @cm , as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure .


Hamstring strain is a common injury in sprinters and jumpers , and therefore time to return to sport and secondary prevention become of particular concern .


To compare the effectiveness of two rehabilitation protocols after acute hamstring injury in Swedish elite sprinters and jumpers by evaluating time needed to return to full participation in the training process .


Prospective randomised comparison of two rehabilitation protocols .


Fifty-six Swedish elite sprinters and jumpers with acute hamstring injury , verified by MRI , were randomly assigned to one of two rehabilitation protocols .


Twenty-eight athletes were assigned to a protocol emphasising lengthening exercises , L-protocol , and @ athletes to a protocol consisting of conventional exercises , C-protocol .


The outcome measure was the number of days to return to full training .


Re-injuries were registered during a period of @ months after return .


Time to return was significantly shorter for the athletes in the L-protocol , mean @ days ( @SD@ , range @-@ days ) , compared with the C-protocol , mean @ days ( @SD@ , range @-@ days ) .


Irrespective of protocol , hamstring injuries where the proximal free tendon was involved took a significantly longer time to return than injuries that did not involve the free tendon , L-protocol : mean @ vs @ days and C-protocol : mean @ vs @ days , respectively .


Two reinjuries were registered , both in the C-protocol .


A rehabilitation protocol emphasising lengthening type of exercises is more effective than a protocol containing conventional exercises in promoting time to return in Swedish elite sprinters and jumpers .


To evaluate the efficacy of autologous serum ( AS ) eye drops for the symptomatic relief of severe dry eye syndrome ( DES ) , as compared to conventional preservative-free artificial tears ( PFAT ) .


This prospective double-blind randomized crossover study used the Ocular Surface Disease Index ( OSDI ) , tear film break-up time ( TBUT ) , Schirmer 's Test , and OXFORD Scale at baseline and after each of two @-month treatment periods to measure the effect of @ % diluted AS eye drops vs. PFAT in @ consecutive severe DES patients that were refractory to conventional treatment .


The study included @ ( @ female and two male ) severe DES patients ( @ eyes ) .


Significantly higher TBUT ( P < @ , Wilcoxon signed-rank test ) and a greater decrease in OSDI score ( @ % decrease in the AS treatment group vs. @ % decrease in the PFAT treatment group ) ( P < @ , Student 's paired samples t-test ) were observed in the AS treatment group after @ month of treatment .


There was n't a significant difference in Schirmer 's test and OXFORD conjunctival and corneal vital dying grading scores between the two treatment groups after @ month of treatment ( P > @ -LSB- Mann-Whitney U test -RSB- ) .


AS eye drops were more effective than conventional eye drops for improving tear film stability and subjective comfort in patients with severe DES .


The maximum plasma concentration ( Cmax ) of oxymorphone extended release ( ER ) @mg and @mg is approximately @ % higher in fed than in fasted subjects , with most of the difference in area-under-the-curve ( AUC ) occurring in the first @ hours post-dose .


Hence , the US FDA recommends in the approved labeling that oxymorphone ER is taken at least @ hour before or @ hours after eating .


In order to determine the potential impact on cognitive performance of the increased absorption of oxymorphone ER , fed versus fasting , we conducted a randomized , rater-blinded , crossover study in @ opioid-tolerant subjects , using tests from the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) .


The subjects randomly received @mg oxymorphone ER after a high-fat meal of approximately @,@ kCal or after fasting for @-@ hours , and were tested @ hour and @ hours post-dose .


The CANTAB tests , Spatial Recognition Memory ( SRM ) and Spatial Working Memory ( SWM ) , showed no statistically significant differences between the fed and fasting conditions .


However , sustained attention , as measured by the Rapid Visual Information Processing ( RVP ) CANTAB test , showed a statistically significant interaction of fed versus fasting and post-dose time of testing ( F -LSB- @,@ -RSB- = @ , P = @ ) , suggesting that @mg oxymorphone ER after a high-fat meal versus fasting mitigates the learning effect in this particular cognition domain from @ hour to @ hours post-dose .


Oxymorphone @mg ER affected cognitive performance similarly within @ hours post-dose , whether given on an empty stomach or after a high-fat meal , suggesting that the effect of food on plasma concentration may not be relevant in the medication 's impact on cognition .


Supplementation of vitamin A in children aged @-@ months improves child survival and is implemented as global policy .


Studies of the efficacy of supplementation of infants in the neonatal period have inconsistent results .


We aimed to assess the efficacy of oral supplementation with vitamin A given to infants in the first @ days of life to reduce mortality between supplementation and @ days ( @ months ) .


We did an individually randomised , double-blind , placebo-controlled trial of infants born in the Morogoro and Dar es Salaam regions of Tanzania .


Women were identified during antenatal clinic visits or in the labour wards of public health facilities in Dar es Salaam .


In Kilombero , Ulanga , and Kilosa districts , women were seen at home as part of the health and demographic surveillance system .


Newborn infants were eligible for randomisation if they were able to feed orally and if the family intended to stay in the study area for at least @ months .


We randomly assigned infants to receive one dose of @,@ IU of vitamin A or placebo in the first @ days after birth .


Infants were randomly assigned in blocks of @ , and investigators , participants ' families , and data analysis teams were masked to treatment assignment .


We assessed infants on day @ and day @ after dosing , as well as at @ , @ , @ , and @ months after birth .


The primary endpoint was mortality at @ months , assessed by field interviews .


The primary analysis included only children who were not lost to follow-up .


This trial is registered with the Australian New Zealand Clinical Trials Registry ( ANZCTR ) , number ACTRN@ .


Between Aug @ , @ , and March @ , @ , @,@ newborn babies were randomly assigned to receive vitamin A ( n = @,@ ) or placebo ( n = @,@ ; @,@ and @,@ included in analysis of mortality at @ months , respectively ) .


We did not find any evidence for a beneficial effect of vitamin A supplementation on mortality in infants at @ months ( @ deaths per @ livebirths in vitamin A vs @ deaths per @ livebirths in placebo group ; risk ratio @ , @ % CI @-@ ; p = @ ) .


There was no evidence of a differential effect for vitamin A supplementation on mortality by sex ; risk ratio for mortality at @ months for boys was @ ( @-@ ) and for girls was @ ( @-@ ) .


There was also no evidence of adverse effects of supplementation within @ days of dosing .


Neonatal vitamin A supplementation did not result in any immediate adverse events , but had no beneficial effect on survival in infants in Tanzania .


These results strengthen the evidence against a global policy recommendation for neonatal vitamin A supplementation .


To estimate the effectiveness of different strategies involving delayed antibiotic prescription for acute respiratory tract infections .


Open , pragmatic , parallel group , factorial , randomised controlled trial .


Primary care in the United Kingdom .


@ patients aged @ years and over with acute respiratory tract infection , recruited between @ March @ and @ March @ by @ health professionals in @ practices .


Patients judged not to need immediate antibiotics were randomised to undergo four strategies of delayed prescription : recontact for a prescription , post-dated prescription , collection of the prescription , and be given the prescription ( patient led ) .


During the trial , a strategy of no antibiotic prescription was added as another randomised comparison .


Analysis was intention to treat .


Mean symptom severity ( @-@ scale ) at days @-@ ( primary outcome ) , antibiotic use , and patients ' beliefs in the effectiveness of antibiotic use .


Secondary analysis included comparison with immediate use of antibiotics .


Mean symptom severity had minimal differences between the strategies involving no prescription and delayed prescription ( recontact , post-date , collection , patient led ; @ , @ , @ , @ , @ , respectively ; likelihood ratio test ( @ ) @ , P = @ ) .


Duration of symptoms rated moderately bad or worse also did not differ between no prescription and delayed prescription strategies combined ( median @ days v @ days ; @ , P = @ ) .


There were modest and non-significant differences in patients very satisfied with the consultation between the randomised groups ( @ % , @ % , @ % , @ % , @ % , respectively ; likelihood ratio test ( @ ) @ , P = @ ) , belief in antibiotics ( @ % , @ % , @ % , @ % , @ % ; @ , P = @ ) , or antibiotic use ( @ % , @ % , @ % , @ % , @ % ; @ , P = @ ) .


By contrast , most patients given immediate antibiotics used antibiotics ( @ % ) and strongly believed in them ( @ % ) , but with no benefit for symptom severity ( score @ ) or duration ( median @ days ) .


Strategies of no prescription or delayed antibiotic prescription result in fewer than @ % of patients using antibiotics , and are associated with less strong beliefs in antibiotics , and similar symptomatic outcomes to immediate prescription .


If clear advice is given to patients , there is probably little to choose between the different strategies of delayed prescription .


To our knowledge , this is the first study to assess the potential to pharmacologically improve auditory function in adults with age-related sensorineural hearing loss .


To explore the potential for the - amino-@-hydroxy-@-methyl-@-isoxazolepropionic acid potentiator mechanism to affect auditory function in individuals with mild to moderate age-related sensorineural hearing loss .


A randomized , double-blind , placebo-controlled , single-dose , @-way crossover study was conducted in @ academic ear , nose , and throat clinics and @ private clinical research centers between December @ , @ , and February @ , @ .


Participants were @ - to @-year-old men and women of nonchildbearing potential with mild to moderate sensorineural hearing loss .


Three single doses of PF-@ , an - amino-@-hydroxy-@-methyl-@-isoxazolepropionic acid glutamate-positive allosteric modulator , and placebo .


Pure-tone average , speech discrimination score , and speech in noise testing change from baseline at @ and @ hours after a single dose of PF-@ .


The treatment was safe and well tolerated .


The estimates for the primary end point change from baseline in pure-tone average compared with placebo at @ hour were -@ ( @ % CI , -@ to @ ) and @ ( @ % CI , -@ to @ ) for @ and @ mg , respectively .


At @ hours the estimates were -@ ( @ % CI , -@ to @ ) and -@ ( @ % CI , -@ to @ ) for @ and @ mg , respectively .


No significant change from baseline was demonstrated compared with placebo in the primary or secondary study end points at @ or @ hours after receiving treatment .


To our knowledge , this clinical trial is the first study of a pharmacologic treatment for age-related sensorineural hearing loss and provides information with regard to study design , end points , variability , data characteristics , and operational feasibility to guide the design of future hearing loss trials .


Kendall suggests testing the rotator cuff muscles in their maximally shortened position , since one-joint muscles are thought to be strongest .


We found little evidence to support this concept .


The purpose of this study was to determine if the shoulder internal rotator ( IR ) and external rotator ( ER ) muscles are strongest when placed in their shortened length position .


Fifty-three subjects participated .


Glenohumeral joint internal rotation and external rotation motion was measured .


Muscle strength was then tested using a hand-held dynamometer in four positions : ( @ ) end-range ER ; ( @ ) neutral @ ; ( @ ) glenohumeral joint mid-range and ( @ ) end-range IR .


Data were analyzed using two repeated measures ANOVA 's .


The results suggest that rotator muscle strength is dependent on muscle length .


IR strength was weakest at end-range IR in its shortest length ; ER muscle strength was weakest at end-range ER in its shortest length .


Muscle strength of the IR or ER was not significantly different when comparing neutral @ to the mid-range position and at their most lengthened position .


The IR and ER muscles were found to be weakest when placed in a position of shortest muscle length , while the neutral @ and mid-range positions were the strongest positions .


To compare the anesthetic effectiveness of topical proparacaine drops , subconjunctival lidocaine , and @ % lidocaine gel .


Ninety-two patients undergoing intravitreal injections were randomized to @ of @ groups : proparacaine @ % drops ( Group Drops ) , proparacaine @ % drops plus subconjunctival lidocaine ( Group SC ) , or @ % lidocaine gel ( Group Gel ) .


Patients were asked to score their pain experience using a visual analog scale of @ to @ immediately following the injections and @ min , @ h , @ h , and @ h after the injections .


Patients also graded the overall injection experience as Excellent , Very Good , Fair , Poor , or Awful .


The physician evaluated the patients ' eye movement during intravitreal injection on @ levels : ( @ ) none or minimal , ( @ ) not compromising the injection , and ( @ ) compromising the injection .


The patients in Group Drops had the worst mean pain scores during the injection and @ min after , with the highest occurrence of movements compromising the procedure ( Grade @ ; @ % ) .


The patients in Group SC had a higher percentage of good experiences ( @ % ) but a higher incidence of chemosis ( @ % ) .


The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis ( @ % ) .


There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma .


Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections .


Although @ % lidocaine gel produced a good overall experience for the patients , the incidence of keratitis was very high ( @ % ) .


Therefore , we do not recommend @ % lidocaine gel as the first anesthetic choice for intravitreal injections .


There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections .


Oral flora , blood-borne pathogens , and bacterial contamination pose a direct risk of infection to patients and health care workers .


We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of @ sets of gloves , with the outer set removed immediately after endotracheal intubation , may reduce this risk .


Forty-one anesthesiology residents ( PGY @-@ ) were enrolled in a study consisting of individual or group simulation sessions .


On entry to the simulated operating room , the residents were asked to perform an anesthetic induction and tracheal intubation timed to approximately @ minutes ; they were unaware of the study design .


Of the @ simulation sessions , @ were conducted with the intubating resident wearing single gloves , and @ with the intubating resident using double gloves with the outer pair removed after verified intubation .


Before the start of the scenario , we coated the lips and inside of the mouth of the mannequin with a fluorescent marking gel as a surrogate pathogen .


After the simulation , an observer examined @ different sites using a handheld ultraviolet light in the operating room to determine the transfer of surrogate pathogens to the patient and the patient 's environment .


Residents who wore double gloves were instructed by a confederate nurse to remove the outer set immediately after completion of the intubation .


Forty sites of potential intraoperative pathogen spread were identified and assigned a score .


The difference in the rate of contamination between anesthesiology residents who wore single gloves versus those with double gloves was clinically and statistically significant .


The number of sites that were contaminated in the operating room when the intubating resident wore single gloves was @ @ ( mean SE ) ; the number of contaminated sites when residents wore double gloves was @ @ ( P < @ ) .


The results of this study suggest that when an anesthesiologist wears @ sets of gloves during laryngoscopy and intubation and then removes the outer set immediately after intubation , the contamination of the intraoperative environment is dramatically reduced .


Little is known about thermoregulation of the newborn while bonding on the mother 's chest immediately after cesarean delivery .


Newborn hypothermia is associated with serious complications and should be avoided .


Therefore , we evaluated whether newborns develop hypothermia during intraoperative bonding while positioned on their mothers ' chests and investigated the effects of active cutaneous warming of the mothers and babies during a @-minute intraoperative bonding period .


We enrolled @ parturients scheduled for elective cesarean delivery under spinal anesthesia .


Mothers and their newborns were randomized to receive either passive insulation or forced-air skin-surface warming during the surgical procedure and bonding period .


The primary outcome was neonatal core temperature at the end of the bonding period .


Core temperatures of the newborns were measured with a rectal probe .


Body temperatures of the mothers were assessed by sublingual measurements .


Skin temperatures , thermal comfort of the mothers , and perioperative shivering were evaluated .


Without active warming from the beginning of the surgical procedure until the end of the bonding period , the mean ( SD ) neonatal core temperature decreased to @ ( @ ) C. Seventeen of @ ( @ % ) newborns became hypothermic ( defined as a core temperature below @ C ) .


Active skin-surface warming from the beginning of the surgical procedure until the end of the bonding period resulted in a neonatal core temperature of @ ( @ ) C and a decreased incidence of hypothermia ( @ of @ ( @ % ) newborns ( P < @ ) ) .


In addition , active warming increased the mean skin temperatures of the infants , maternal core and skin temperatures , maternal thermal comfort , and reduced perioperative shivering .


Active forced-air warming of mothers and newborns immediately after cesarean delivery reduces the incidence of infant and maternal hypothermia and maternal shivering , and increases maternal comfort .


Several feasibility studies show promising results of telehealthcare on health outcomes and health-related quality of life for patients suffering from chronic obstructive pulmonary disease , and some of these studies show that telehealthcare may even lower healthcare costs .


However , the only large-scale trial we have so far - the Whole System Demonstrator Project in England - has raised doubts about these results since it conclude that telehealthcare as a supplement to usual care is not likely to be cost-effective compared with usual care alone .


The present study is known as ` TeleCare North ' in Denmark .


It seeks to address these doubts by implementing a large-scale , pragmatic , cluster-randomized trial with nested economic evaluation .


The purpose of the study is to assess the effectiveness and the cost-effectiveness of a telehealth solution for patients suffering from chronic obstructive pulmonary disease compared to usual practice .


General practitioners will be responsible for recruiting eligible participants ( @,@ participants are expected ) for the trial in the geographical area of the North Denmark Region .


Twenty-six municipality districts in the region define the randomization clusters .


The primary outcomes are changes in health-related quality of life , and the incremental cost-effectiveness ratio measured from baseline to follow-up at @ months .


Secondary outcomes are changes in mortality and physiological indicators ( diastolic and systolic blood pressure , pulse , oxygen saturation , and weight ) .


There has been a call for large-scale clinical trials with rigorous cost-effectiveness assessments in telehealthcare research .


This study is meant to improve the international evidence base for the effectiveness and cost-effectiveness of telehealthcare to patients suffering from chronic obstructive pulmonary disease by implementing a large-scale pragmatic cluster-randomized clinical trial .


Choosing the right infusion set site can be an important factor in obtaining good glycemic control , especially in very young children .


In an attempt to identify the best infusion site , we performed a crossover study in six preschool children with type @ diabetes using insulin pump therapy .


We enrolled six patients @ years old ( range , @-@ years ) , with type @ diabetes for more than @ years , using insulin pump therapy for at least @ months .


For each patient , body mass index , glycated hemoglobin , and all data downloaded from the system were evaluated on two occasions : the first with the infusion set placed on the buttock and the second on the abdomen , each for @ days .


The order of infusion set placement was randomized .


Mean capillary blood glucose , mean continuous glycemia , mean area under the curve ( AUC ) using the trapezoidal rule for both > @mg/dL and < @mg/dL , insulin daily dose , carbohydrate/insulin ratio , total basal insulin , total bolus insulin , and mean amplitude of glucose excursions ( MAGE ) were evaluated .


Mean glycemic values , mean AUC > @mg/dL , and MAGE were significantly lower when the infusion set was placed on the buttock versus the abdomen ( @ mg/dL vs. @ mg/dL -LSB- P = @ -RSB- , @ % vs. @ % -LSB- P = @ -RSB- , and @ vs. @mg/dL -LSB- P < @ -RSB- , respectively ) , whereas mean AUC < @mg/dL was higher ( @ % vs. @ % -LSB- P < @ -RSB- ) .


The present findings suggest that preschool children with type @ diabetes using insulin pump therapy could benefit from inserting the infusion set in the buttock instead of the abdomen .


To evaluate risk factors for GI adverse events ( AEs ) within a phase III trial of bevacizumab in first-line ovarian cancer therapy .


Women with previously untreated advanced disease after surgery were randomly allocated to six cycles of platinum-taxane chemotherapy plus placebo cycles ( C ) @ to C@ ( R@ ) ; chemotherapy plus bevacizumab C@ to C@ plus placebo C@ to C@ ( R@ ) ; or chemotherapy plus bevacizumab C@ to C@ ( R@ ) .


Patients were evaluated for history or on-study development of potential risk factors for GI AEs defined as grade @ perforation , fistula , necrosis , or hemorrhage .


Of @,@ patients enrolled , @,@ ( @ % ) were evaluable , and @ % ( @ of @,@ ) experienced a GI AE : @ of @ ( @ % , R@ ) , @ of @ ( @ % , R@ ) , and @ of @ ( @ % , R@ ) .


Univariable analyses indicated that previous treatment of inflammatory bowel disease ( IBD ; P = @ ) and small bowel resection ( SBR ; P = @ ) or large bowel resection ( LBR ; P = @ ) at primary surgery were significantly associated with a GI AE .


The multivariable estimated relative odds of a GI AE were @ ( @ % CI , @ to @ ; P < @ ) for IBD ; @ ( @ % CI , @ to @ ; P = @ ) for LBR ; @ ( @ % CI , @ to @ ; P = @ ) for SBR ; and @ for bevacizumab exposure ( aggregated @ % CI , @ to @ ; P = @ ) .


History of treatment for IBD , and bowel resection at primary surgery , increase the odds of GI AEs in patients receiving first-line platinum-taxane chemotherapy for advanced ovarian cancer .


After accounting for these risk factors , concurrent bevacizumab doubles the odds of a GI AE , but is not appreciably increased by continuation beyond chemotherapy .


Compliance with immunosuppressive regimens may affect clinical outcomes in renal transplant recipients .


The aim of this study was to assess the safety and efficacy of standard-dose tacrolimus modified-release ( TAC-MR ) once daily versus tacrolimus ( TAC ) twice daily in stable renal transplant recipients .


Ninety-nine stable renal transplant recipients were randomized to receive standard-dose tacrolimus twice daily or standard-dose modified-release tacrolimus once daily on a @:@ ( mg : mg ) basis .


The primary end point was the incidence of adverse events ( AEs ) in both groups .


Secondary end points included biopsy-proven acute rejection , graft survival , patient survival , clinical indicators , and change in score of questionnaire .


The incidence of AEs was not different between the TAC and TAC-MR groups ( @ % vs @ % , P > @ ) .


There were no significant differences in mean calculated glomerular filtration rate , blood pressure , glycosylated hemoglobulin ( HbA@c ) , blood concentration of tacrolimus , and drug compliance .


The scores of all items in the @-item short form health survey ( SF-@ ) were not different between groups , except for vitality .


With respect to the subject questionnaire , there was no difference in question scores between the two treatment groups .


A regimen of TAC-MR once daily can be considered as an effective and safe alternative formulation of tacrolimus in stable renal transplant patients .


To evaluate the possible renal and hepatic toxicity of tepoxalin in dogs exposed to hypotension during isoflurane anesthesia .


Prospective , randomized experimental study .


Twenty adult mixed-breed dogs , weighing @ kg .


The animals received @mgkg ( -@ ) tepoxalin orally @hours before the anesthetic procedure ( PRE ; n = @ ) , or @minutes after anesthesia ( POST ; n = @ ) , along with a control group ( CON ; n = @ ) , which were only anesthetized .


The PRE and POST groups also received the same dose of tepoxalin for @days post-procedure .


All dogs were anesthetized with propofol and maintained with isoflurane and the end-tidal isoflurane ( Fe'Iso ) was increased until mean arterial pressure decreased to @-@mmHg .


These pressures were maintained for @minutes .


Heart rate , arterial pressures and Fe'Iso were recorded at @ , @ and every @minutes up to @minutes of hypotension .


Blood gases , pH , electrolytes and bleeding time were analyzed before and at @ and @minutes of hypotension .


Renal and hepatic changes were quantified by serum and urinary biochemistry and creatinine clearance .


Serum concentrations of alanine amino transferase ( ALT ) , alkaline phosphatase ( ALP ) and - glutamyl transferase ( GGT ) , blood urea nitrogen ( BUN ) and creatinine ( Cr ) , and urinary output , urinary Cr , Cr clearance , and GGT : Cr ratio remained stable throughout the evaluations .


During the anesthetic procedure there were no important variations in the physiological parameters .


No side effects were observed in any of the groups .


Tepoxalin did not cause significant effects on renal function or cause hepatic injury in healthy dogs exposed to hypotension with isoflurane , when administered pre - or postanesthetic and continued for five consecutive days .


An exploratory analysis of the German Off Pump Coronary Artery Bypass Grafting in Elderly Patients ( GOPCABE ) trial was performed to investigate the effect of off-pump coronary artery bypass grafting ( CABG ) on kidney function after the operation .


Data on kidney function were available from @,@ patients , representing @ % of the study population .


Preoperative kidney function was graded according to the glomerular filtration rate .


Acute kidney injury ( AKI ) within the first week after the operation was defined and classified according to the Acute Kidney Injury Network ( AKIN ) criteria .


The incidence and severity of AKI was compared between patients operated on on-pump or off-pump .


Impaired kidney function was seen in @ patients ( @ % ) , and @ patients had preexisting end-stage kidney disease .


AKI of any severity occurred in half of all patients undergoing CABG , with AKIN stage @ accounting for most of the cases .


The incidence and severity of AKI in patients undergoing on-pump vs off-pump CABG was AKIN stage @ : @ ( @ % ) vs @ ( @ % ) ; AKIN stage @ : @ ( @ % ) vs @ ( @ % ) ; and AKIN stage @ : @ ( @ % ) vs @ ( @ % ) , which did not differ significantly ( p = @ ) .


New renal replacement therapy was necessary in @ % ( on-pump ) and in @ % ( off-pump ) of all patients .


Stratification according to preoperative kidney function yielded comparable frequencies of AKI for on-pump and off-pump CABG .


AKI was common in elderly patients undergoing CABG , but deterioration of kidney function requiring renal replacement therapy was a rare event .


Off-pump CABG was not associated with decreased rates or reduced severity of AKI in elderly patients .


Obstructive sleep apnea ( OSA ) diagnosis using simplified methods such as portable sleep monitoring ( PM ) is only recommended in patients with a high pretest probability .


The aim is to determine the diagnostic efficacy , consequent therapeutic decision-making , and costs of OSA diagnosis using polysomnography ( PSG ) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms .


Randomized , blinded , crossover study of @ nights of PM ( @N-PM ) versus PSG .


The diagnostic efficacy was evaluated with receiver operating characteristic ( ROC ) curves .


Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians ( staff and residents ) using agreement level and kappa coefficient .


The costs of each diagnostic strategy were considered .


Fifty-six patients were selected .


Epworth Sleepiness Scale was @ ( @ ) points .


Bland-Altman plot for apnea-hypopnea index ( AHI ) showed good agreement .


ROC curves showed the best area under the curve in patients with PSG AHI @ -LSB- @ ( confidence interval = @-@ @ ) -RSB- .


For a PSG AHI @ , a PM AHI of @ would effectively exclude and confirm OSA diagnosis .


For a PSG AHI @ , a PM AHI @ would confirm and PM AHI < @ would exclude OSA .


The best agreement of therapeutic decisions was achieved by the sleep medicine specialists ( @ % ) .


The best cost-diagnostic efficacy was obtained by the @N-PM .


Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities .


Low high-density lipoprotein cholesterol ( HDL-C ) is a risk factor for coronary artery disease .


Investigating mechanisms underlying acquired severe HDL deficiency in noncritically ill patients ( `` disappearing HDL syndrome '' ) could provide new insights into HDL metabolism .


To determine the cause of low HDL-C in patients with severe acquired HDL deficiency .


Patients with intravascular large B-cell lymphoma ( n = @ ) , diffuse large B-cell lymphoma ( n = @ ) , and autoimmune lymphoproliferative syndrome ( n = @ ) presenting with markedly decreased HDL-C , low low-density lipoprotein cholesterol ( LDL-C ) , and elevated triglycerides were identified .


The abnormal lipoprotein profile returned to normal after therapy in all @ patients .


All patients were found to have markedly elevated serum interleukin-@ ( IL-@ ) levels that also normalized after therapy .


In a cohort of autoimmune lymphoproliferative syndrome patients ( n = @ ) , IL-@ showed a strong inverse correlation with HDL-C ( R ( @ ) = @ , P < @ ) .


A direct causal role for increased serum IL-@ in inducing the observed changes in lipoproteins was established in a randomized , placebo-controlled clinical trial of recombinant human IL-@ in psoriatic arthritis patients ( n = @ ) .


Within a week of initiating subcutaneous recombinant human IL-@ injections , HDL-C precipitously decreased to near-undetectable levels .


LDL-C also decreased by more than @ % ( P < @ ) and triglycerides increased by approximately @-fold ( P < @ ) .


All values returned to baseline after discontinuing IL-@ therapy .


Increased IL-@ causes severe HDL-C deficiency , low LDL-C , and elevated triglycerides .


IL-@ is thus a potent modulator of lipoprotein levels , a potential new biomarker for B-cell disorders , and a novel cause of disappearing HDL syndrome .


The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent ( DES ) outcomes according to diabetic status .


Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus ( DM ) .


Patient-level data from @ prospective randomized trials were pooled .


DES treatment outcomes in patients with versus without DM were analyzed in @ propensity score-matched groups further stratified according to lesion complexity ( American College of Cardiology and American Heart Association class A/B@ vs. B@/C ) .


Remaining baseline differences were adjusted for by multivariate analysis .


DM was present in @,@ of @,@ patients ( @ % ) .


DM was a predictor of @-year repeat revascularization ( target lesion revascularization : hazard ratio : @ ; @ % confidence interval : @ to @ ; target vessel revascularization : hazard ratio : @ ; @ % confidence interval : @ to @ ) and cardiac death or myocardial infarction ( hazard ratio : @ ; @ % confidence interval : @ to @ ) .


Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B@/C lesions ( @ % vs. @ % and @ % vs. @ % , respectively , p < @ for both ) , but not in patients with only type A/B@ lesions ( @ % vs. @ % , p = @ , and @ % vs. @ % , p = @ , respectively ) , with a significant interaction between DM and lesion type observed for both endpoints ( p = @ and p = @ , respectively ) .


No interaction was observed for death or myocardial infarction ( p = @ ) .


In the DES era , patients with DM remain at increased risk for cardiac death or myocardial infarction .


However , DM is a risk factor for repeat revascularization only in those patients with complex lesions ; patients with DM and noncomplex lesions have similar rates of @-year freedom from repeat revascularization as do patients without DM .


Data on the benefits of synbiotics in functional constipation are conflicting .


The aim of this study was to assess whether the administration of the synbiotic supplement Psyllogel Megafermenti ( ) normalized stool consistency and decreased intestinal transit time ( ITT ) in patients with severe functional constipation , based on its ability to impact on the gut microbiota .


We conducted a pilot randomized , double-blind , controlled trial .


After a @-week run-in period , patients from a tertiary care setting with severe functional constipation fulfilling the Rome III Diagnostic Criteria in the past year were randomly assigned to receive by mouth @ bags/day of Psyllogel Megafermenti ( ) ( Group A ) or @ g of maltodextrin twice daily ( Group B ) for @ weeks .


Primary endpoints were increase of bowel evacuations with normal stool consistency and volume , and ITT reduction .


Secondary endpoints included symptom improvement according to the Rome III Diagnostic Criteria , reduction of the Agachan-Wexner score and changes in gut microbiota composition .


Twenty-nine patients completed the study : @ were allocated to Group A and @ to Group B.


A statistically significant increase in stools with normal consistency was observed only in Group A ( p = @ ) , even when considering patients with normal stools @ % of time at baseline .


In Group A , a significant reduction in ITT was also found ( p = @ ) .


According to polymerase chain reaction-denaturing gradient gel electrophoresis profiling of stool samples , @ % of the patients treated with synbiotics harbored all the probiotic species of the study product .


An @-week treatment with Psyllogel Megafermenti ( ) improved the main clinical parameters of functional constipation in patients extremely homogeneous for disorder severity and underlying pathophysiology ( Eudract.ema.europa.eu , No. @-@-@ ) .


In orthodontics , adding restorative materials on occlusal or lingual surfaces is a common method to create a mini-biteplane to increase patients ' vertical dimension temporarily to facilitate several treatment procedures .


However , this method transmits excessive occlusal forces through the periodontal ligament and causes trauma .


In this prospective randomized clinical trial , we measured and compared quantitatively the volumes of root resorption after @ weeks of occlusal trauma .


Forty-eight maxillary and mandibular first premolars of @ patients ( @ girls , @ boys ) comprised the sample for this study .


One side of each patient was randomly selected as the control .


On the contralateral side , a light-cured glass ionomer cement ( Transbond Plus Light Cure Band Adhesive ; @M Unitek , Monrovia , Calif ) was bonded onto the occlusal surface of the mandibular first premolar so that the cement was in contact with the maxillary first premolar .


After @ weeks , both first premolars were extracted .


Each sample was imaged using a microcomputed tomography system ( @ ; SkyScan , Aartselaar , Belgium ) and analyzed with specially designed software for volumetric measurements of resorption craters .


Furthermore , pain was evaluated with a visual analog scale for @ days .


There were significant differences in the amounts of root resorption between the control and the experimentally traumatized teeth .


No significant difference among the buccal , lingual , mesial , and distal surfaces was found in either jaw .


Furthermore , no significant difference existed in the amount of root resorption among the cervical , middle , and apical thirds of both jaws .


There was no correlation between age , sex , volume of the root resorption craters , and pain .


Restorative buildups , used to increase the vertical dimension by @ mm for @ weeks , caused root resorption along the sides of the teeth during the active bite-increase period .


The effect profile of differing antihypertensive agents is well studied , but minimal data regarding the interaction between hemodynamic response and presenting blood pressure ( BP ) exist .


Achievement of target BP is less likely in patients with higher initial BPs .


This is a substudy of the multicenter safety and efficacy Evaluation of intravenous Cardene ( nicardipine ) and Labetalol Use in the Emergency department ( CLUE ) trial that randomized patients to Food and Drug Administration-recommended intravenous dosing of nicardipine or labetalol to reach a physician predefined systolic BP ( SBP ) and target range ( TR ) of @ mm Hg within @ minutes .


The proportion achieving TR was assessed as a function of initial SBP , and dichotomized comparisons were made using median SBP .


Likelihood of a final BP within TR was modeled using logistic regression with forced inclusion of initial BP as a categorical variable .


A total @ patients were enrolled ; @ ( @ % ) had an initial SBP greater than the median @ mm Hg .


The median SBP ( interquartile range ) of the high BP group was @ ( @-@ ) mm Hg vs the low BP group @ ( @-@ ) mm Hg ( P < @ ) .


No groupwise differences existed except that the high group had higher mean ( SD ) serum creatinine level at baseline ( @ -LSB- @ -RSB- vs @ -LSB- @ -RSB- , P = @ ) .


The proportion of patients achieving SBP within TR at @ minutes did not differ ( @ % -LSB- @ of @ -RSB- vs @ % -LSB- @ of @ -RSB- , P = @ ) .


Randomization to nicardipine ( odds ratio = @ ; @ % confidence interval , @-@ @ ) , but not initial SBP ( odds ratio = @ ; @ % confidence interval , @-@ @ ) , was associated with achievement of target SBP at @ minutes .


Initial SBP is not a predictor of the ability to achieve a prespecified target range SBP within @ minutes .


High-density lipoproteins ( HDLs ) from type @ diabetic patients are unable to counteract the inhibitory effect of oxidized low-density lipoproteins ( ox-LDLs ) on vasorelaxation .


We hypothesized that glitazones , which improve glycemic control and dyslipidemia , could correct this abnormality .


We compared the ability of HDL from controls ( n = @ ) and from type @ diabetic patients before and after @ months of treatment with either rosiglitazone ( n = @ ) or pioglitazone ( n = @ ) to counteract the inhibitory effect of ox-LDL on vasodilatation of rabbit aorta rings .


Rosiglitazone induced a decrease in hemoglobin A@c ( @ % @ % vs @ % @ % , P = @ ) and an increase in HDL cholesterol ( @ @ vs @ @ mmol/L , P = @ ) .


Pioglitazone induced a decrease in hemoglobin A@c ( @ % @ % vs @ % @ % , P = @ ) and serum triglycerides ( @ @ vs @ @ mmol/L , P = @ ) and an increase in HDL cholesterol ( @ @ vs @ @ mmol/L , P = @ ) .


The triglyceride content of HDL was unchanged by rosiglitazone and was decreased by @ % ( P = @ ) by pioglitazone .


HDL from controls counteracted the inhibitory effect of ox-LDL on vasodilatation ( maximal relaxation -LSB- Emax -RSB- = @ % @ % vs @ % @ % , P = @ ) , whereas HDL from type @ diabetic patients did not ( Emax = @ % @ % vs @ % @ % -LSB- P = @ -RSB- and @ % @ % vs @ % @ % -LSB- P = @ -RSB- for the rosiglitazone and pioglitazone group , respectively ) .


Rosiglitazone or pioglitazone did not improve Emax ( @ % @ % vs @ % @ % -LSB- P = @ -RSB- and @ % @ % vs @ % @ % -LSB- P = @ -RSB- , respectively ) .


Glitazones increased the concentration of HDL cholesterol without restoring the ability of HDL particles to protect the endothelium from oxidative stress-induced dysfunction , meaning that HDL remained dysfunctional with impaired antiatherogenic properties .


Osteonecrosis of the femoral head frequently leads to collapse of the necrotic portion and subsequent degenerative joint disease of the hip , which is the most common diagnosis leading to total hip arthroplasty in young adults .


Bisphosphonate therapy has been reported to potentially retard the collapse .


We conducted a two-year prospective , randomized , open-label , multicenter study to determine whether zoledronate prevents the collapse and reduces the need for total hip arthroplasty .


We randomly assigned patients who had Steinberg stage-I or II nontraumatic osteonecrosis of the femoral head with a necrotic area of @ % to either the zoledronate group or the control group .


Patients in the zoledronate group received @ mg of zoledronate intravenously per year for two years , while patients in the control group did not receive this medication .


The primary efficacy outcome was the survival rate in terms of the occurrence of collapse ( @ mm ) .


The patients were observed for a minimum of two years after enrollment .


A total of @ patients ( @ hips ) underwent randomization ; fifty-five patients were assigned to the zoledronate group and fifty-five , to the control group .


During the two-year follow-up , twenty-nine femoral heads in the zoledronate group and twenty-two in the control group collapsed ( p > @ ) .


Nineteen hips in the zoledronate group and twenty in the control group underwent total hip arthroplasty ( p > @ ) .


Zoledronate for Steinberg stage-I or II osteonecrosis of the femoral head , with a medium to large necrotic area , did not prevent the collapse of the femoral head or reduce the need for total hip arthroplasty .


Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence .


Exposure , trauma-focused cognitive therapy and eye-movement desensitisation and re-processing ( EMDR ) are effective treatments for posttraumatic stress disorder ( PTSD ) producing equivalent outcomes .


How might the field advance ?


One way is to base new treatments on PTSD maintenance mechanisms .


A treatment that does this , metacognitive therapy ( MCT ) , underwent preliminary controlled evaluation in this study .


Twenty participants aged @ to @ years with chronic PTSD were randomly allocated to either a total of @ sessions of MCT or a delayed treatment control .


Measures of PTSD , emotional symptoms , and underlying metacognitive variables were obtained at pretreatment and posttreatment .


Patients were followed-up at @ and @ months postintervention .


Statistically significant reductions in PTSD symptoms , depression , and anxiety at posttreatment were observed in the MCT group but not in the control group .


Changes were maintained over follow-up .


The average number of sessions delivered was @ .


Eighty percent of patients ( intention to treat ) met clinical significance criteria for recovery based on the IES .


Treatment was well tolerated with only one ( @ % ) dropout .


Changes in thought control strategy hypothesized to be involved in the maintenance of PTSD were found .


MCT appeared to be a brief treatment producing high recovery rates .


The data add to existing uncontrolled evaluations and provide strong justification for future evaluation of this treatment against existing evidence-based interventions .


Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices .


This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care ( MTFC ) in child public service systems in California and Ohio , including child welfare , juvenile justice , and mental health .


Fifty-one counties were assigned randomly to one of two different implementation strategies ( Community Development Teams ( CDT ) or independent county implementation strategy ( IND ) ) across four cohorts after being matched on county characteristics .


We compared these two strategies on implementation process , quality , and milestone achievements using the Stages of Implementation Completion ( SIC ) ( Implement Sci @ ( @ ) :@ -@ , @ ) .


A composite score for each county , combining the final implementation stage attained , the number of families served , and quality of implementation , was used as the primary outcome .


No significant difference between CDT and IND was found for the composite measure .


Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs ( i.e. , placed at least one family in MTFC ) .


For counties that did implement MTFC , those in the CDT condition served over twice as many youth during the study period as did IND. .


Of the counties that successfully achieved program start-up , those in the CDT condition completed the implementation process more thoroughly , as measured by the SIC .


We found no significant differences by implementation condition on the time it took for first placement , achieving competency , or number of stages completed .


This trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services .


This trial was successful from a design perspective in that no counties dropped out , even though this study took place during an economic recession .


We believe that this methodologic approach of measurement utilizing the SIC , which is comprised of the three dimensions of quality , quantity , and timing , is appropriate for a wide range of implementation and translational studies .


To evaluate the efficacy of ampicillin versus cefazolin as prophylactic antibiotics prior to cesarean delivery in Rwanda .


In a prospective , randomized , open-label , single-site study conducted between March and May @ , the effects of prophylactic ampicillin versus cefazolin were compared among women undergoing cesarean delivery at the Centre Hospitalier Universitaire de Kigali , Rwanda .


Postoperatively , participants were evaluated daily for infectious morbidity while in the hospital .


Follow-up was done by phone and by appointment at the hospital within @ weeks of delivery .


During the study period , there were @ total deliveries and @ cesarean deliveries ( @ % ) .


Overall , @ women were enrolled in the study and randomized to receive either ampicillin ( n = @ ) or cefazolin ( n = @ ) .


No women were lost to follow-up .


The overall infection rate was @ % ( @/@ ) .


The infection rate in the ampicillin group and the cefazolin group was @ % ( @/@ ) and @ % ( @/@ ) , respectively .


Implementing a universal protocol in Rwanda of prophylactic cefazolin prior to cesarean delivery might reduce postoperative febrile morbidity , use of postoperative antibiotics , and number of postoperative days in hospital .


To observe the effect of acupuncture of Neiguan ( PC @ ) , Sanyinjiao ( SP @ ) , etc. on plasma lysophosphatidic acid ( LPA ) level in patients with acute cerebral infarction ( ACI ) so as to study its mechanism underlying improvement of ACI .


A total of @ patients with ACI were randomly divided into four groups : medication ( Aspirin and Panax Notoginseng Saponins for improving blood circulation ) , acupuncture , Tongxinluo , and acupuncture + Tongxinluo groups , with @ cases being in each group .


Plasma LPA content was measured using biochemical method , and the therapeutic effects of the @ groups were assessed by neurologic deficit score which were evaluated using the modified standards of the @Th Session of Chinese National Cerebrovascular Conference issued in @ .


Following the treatment , plasma LPA levels and neurological deficit scores were significantly decreased in the medication , acupuncture , Tongxinluo and acupuncture + Tongxinluo groups in com - parison with pre-treatment in each group ( P < @ ) , and LPA level and neurological deficit score of the acupuncture + Tongxinluo group were significantly lower than those of the other three groups ( P < @ ) .


Of the four @ cases in the medication , acupuncture , Tongxinluo and acupuncture + Tongxinluo groups , @ , @ , @ and @ patients were basically cured , @ , @ , @ and @ experienced marked improvement in their symptoms , @ , @ , @ and @ were improved , @ , @ , @ and @ were invalid , @ , @ , @ and @ got worsened , with the effective rates ( basically cured + improvement ) being @ % , @ % , @ % and @ % , respectively .


The therapeutic effect of the acupuncture + Tongxinluo group was significantly superior to those of the other three groups ( P < @ ) .


Acupuncture can accelerate the recovery of neurological function and ameliorate clinical symptoms in ACI patients , which may be related to its effect in lowering plasma PLA .


The therapeutic effect of acupuncture + Tongxinluo is relatively better than simple acupuncture and simple medication .


Generalized Anxiety Disorder ( GAD ) , characterized by excessive and uncontrollable worry , has a negative impact on the health , well-being , and functioning of older adults .


Cognitive behavioral therapy has demonstrated efficacy in reducing anxiety and worry in older adults , but the generalizability of these findings to community-dwelling older adults is unknown .


The aim of the current study is to examine the efficacy of a cognitive-behavioral intervention delivered by telephone in reducing anxiety and worry in rural community-dwelling older adults with GAD .


We propose a randomized controlled trial comparing telephone-delivered cognitive behavioral therapy ( CBT-T ) with nondirective supportive therapy ( NST-T ) .


One hundred seventy six adults @ years and older diagnosed with GAD will be randomized to one of the two treatment conditions .


The primary outcomes are self-report worry and clinician-rated anxiety .


Secondary outcomes include depressive symptoms , sleep , quality of life , and functional status .


It is hypothesized that CBT-T will be superior to NST-T in reducing anxiety and worry among older adults with GAD .


Further , CBT-T is hypothesized to be superior to NST-T in reducing problems with depressive symptoms , sleep , functional status and quality of life .


If this program is successful , it could be implemented as a low-cost program to treat late-life anxiety , especially in rural areas or in circumstances where older adults may not have access to qualified mental health providers .


To evaluate the ultrasound ( US ) characteristics of peripheral nerves in chronic inflammatory demyelinating polyradiculoneuropathy ( CIDP ) and their correlations with electrodiagnostic ( EDX ) characteristics .


Nineteen patients with CIDP and @ healthy controls matched by age and body mass index were included in a blind case-control , observational study .


All patients underwent a neurologic examination ( including inflammatory neuropathy cause and treatment -LSB- INCAT -RSB- and Medical Research Council -LSB- MRC -RSB- sum score ) and an EDX study .


Each patient and each control underwent a US study of @ nerve segments , yielding a total number of @ segments scanned in each group .


US changes , characterized by an increased nerve cross-sectional area ( NCSA ) , were detected in @ % of the @ patient nerve segments .


Mean NCSA was higher in nerve segments of patients than in those of controls ( p < @ ) .


Nerve segments with abnormal US belonged to patients with longer disease duration , lower MRC sum score , higher INCAT score , and progressive disease form ( all p < @ ) .


All the aforementioned variables were independently associated with the occurrence of US changes .


Motor nerve conduction was significantly lower in nerve segments with increased NCSA than in those with normal NCSA ( p < @ ) .


NCSA in segments with prevalent myelin damage was higher than that in segments with prevalent axonal damage ( p = @ ) or in segments with normal EDX characteristics ( p < @ ) .


NCSA and motor nerve conduction velocity were inversely correlated in nerve segments with EDX evidence of myelin damage ( R = @ ; p < @ ) .


Conduction blocks were associated with increased NCSA ( p = @ ) .


US may , similar to MRI , have a supporting role in the diagnosis of CIDP .


US and EDX changes are correlated .


Vitamin D deficiency is associated with heart failure ( HF ) events , and in animal models vitamin D down-regulates renin-angiotensin-aldosterone system hormones .


Patients with New York Heart Association ( NYHA ) functional class II-IV HF and a @OH-D level @ ng/mL received @,@ IU vitamin D@ weekly ( n = @ ) or placebo ( n = @ ) for @ months .


Serum aldosterone , renin , echocardiography , and health status were determined at baseline and @ months .


Mean age of participants was @ @ years , @ % were women , @ % were African American , mean ejection fraction was @ @ % , @ % were in NYHA functional class III , and @ % were in class II .


The vitamin D group increased serum @OH-D ( @ @ to @ @ ng/mL ) and the placebo group did not ( @ @ to @ @ ng/mL ) .


Aldosterone decreased in the vitamin D group ( @ @ to @ @ ng/dL ) and not in the placebo group ( @ @ to @ @ ng/dL ; P = @ ) .


There was no difference between groups in renin , echocardiographic measures , or health status from baseline to @ months .


Modeling indicated that variables which predicted change in aldosterone included receiving vitamin D , increasing age , African American race , and lower glomerular filtration rate .


Vitamin D@ repletion decreases aldosterone in patients with HF and low serum vitamin D. Vitamin D may be an important adjunct to standard HF therapy .


Further study will assess if vitamin D provides long-term benefit for patients with HF .


The purposes of this study were to identify nocturnal patterns of heart rate ( HR ) in depressed and nondepressed patients after an acute myocardial infarction ( MI ) and to determine which patterns , if any , are associated with all-cause mortality or recurrent infarction .


Functional data analysis and model-based clustering methods were used to identify nocturnal HR patterns in @ depressed and @ nondepressed patients with a recent MI .


All-cause mortality and recurrent infarctions were ascertained over a median follow-up of @ months .


Three HR activity patterns were identified .


In the first , HR gradually declined during the nighttime and increased the next morning .


The second pattern was similar , but with a higher overall HR during the recording interval .


The third showed almost no decrease in HR at night ( ie , `` nondipping '' ) .


All-cause mortality was higher among patients with pattern @ than pattern @ ( P = @ ) , and the combined end point of recurrent MI or all-cause mortality was higher in pattern @ than pattern @ ( P = @ ) .


Patterns @ and @ were more common in the depressed than in the nondepressed patients .


The nondipping nocturnal HR independently predicts all-cause mortality and recurrent MI .


Future studies should examine the underlying causes of nondipping nocturnal HR and its association with depression and investigate the effects of treatment on survival .


Endothelial dysfunction is the first , although reversible , sign of atherosclerosis and is present in obese adolescents .


The primary end point of this study was to investigate the influence of a multicomponent treatment on microvascular function .


Additional objectives and end points were a reduced BMI SD score , improvements in body composition , exercise capacity , and cardiovascular risk factors , an increase in endothelial progenitor cells ( EPCs ) , and a decrease in endothelial microparticles ( EMPs ) .


We used a quasi-randomized study with @ cohorts of obese adolescents : an intervention group ( n = @ ; @ @ years , @ girls and @ boys ) treated residentially with supervised diet and exercise and a usual care group ( n = @ ; @ @ years , @ girls and @ boys ) , treated ambulantly .


Changes in body mass , body composition , cardiorespiratory fitness , microvascular endothelial function , and circulating EPCs and EMPs were evaluated after @ months and at the end of the @-month program .


Residential intervention decreased BMI and body fat percentage , whereas it increased exercise capacity ( P < @ after @ and @ months ) .


Microvascular endothelial function also improved in the intervention group ( P = @ at @ months ; + @ @ compared with + @ @ arbitrary units ) .


Furthermore , intervention produced a significant reduction in traditional cardiovascular risk factors , including high-sensitivity C-reactive protein ( P = @ at @ months ) .


EPCs were increased after @ months ( P = @ ) , and EMPs decreased after @ months ( P = @ ) .


A treatment regimen consisting of supervised diet and exercise training was effective in improving multiple adolescent obesity-related end points .


Quantitative light intensity analysis of the strut core by optical coherence tomography ( OCT ) may enable assessment of changes in the light reflectivity of the bioresorbable polymeric scaffold from polymer to provisional matrix and connective tissues , with full disappearance and integration of the scaffold into the vessel wall .


The aim of this report was to describe the methodology and to apply it to serial human OCT images post procedure and at @ , @ , @ and @ months in the ABSORB cohort B trial .


In serial frequency-domain OCT pullbacks , corresponding struts at different time points were identified by @-dimensional foldout view .


The peak and median values of light intensity were measured in the strut core by dedicated software .


A total of @ corresponding struts were serially analyzed at @ time points .


In the sequential analysis , peak light intensity increased gradually in the first @ months after implantation and reached a plateau ( relative difference with respect to baseline -LSB- % Dif -RSB- : @ % at @ months , @ % at @ months , @ % at @ months ) , while the median intensity kept increasing at @ months ( % Dif : @ % at @ months , @ % at @ months , @ % at @ months ) .


Quantitative light intensity analysis by OCT was capable of detecting subtle changes in the bioresorbable strut appearance over time , and could be used to monitor the bioresorption and integration process of polylactide struts .


Many stroke survivors report participation challenges .


Occupational Performance Coaching for stroke survivors ( OPC-Stroke ) is designed to assist stroke survivors to develop the ability to plan and manage engagement in occupation .


This approach combines emotional support , individualized education , and goal-focused problem solving to promote occupational engagement .


This study will explore the potential efficacy of OPC-Stroke and the feasibility of the research methods for use in a larger trial .


A pilot randomized controlled trial will be undertaken .


Participants will be randomly assigned to receive @ sessions of OPC-Stroke or usual care .


Participation , perceived goal performance , satisfaction and self-efficacy , emotional well-being , and cognition will be measured at three time points .


This research will test the potential usefulness of OPC-Stroke as well as the study methods , and thereby inform the continuing development of OPC-Stroke and further studies to measure its effectiveness .


The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care , neck pain , and global satisfaction .


This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy ( SMT ) delivered by doctors of chiropractic , home exercise and advice ( HEA ) delivered by exercise therapists , and medication ( MED ) prescribed by a medical doctors for acute/subacute neck pain .


Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model .


The relationship between specific aspects of care and ( @ ) change in neck pain ( primary outcome of the randomized trial ) and ( @ ) global satisfaction were assessed using Pearson 's correlation and multiple linear regression .


Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants .


Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment ; however , the SMT group was more satisfied with general care .


Satisfaction with general care ( r = -@ to -@ ; R ( @ ) = @-@ @ ) had a stronger relationship with global satisfaction compared with satisfaction with information provided ( r = -@ to @ ; R ( @ ) = @-@ @ ) .


The relationship between satisfaction with care and neck pain was weak ( r = @-@ @ ; R ( @ ) = @-@ @ ) .


Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication .


The relationship between neck pain and satisfaction with care was weak .


The need for assistance from others is a hallmark concern in Alzheimer 's disease ( AD ) .


The psychometric properties of the Dependence Scale ( DS ) for measuring treatment benefit were investigated in large randomized clinical trials of patients with mild to moderate AD .


Reliability , validity , and responsiveness of the DS were examined .


Path models appraised relationships and distinctiveness of key AD measures .


The responder definition was empirically derived .


Generally acceptable reliability ( @ ) , significant ( P < @ ) known-groups tests , and moderate to strong correlations ( r @ ) confirmed the DS psychometric properties .


Path models supported relationships and distinctiveness of key AD measures .


A DS change of @ point for patients with limited home care and @ points for patients with assisted living care best described stability of the level of dependence on caregivers .


The DS is a psychometrically robust measure in mild to moderate AD .


The empirically derived responder definition aids in the interpretation of DS change .


This study compared the oral hygiene and caries risk of patients treated with labial and lingual orthodontic appliances throughout a prospective evaluation of the status of the oral environment before and after bracket placement .


A total of @ orthodontic patients aged @ to @ years were included in the study and were divided into two groups : @ patients wore Roth labial appliance ( American Orthodontics , Sheboygan , WI , USA ) and @ patients wore STb lingual appliance ( Ormco Corporation , Glendora , CA , USA ) .


Plaque index ( PI ) , gingival bleeding index ( GBI ) , salivary flow rate , saliva buffer capacity , salivary pH , and Streptococcus mutans and Lactobacillus counts in saliva were determined at three time points : before orthodontic appliance placement ( T@ ) , @ weeks after bonding ( T@ ) , and @ weeks after bonding ( T@ ) .


After appliance placement , all patients were periodically educated to the oral hygiene procedures .


Wilcoxon rank and Mann-Whitney U tests were used to determine intragroup and intergroup differences as regards qualitative data .


To compare quantitative data between the groups , chi-square and Fisher 's exact tests were undertaken , while intragroup differences were tested with McNemar test .


The level of statistical significance was set at p < @ .


Statistical analysis of the data obtained revealed a statistically significant difference between the data of T@ and T@ and the data of T@ and T@ of the PI scores and between T@ and T@ of the GBI scores in the group treated with the lingual appliance .


The GBI value increased significantly between T@ and T@ but decreased significantly between T@ and T@ ( p < @ ) in the group treated with labial appliance .


S. mutans counts increased significantly between T@ and T@ in the saliva samples of patients treated with lingual appliance .


No statistically significant differences were found between S. mutans and Lactobacillus counts at the three terms of saliva collection in patients treated with labial appliance .


No statistically significant differences were found between the two groups at the three time points as regards the salivary flow rate and saliva buffer capacity .


Lingual and labial orthodontic appliances showed a different potential in modifying the investigated clinical parameters : patients wearing STb lingual orthodontic appliance had more plaque retention @ and @ weeks after bonding , while there were more gingival inflammation and more S. mutans counts @ weeks after bonding .


No differences were found between the two groups as regards the Lactobacillus counts , the salivary flow rate , and saliva buffer capacity .


Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation .


However , there is lack of evidence of the clinical effects .


The aim of the present study was to investigate the pain - and seroma-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair .


Based on power analysis , a minimum of @ patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included .


Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week .


Standardized surgical technique , anaesthesia , and analgesic regimens were used and study observers were blinded towards the intervention .


Postoperative pain ( visual analogue score ) on day @ was the primary outcome .


In addition , ultrasonographic evaluation of seroma formation and several subjective patient-related parameters were registered .


Furthermore , patients in the abdominal binder group were asked to rate benefits or discomforts of wearing the binder .


Data from @ patients ( abdominal binder , n = @ ; no binder , n = @ ) were available for analysis .


No significant intergroup differences in postoperative pain or any of the other surgical outcomes , including seroma formation , were found .


However , the abdominal binder group reported subjective beneficial effect of wearing the binder in @ of the @ patients ( @ % ) .


No adverse effects of the abdominal binder were found .


There were no effects of an abdominal binder on pain , movement limitation , fatigue , seroma formation , general well-being , or quality of life .


However , most patients claimed a subjective beneficial effect of using their abdominal binder .


This study aimed to examine the association between changes in objectively measured overall physical activity ( PA ) and changes in fasting and postprandial plasma insulin , C-peptide , and glucose concentrations in type @ diabetes-prone immigrant Pakistani men living in Norway and to examine whether this association is explained by changes in moderate and vigorous PA ( MVPA ) or changes in sedentary time .


The current study is a secondary cohort analysis on data collected from the Physical Activity and Minority Health study , a randomized controlled trial aimed at increasing the PA level , and not sedentary time per se , in a group of sedentary immigrant Pakistani men ( n = @ ) .


For the present analyses , the two groups were merged and a cohort analysis was performed .


Overall PA ( counts per minute ) and its subcomponents , sedentary time and MVPA , were measured with accelerometry .


Outcome variables were measured after a @-h standardized glucose tolerance test .


Change in overall PA was significantly associated with postprandial log-transformed plasma insulin ( = -@ ; @ % confidence interval ( CI ) , -@ to @ ; P = @ ) , C-peptide ( = -@ ; @ % CI , -@ to -@ ; P = @ ) , and glucose concentration ( = -@ ; @ % CI , -@ to -@ ; P = @ ) .


Change in sedentary time was significantly and beneficially associated with changes in postprandial log-transformed plasma insulin ( = @ ; @ % CI , @-@ @ ; P = @ ) , C-peptide ( = @ ; @ % CI , @-@ @ ; P = @ ) , and glucose concentration ( = @ ; @ % CI , @-@ @ ; P = @ ) , independent of changes in MVPA , waist circumference , and other confounders .


Increasing overall PA by reducing sedentary time seems as important as increasing time spent at MVPA in relation to postprandial plasma insulin and glucose levels in diabetes-prone immigrant men .


Exercise treatment is recommended for all patients with hip osteoarthritis ( OA ) , but its effect on the long-term need for total hip replacement ( THR ) is unknown .


We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the @-year cumulative survival of the native hip to THR in @ patients with symptomatic and radiographic hip OA .


Results regarding the primary outcome measure of the trial , self-reported pain at @months follow-up , have been reported previously .


There were no group differences at baseline .


The response rate at follow-up was @ % .


@ patients in the group receiving both exercise therapy and patient education and @ patients in the group receiving patient education only underwent THR during the follow-up period , giving a @-year cumulative survival of the native hip of @ % and @ % , respectively ( p = @ ) .


The HR for survival of the native hip was @ ( CI @ to @ ) for the exercise therapy group compared with the control group .


Median time to THR was @ and @ years , respectively .


The exercise therapy group had better self-reported hip function prior to THR or end of study , but no significant differences were found for pain and stiffness .


Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by @ % in patients with hip OA .


ClinicalTrials.gov number NCT@ ( original project protocol ) and NCT@ ( additional protocol for long-term follow-up ) .


Previous trials of prenatal iron supplementation had limited measures of maternal or neonatal iron status .


The purpose was to assess effects of prenatal iron-folate supplementation on maternal and neonatal iron status .


Enrollment occurred June @ through December @ in Hebei , China .


Women with uncomplicated singleton pregnancies at @ wk gestation , aged @ y , and with hemoglobin @ g/L were randomly assigned @:@ to receive daily iron ( @ mg ferrous sulfate ) or placebo + @ mg folate from enrollment to birth .


Iron status was assessed in maternal venous blood ( at enrollment and at or near term ) and cord blood .


Primary outcomes were as follows : @ ) maternal iron deficiency ( ID ) defined in @ ways as serum ferritin ( SF ) < @ g/L and body iron ( BI ) < @ mg/kg ; @ ) maternal ID anemia -LSB- ID + anemia ( IDA ) ; hemoglobin < @ g/L -RSB- ; and @ ) neonatal ID ( cord blood ferritin < @ g/L or zinc protoporphyrin/heme > @ mol/mol ) .


A total of @ women were randomly assigned , with outcomes for @ women or neonates ( @ placebo/folate , @ iron/folate ; @ mother-newborn pairs , @ mothers , @ neonates ) .


Most infants ( @ % ) were born at term .


At or near term , maternal hemoglobin was significantly higher ( +@ g/L ) for iron vs. placebo groups .


Anemia risk was reduced ( RR : @ ; @ % CI : @ , @ ) , as were risks of ID ( RR : @ ; @ % CI : @ , @ by SF ; RR : @ ; @ % CI : @ , @ by BI ) and IDA ( RR : @ ; @ % CI : @ , @ by SF ; RR : @ ; @ % CI : @ , @ by BI ) .


Most women still had ID ( @ % by SF , @ % by BI ) .


Adverse effects , all minor , were similar by group .


There were no differences in cord blood iron measures ; > @ % of neonates in each group had ID .


However , dose-response analyses showed higher cord SF with more maternal iron capsules reported being consumed ( per @ capsules = @ , P < @ ) .


Prenatal iron supplementation reduced anemia , ID , and IDA in pregnant women in rural China , but most women and > @ % of neonates had ID , regardless of supplementation .


This trial was registered at clinicaltrials.gov as NCT@ .


Noise as a common physical hazard may lead to noise-induced hearing loss , an irreversible but preventable disorder .


Annual audiometric evaluations help detect changes in hearing status before clinically significant hearing loss develops .


This study was designed to track hearing threshold changes during @-year follow-up among tile and ceramic workers .


This follow-up study was conducted on @ workers ( totally @ ears ) .


Subjects were divided into four groups according to the level of noise exposure .


Hearing threshold in conventional audiometric frequencies was measured and standard threshold shift was calculated for each ear .


Hearing threshold was increased during @ years of follow-up .


Increased hearing threshold was most frequently observed at @ , @ , and @ Hz .


Standard threshold shift was observed in @ ( @ % ) , @ ( @ % ) , @ ( @ % ) , and @ ( @ % ) subjects in the first and second years of follow-up in the right and left ears , respectively .


This study has documented a high incidence of noise-induced hearing loss in tile and ceramic workers that would put stress on the importance of using hearing protection devices .


Uruguay is located at the southern border of Aedes aegypti distribution on the South American sub-continent .


The reported dengue cases in the country are all imported from surrounding countries .


One of the cities at higher risk of local dengue transmission is Salto , a border city with heavy traffic from dengue endemic areas .


We completed an intervention study using a cluster randomized trial design in @ randomly selected ` clusters ' in Salto .


The clusters were located in neighborhoods of differing geography and economic , cultural and social aspects .


Entomological surveys were carried out to measure the impact of the intervention on vector densities .


Through participatory processes of all stakeholders , an appropriate ecosystem management intervention was defined .


Residents collected the abundant small water holding containers and the Ministry of Public Health and the Municipality of Salto were responsible for collecting and eliminating them .


Additional vector breeding places were large water tanks ; they were either altered so that they could not hold water any more or covered so that oviposition by mosquitoes could not take place .


The response from the community and national programme managers was encouraging .


The intervention evidenced opportunities for cost savings and reducing dengue vector densities ( although not to statistically significant levels ) .


The observed low vector density limits the potential reduction due to the intervention .


A larger sample size is needed to obtain a statistically significant difference .


Nivolumab , a fully human IgG@ programmed death @ ( PD-@ ) immune-checkpoint-inhibitor antibody , disrupts PD-@-mediated signaling and may restore antitumor immunity .


In this randomized , open-label , international phase @ study , we assigned patients with nonsquamous non-small-cell lung cancer ( NSCLC ) that had progressed during or after platinum-based doublet chemotherapy to receive nivolumab at a dose of @ mg per kilogram of body weight every @ weeks or docetaxel at a dose of @ mg per square meter of body-surface area every @ weeks .


The primary end point was overall survival .


Overall survival was longer with nivolumab than with docetaxel .


The median overall survival was @ months ( @ % confidence interval -LSB- CI -RSB- , @ to @ ) among @ patients in the nivolumab group and @ months ( @ % CI , @ to @ ) among @ patients in the docetaxel group ( hazard ratio for death , @ ; @ % CI , @ to @ ; P = @ ) .


At @ year , the overall survival rate was @ % ( @ % CI , @ to @ ) with nivolumab versus @ % ( @ % CI , @ to @ ) with docetaxel .


With additional follow-up , the overall survival rate at @ months was @ % ( @ % CI , @ to @ ) with nivolumab versus @ % ( @ % CI , @ to @ ) with docetaxel .


The response rate was @ % with nivolumab versus @ % with docetaxel ( P = @ ) .


Although progression-free survival did not favor nivolumab over docetaxel ( median , @ months and @ months , respectively ) , the rate of progression-free survival at @ year was higher with nivolumab than with docetaxel ( @ % and @ % , respectively ) .


Nivolumab was associated with even greater efficacy than docetaxel across all end points in subgroups defined according to prespecified levels of tumor-membrane expression ( @ % , @ % , and @ % ) of the PD-@ ligand .


Treatment-related adverse events of grade @ or @ were reported in @ % of the patients in the nivolumab group , as compared with @ % of those in the docetaxel group .


Among patients with advanced nonsquamous NSCLC that had progressed during or after platinum-based chemotherapy , overall survival was longer with nivolumab than with docetaxel .


( Funded by Bristol-Myers Squibb ; CheckMate @ ClinicalTrials.gov number , NCT@ . )


Gross cystic disease fluid protein @ ( GCDFP-@ ) , which is regulated by the androgen receptor ( AR ) , is a diagnostic marker for mammary differentiation in histopathology .


We determined the expression of GCDFP-@ in breast cancer subtypes , its potential prognostic and predictive value , as well as its relationship to AR expression .


@ pre-therapeutic breast cancer core biopsies from the phase III randomized neoadjuvant GeparTrio trial ( NCT@ ) were investigated for GCDFP-@ expression by immunohistochemistry .


Expression data were correlated with disease-free ( DFS ) and overall survival ( OS ) time as well as pathological complete response ( pCR ) to neoadjuvant chemotherapy .


@ tumors ( @ % ) were GCDFP-@ positive .


GCDFP-@ expression was positively linked to hormone receptor ( HR ) and HER@ positive tumor type , while most triple negative carcinomas were negative ( p < @ ) .


GCDFP-@ was also strongly correlated to AR expression ( p @ ) , and to the so-called molecular apocrine subtype ( HR - / AR + , p < @ ) .


Higher rates of GCDFP-@ positivity were seen in tumors of lower grade ( < @ ) and negative nodal status ( p = @ ) .


GCDFP-@ positive tumors tended to have a more favourable prognosis than GCDFP-@ negative tumors ( DFS ( p = @ ) and OS ( p = @ ) ) , which was not independent from other factors in multivariate analysis .


GCDFP-@ expression was not linked to pCR .


Histological apocrine differentiation was frequent in molecular apocrine carcinomas ( @ % ) , and was associated with GCDFP-@ within this group ( p = @ ) .


GCDFP-@ expression is higher in tumors with favorable prognostic features .


GCDFP-@ expression is further a frequent feature of AR positive tumors and the molecular apocrine subtype .


It might have reduced sensitivity as a diagnostic marker for mammary differentiation in triple negative tumors as compared to HR or HER@ positive tumor types .


Owing to mobility limitations , people with lumbar spinal stenosis ( LSS ) are at risk for diseases of inactivity , including obesity .


Therefore , weight management in LSS is critical .


Body mass index is the strongest predictor of function in LSS , suggesting that weight loss may promote physical activity and provide a unique treatment option .


We propose a lifestyle modification approach of physical activity and nutrition education , delivered through an e-health platform .


The purpose of this study was to develop and pilot an e-health intervention aimed at increasing physical activity and decreasing fat mass in people with LSS .


The study design was based on intervention development and pilot .


Ten overweight or obese individuals with LSS were confirmed clinically and on imaging .


Self-reported measures were food record , Short-Form @ ( SF-@ ) , pain scales , Swiss Spinal Stenosis Symptom and Physical Function Scales , Oswestry Disability Index ( ODI ) , Pain Catastrophizing Questionnaire , Tampa Scale for Kinesiophobia , Center for Epidemiologic Studies ( Depression ) Scale , Behavioral Regular in Exercise Questionnaire , and Regulation for Eating Behavior Scale and physiologic measures were dual-energy X-ray absorptiometry ( DXA ) , blood draw , @-day accelerometry , self-paced walking test , and balance test .


The e-health platform was developed .


during Week @ , participants received a pedometer and a personalized consultation with a dietitian and an exercise physiologist .


For @ weeks , participants logged on to the e-health Web site to access personal step goals , nutrition education videos , and a discussion board .


Follow-up occurred at Week @ .


Nine participants had a mean age of @ years ( @ % women ) .


Significant improvements were observed for fat mass ( DXA ) , trunk fat mass , symptom severity ( Swiss Symptom Scale ) , energy intake , maximum continuous activity ( accelerometry ) , and mental health ( SF-@ ) ( p < @ ) .


Nonsignificant improvements were observed for waist circumference , pain , ODI , and obesity biomarkers .


Seventy percent lost weight , @ % increased walking capacity , and @ % increased quality of life .


The mean increase in steps was @ % .


The spinal stenosis pedometer and nutrition lifestyle intervention was shown to be feasible , attractive to participants , and effective in this small sample .


This intervention provides people with LSS the opportunity to participate in their own health management , potentially improving access to care .


Efficacy is currently being assessed in a randomized trial .


Guideline implementation in primary care has proven difficult .


Although external assistance through performance feedback , academic detailing , practice facilitation ( PF ) , and learning collaboratives seems to help , the best combination of interventions has not been determined .


In a cluster randomized trial , we compared the independent and combined effectiveness of PF and local learning collaboratives ( LLCs ) , combined with performance feedback and academic detailing , with performance feedback and academic detailing alone on implementation of the National Heart , Lung and Blood Institute 's Asthma Guidelines .


The study was conducted in @ primary care practice-based research networks .


Medical records of patients with asthma seen during pre - and postintervention periods were abstracted to determine adherence to @ guideline recommendations .


McNemar 's test and multivariate modeling were used to evaluate the impact of the interventions .


Across @ practices , @,@ patients met inclusion criteria .


Overall , adherence to all @ recommendations increased ( P @ ) .


Examination of improvement by study arm in unadjusted analyses showed that practices in the control arm significantly improved adherence to @ of @ recommendations , whereas practices in the PF arm improved in @ , practices in the LLCs improved in @ , and practices in the PF + LLC arm improved in @ of @ recommendations .


In multivariate modeling , PF practices significantly improved assessment of asthma severity ( odds ratio -LSB- OR -RSB- = @ , @ % CI , @-@ @ ) and assessment of asthma level of control ( OR = @ , @ % CI , @-@ @ ) compared with control practices .


Practices assigned to LLCs did not improve significantly more than control practices for any recommendation .


Addition of PF to performance feedback and academic detailing was helpful to practices attempting to improve adherence to asthma guidelines .


The Single combination budesonide-formoterol inhaler Maintenance And Reliever Therapy ( SMART ) regimen reduces severe asthma exacerbations in patients , but whether the high doses of corticosteroid and agonist increase the risk of adverse effects with both short-term and cumulative exposure is not certain .


Our aim was to investigate whether the SMART regimen would reduce the risk of overuse of agonist , reduce the likelihood of patients to seek medical review when such episodes occurred , and if any reduction in severe asthma exacerbations would be at the cost of a higher burden of systemic corticosteroid .


In this @-week trial undertaken at four primary health-care practices and one hospital in New Zealand , patients ( aged @-@ years ) with a recent asthma exacerbation were randomly assigned in a @:@ ratio to the SMART or standard fixed-dose regimen .


Treatment in the SMART group consisted of two actuations of budesonide-formoterol ( @ g and @ g , respectively , per actuation ) twice daily , delivered through a combination metered dose inhaler ( MDI ) , with one extra actuation as needed for relief of symptoms ; treatment in the standard group consisted of two actuations of budesonide-formoterol ( @ g and @ g , respectively , per actuation ) twice daily through a combination MDI with one to two actuations of salbutamol ( @ g per actuation ) by MDI as needed for relief of symptoms .


MDIs were monitored electronically to measure actual use of medication .


The allocation sequence for randomisation was computer generated , with a block size of eight per site .


Participants , investigators , and the statistician were not masked to group assignment .


The primary outcome was the proportion of participants with at least one high-use episode of agonist ( more than eight actuations per day of budesonide-formoterol in addition to the four maintenance doses in the SMART group or more than @ actuations per day of salbutamol in the standard group ) .


Analysis was by intention to treat .


This trial is registered with the Australian New Zealand Clinical Trials Registry , number ACTRN@ .


@ patients were randomly assigned to the SMART ( n = @ ) or standard group ( n = @ ) .


No significant difference was noted between the SMART and standard groups in the proportion of participants with at least one high-use episode of agonist ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- , respectively , relative risk @ -LSB- @ % CI @-@ -RSB- ; p = @ ) .


There were fewer days of high use in the SMART group ( mean @ days -LSB- SD @ -RSB- vs @ days -LSB- @ -RSB- , relative rate @ -LSB- @-@ -RSB- ; p = @ ) .


Of the patients who had at least one high-use episode , those in the SMART group had fewer days of high use without medical review ( @ days -LSB- @ -RSB- vs @ days -LSB- @ -RSB- , @ -LSB- @-@ -RSB- ; p = @ ) .