Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals .


Eligible consenting patients are randomised to either a community practice site ( intervention ) or a hospital site ( usual care ) .


In the intervention model , medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist .


Quantitative measures include clinical indicators with HbA@c as the primary outcome ; patient-reported outcomes include health-related quality of life , mental health and satisfaction with care .


Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care .


An economic evaluation will also be undertaken .


This model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes .


The study will provide empirical evidence about the impact of the model of care on health outcomes , patient and clinician satisfaction , as well as any economic impacts .


The effect of hypoglycemia related to treatment of type @ diabetes mellitus ( T@DM ) on brain structure remains unclear .


We aimed to assess whether symptomatic severe hypoglycemia is associated with brain atrophy and/or white matter abnormalities .


We included T@DM participants with brain MRI from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes ( ACCORD-MIND ) trial .


Symptomatic severe hypoglycemia was defined as blood glucose < @ mmol/L or symptoms resolved with treatments that required the assistance of another person or medical assistance ( hypoglycemia requiring assistance -LSB- HA -RSB- ) .


Standardized brain MRI was performed at baseline and at @ months .


Total brain volume ( TBV ) and abnormal white matter ( AWM ) volume were calculated using an automated computer algorithm .


Brain MRI scans of hypoglycemic participants were also reviewed for local disease .


Of the @ T@DM participants ( mean age , @ years ) with successful baseline and @-month brain MRI , @ had at least one HA episode during the @-month follow-up .


Compared with participants without HA , those with HA had marginally significant less atrophy ( less decrease in TBV ) from baseline to @ months ( -@ -LSB- @ % CI -@ , -@ -RSB- vs. -@ -LSB- @ % CI -@ , -@ -RSB- , P = @ ) , and no significant increase of AWM volume ( @ -LSB- @ % CI @ , @ -RSB- vs. @ -LSB- @ % CI @ , @ -RSB- , P = @ ) .


In addition , no unexpected local signal changes or volume loss were seen on hypoglycemic participants ' brain MRI scans .


Our study suggests that hypoglycemia related to T@DM treatment may not accentuate brain pathology , specifically brain atrophy or white matter abnormalities .


Emotional support has traditionally been conceived as something a breast cancer patient receives .


However , this framework may obscure a more complex process , facilitated by the emerging social media environment , which includes the effects of composing and sending messages to others .


Accordingly , this study explores the effects of expression and reception of emotional support messages in online groups and the importance of bonding as a mediator influencing the coping strategies of breast cancer patients .


Data were collected as part of two National Cancer Institute-funded randomized clinical trials .


Eligible subjects were within @ months of diagnosis of primary breast cancer or recurrence .


Expression and reception of emotionally supportive messages were tracked and coded for @ breast cancer patients .


Analysis resulted from merging @ ) computer-aided content analysis of discussion posts , @ ) action log analysis of system use , and @ ) longitudinal survey data .


As expected , perceived bonding was positively related to all four coping strategies ( active coping : = @ , P = @ ; positive reframing : = @ , P = @ ; planning : = @ , P = @ ; humor : = @ , P = @ ) .


More importantly , expression ( = @ , P = @ ) , but not reception ( = -@ , P = @ ) , of emotional support increases perceived bonding , which in turn mediates the effects on patients ' positive coping strategies .


There is increasing importance for scholars to distinguish the effects of expression from reception to understand the processes involved in producing psychosocial benefits .


This study shows that emotional support is more than something cancer patients receive ; it is part of an active , complex process that can be facilitated by social media .


Efavirenz is widely prescribed for HIV-@ infection , and CYP@B@ polymorphisms @GT and @TC define efavirenz slow metabolizer genotypes .


To identify genetic predictors of higher plasma efavirenz concentrations beyond these two common functional alleles , we characterized associations with mid-dosing interval efavirenz concentrations in @ HIV-infected adults , all carrying two copies of these major loss-of-function CYP@B@ alleles .


Study participants had been randomized to efavirenz-containing regimens in prospective clinical trials and had available plasma efavirenz assay data .


Analyses focused on secondary metabolism pathway polymorphisms CYP@A@ -@ TG ( rs@ ) , UGT@B@ @AG ( rs@ ) and UGT@B@ @TC ( rs@ ) .


Exploratory analyses also considered @ polymorphisms and @ copy number variants in @ drug metabolism/transport genes .


Mid-dosing interval efavirenz concentrations at steady-state were obtained @ h but < @ h post-dose .


Linear regression was used to test for associations between polymorphisms and log-transformed efavirenz concentrations .


Increased efavirenz concentrations were associated with CYP@A@ -@ TG in all subjects ( P = @ ( -@ ) ) and in Black subjects ( P = @ ) and White subjects ( P = @ ) analysed separately ; and with UGT@B@ @ G/G homozygosity in all subjects ( P = @ ) and in Black subjects ( P = @ ) and White subjects ( P = @ ) analysed separately .


In a multivariable model , CYP@A@ -@ TG and UGT@B@ @ G/G homozygosity remained significant ( P < @ for each ) .


No additional polymorphisms or copy number variants were significantly associated with efavirenz concentrations .


Among individuals with a CYP@B@ slow metabolizer genotype , CYP@A@ and possibly UGT@B@ polymorphisms contribute to even higher efavirenz concentrations .


Retrospective series report varied rates of bleeding and infection with external ventricular drainage ( EVD ) .


There have been no prospective studies of these risks with systematic surveillance , threshold definitions , or independent adjudication .


To analyze the rate of complications in the ongoing Clot Lysis : Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III ( CLEAR III ) trial , providing a comparison with a systematic review of complications of EVD in the literature .


Patients were prospectively enrolled in the CLEAR III trial after placement of an EVD for obstructive intraventricular hemorrhage and randomized to receive recombinant tissue-type plasminogen activator or placebo .


We counted any detected new hemorrhage ( catheter tract hemorrhage or any other distant hemorrhage ) on computed tomography scan within @ days from the randomization .


Meta-analysis of published series of EVD placement was compiled with STATA software .


Growing or unstable hemorrhage was reported as a cause of exclusion from the trial in @ of @ cases ( @ % ) screened for CLEAR III .


The first @ patients enrolled have completed adjudication of adverse events .


Forty-two subjects ( @ % ) experienced @ new bleeds or expansions , and @ of @ subjects ( @ % ) suffered symptomatic hemorrhages .


Eleven cases ( @ % ) had culture-proven bacterial meningitis or ventriculitis .


Risks of bleeding and infection in the ongoing CLEAR III trial are comparable to those previously reported in EVD case series .


In the present study , rates of new bleeds and bacterial meningitis/ventriculitis are very low despite multiple daily injections , blood in the ventricles , the use of thrombolysis in half the cases , and generalization to > @ trial sites .


To assess the impact of between-training-sessions recovery strategies ( passive -LSB- PAS -RSB- , active -LSB- ACT -RSB- , cold-water immersion -LSB- CWI -RSB- , and ingestion of a recovery drink -LSB- NUTR -RSB- ) on maximal cycling performance , perceptions of delayed-onset muscle soreness ( DOMS ) , and fatigue in world-class BMX riders .


Eleven elite BMX athletes , members of the French national team ( top country in the @ international ranking , @ medals at the @ World Championships , top European country ) , participated in the study , which involved standardized training periods .


Athletes performed @ maximal-sprint power tests : the first day of the week before the training session and before and after training on the third day of the week ( D@ ) .


The recovery strategy was randomly assigned to each participant on day @ immediately after the last training period of the day .


Perceptions of DOMS and general fatigue were recorded on D@ .


After training on D@ , the decrease in maximal-sprint power ( Pmax ) was significantly greater for PAS than with CWI ( P = @ ) and NUTR ( P = @ ) .


Similar results were found with ACT ( vs CWI P = @ , and vs NUTR P = @ ) .


Self-reported DOMS and fatigue were significantly greater after PAS than after other strategies .


For elite BMX riders , between training days , nutritional and/or CWI recovery strategies appear to be best for reducing muscle fatigue and increasing the capacity to withstand the training schedule .


In this randomized clinical trial ginger efficacy for prevention of antiretroviral-induced nausea and vomiting ( N/V ) was investigated .


From July @ until the end of June @ , @ HIV positive patients attending the HIV clinic of Imam Khomeini Hospital participated in the study .


In a double blinded manner , participants randomly received either @ mg ginger or placebo two times per day , @ min before each dose of antiretroviral regimen for @ days .


The severity of nausea was assessed based on the visual analogue scale .


The number of vomiting episodes were also recorded during the study period .


A total of @ ( @ % ) and @ ( @ % ) of the patients in placebo and ginger groups experienced some degree of nausea during the first @ weeks of antiretroviral therapy ( ART ) , respectively ( p = @ ) .


Frequency of mild , moderate and severe nausea were significantly lower in the ginger than placebo group ( p = @ ) .


Also , @ ( @ % ) and @ ( @ % ) of the patients in the placebo and ginger groups reported at least one episode of vomiting during their time on ART , respectively ( p = @ ) .


Ginger was effective in ameliorating of antiretroviral-induced N/V .


Chronic myeloid leukemia ( CML ) treatment relies on tyrosine kinase inhibitors ( TKIs ) , but their use can be associated with low-grade adverse events ( AEs ) .


This analysis aimed to identify the low-grade AEs which significantly impact the Health Related Quality of Life ( HRQoL ) of CML patients in chronic phase ( CP ) and to compare the incidence of such AEs among nilotinib - and imatinib-treated patients .


Data from the @ month ENESTnd trial were used ( N = @ patients ) .


HRQoL was assessed using generic ( SF-@ ) and leukemia-specific ( FACT-Leu ) HRQoL surveys .


AEs were categorized into @ system organ classes .


In the adjusted regression model , five low-grade AE categories - gastrointestinal disorders , blood and lymphatic system disorders , general disorders and administration site conditions , musculoskeletal disorders , and psychiatric disorders - significantly impaired at least one HRQoL score .


The incidence rate of these five AE categories was either significantly lower for nilotinib than imatinib or not different between the two drugs .


The AE categories with lower incidence for both nilotinib @mg BID and @mg BID versus imatinib @mg daily were gastrointestinal , blood and lymphatic system , and musculoskeletal ; nilotinib @mg BID had lower incidence than imatinib for general disorders .


Low-grade AEs were grouped and analyzed by system organ class category , so the effect of some rare individual AEs on HRQoL may have been missed .


The impact of low-grade AEs on HRQoL should be taken into account , along with other factors , when selecting the optimal treatment for patients newly diagnosed with CML-CP .


To assess the difference between drainage and non-drainage after total hip arthroplasty ( THA ) in Chinese subjects by evaluating post-operative complications and joint function .


One hundred and sixty-eight patients undergoing THA were randomly allocated into drainage ( @ patients ) and non-drainage groups ( @ patients ) .


All surgeries were performed by one surgical team using the same pre - , intra - , and postoperative techniques .


Measured items included : hemoglobin ( Hb ) , superficial and deep wound infection , volume of blood transfusion , wound hematoma thickness , range of motion ( ROM ) of the hip , wound healing time , ecchymosis and tension vesicles around the wound .


Early after THA , the Hb decreased significantly in the drainage group .


There was no significant difference between non-drainage and drainage groups in need for or volume of blood transfusions ( @ % vs @ % , P = @ ; @ units vs @ units , P = @ , respectively ) .


In the non-drainage group , the incidence of superficial infection , ecchymosis and tension vesicles was significantly higher than in the drainage group ( @ % vs @ % , P = @ ; @ % vs @ % , P = @ ; @ % vs @ % , P = @ , respectively ) .


In addition , the non-drainage group had a greater volume of hematomas ( P = @ ) .


Patients in the non-drainage group had smaller ROMs early after surgery but the final ROMs did not differ significantly between groups .


No deep infection occurred in either group .


Non-drainage may reduce postoperative blood loss but has no benefits regarding blood transfusion or deep infection .


It may cause more post-operative complications because of restriction of early postoperative exercise by pain and swelling .


Therefore we suggest routine use of drainage after THA .


Using the reverse Trendelenburg position ( RTP ) during functional endoscopic sinus surgery ( FESS ) is a safe , simple , and cost-free method that has been found to reduce intraoperative blood loss .


However , the critical angle of RTP that produces the least amount of bleeding without compromising surgical technique and safety remains unanswered .


The objective of this study was to assess the effects of @-degree , @-degree , and @-degree RTP ( @-RTP , @-RTP , and @-RTP , respectively ) on intraoperative bleeding during FESS .


This double-blind randomized controlled trial involved @ patients with chronic rhinosinusitis ( CRS ) with and without nasal polyposis undergoing FESS .


Twenty-five patients were enrolled into each group : @-RTP , @-RTP , and @-RTP .


Boezaart endoscopic field-of-view score ( BS ) , total blood loss ( TBL ) , mean arterial blood pressure ( MABP ) , operating time , and blood loss per minute were recorded .


An intention-to-treat analysis was used , with a Bonferroni adjustment for multiple comparisons .


Intervention groups were comparable in age , sex , nasal polyposis , and disease severity .


Mean values of BS and TBL were as follows : @-RTP ( @ , @ mL ) , @-RTP ( @ , @ mL ) , and @-RTP ( @ , @ mL ) .


The differences in means were significant for BS ( p < @ ) and TBL ( p = @ ) .


There was no significant difference in MABP ( p = @ ) , operating time ( p = @ ) , or blood loss per minute ( p = @ ) between the @ groups .


Pairwise comparison between @-RTP vs @-RTP found significant difference in BS ( p < @ ) but not TBL ( p = @ ) .


Significance was not found in similar comparisons of @-RTP vs @-RTP and @-RTP vs @-RTP ( p > @ ) .


FESS in @-RTP produced the best BS and lowest blood loss without compromising surgical technique .


This paper aimed to develop a short version of the @-item Ageing Perceptions Questionnaire ( APQ ) , a multi-dimensional measure based on Leventhal 's self-regulation model .


Ageing perceptions are a key area of interest for large-scale surveys of ageing populations .


As these studies capture a broad range of health and social variables , included instruments need to be as concise as possible .


Data from the Irish Longitudinal Study of Ageing ( TILDA ) , a representative sample of community-dwelling individuals aged @ + ( n = @,@ ) , was used to revise the scale .


Items for exclusion were identified by examining conceptual content , descriptive statistics , and by detecting sources of poor model fit using confirmatory factor analysis ( CFA ) .


Potential combinations of dimensions were also tested using CFA .


Finally , we identified any dimensions that could be excluded without limiting the conceptual coverage and coherence of the scale .


Model modifications were done sequentially and with regard to theoretical considerations .


Internal consistency and construct validity of the concise scale were compared with the longer version .


Initially , @ items were excluded on the basis of conceptual and empirical overlap with other items .


CFA indicated that the negative-control and negative-consequences dimensions could be combined , allowing us to exclude a further item from this dimension .


The @-item timeline-cyclical dimension was also excluded , as it was less well-established conceptually and empirically than the other dimensions .


The final @-item , @-dimension model was consistent with the original conceptual model and fit the data well ( chi-sq = @ , df ( @ ) , p < @ , RMSEA = @ , CFI = @ , TLI = @ ) .


The Brief-APQ ( B-APQ ) is a concise , multi-dimensional measure of ageing perceptions , which is psychometrically valid for use with the Irish population aged @ + .


The concise version preserved the internal consistency and construct validity of the original .


Its brevity makes it particularly suitable for use with large-scale adult population surveys .


The psychometric analysis supports the application of the self-regulation model to ageing perceptions , but also the existence of distinct `` physical decline '' and `` ongoing development '' dimensions of perceptions .


Organized screening based on Pap tests has substantially reduced deaths from cervical cancer in many countries , including Australia .


However , the impact of the program depends upon the degree to which women participate .


A new method of screening , testing for human papillomavirus ( HPV ) DNA to detect the virus that causes cervical cancer , has recently become available .


Because women can collect their own samples for this test at home , it has the potential to overcome some of the barriers to Pap tests .


The iPap trial will evaluate whether mailing an HPV self-sampling kit increases participation by never - and under-screened women within a cervical screening program .


The iPap trial is a parallel randomized controlled , open label , trial .


Participants will be Victorian women age @-@ years , for whom there is either no record on the Victorian Cervical Cytology Registry ( VCCR ) of a Pap test ( never-screened ) or the last recorded Pap test was between five to fifteen years ago ( under-screened ) .


Enrolment information from the Victorian Electoral Commission will be linked to the VCCR to determine the never-screened women .


Variables that will be used for record linkage include full name , address and date of birth .


Never - and under-screened women will be randomly allocated to either receive an invitation letter with an HPV self-sampling kit or a reminder letter to attend for a Pap test , which is standard practice for women overdue for a test in Victoria .


All resources have been focus group tested .


The primary outcome will be the proportion of women who participate , by returning an HPV self-sampling kit for women in the self-sampling arm , and notification of a Pap test result to the Registry for women in the Pap test arm at @ and @ months after mailout .


The most important secondary outcome is the proportion of test-positive women who undergo further investigations at @ and @ months after mailout of results .


The iPap trial will provide strong evidence about whether HPV self-sampling could be used in Australia to improve participation in cervical screening for never-and under-screened women .


eHealth interventions are effective for weight control and have the potential for broad reach .


Little is known about the use of interactive voice response ( IVR ) technology for self-monitoring in weight control interventions , particularly among populations disproportionately affected by obesity .


This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention .


The Shape Program was a randomized controlled trial comparing a @-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting .


Intervention participants ( n = @ ) used IVR technology to self-monitor behavior change goals ( eg , no sugary drinks , @,@ steps per day ) via weekly IVR calls .


Weight data were collected in clinic at baseline , @ , and @ months .


Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call .


Over @ months , the average IVR completion rate was @ % ( SD @ ) and @ % ( @/@ ) had an IVR completion rate @ % .


At @ months , IVR call completion was significantly correlated with weight loss ( r = -@ ; P = @ ) and participants with an IVR completion rate @ % had significantly greater weight loss compared to those with an IVR completion rate < @ % ( -@ kg , SE @ vs @ kg , SE @ ; P = @ ) .


Similar outcomes were found for change in body mass index ( BMI ; mean difference -@ kg , @ % CI -@ to -@ ; P = @ ) .


Older , more educated participants were more likely to achieve high IVR call completion .


Participants reported positive attitudes toward IVR self-monitoring .


Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention .


Higher adherence to IVR self-monitoring was also associated with greater weight change .


IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability .


To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent .


Prospective , double-blinded , randomized controlled trial .


Operating room of a university hospital .


@ ASA physical status @ and @ patients scheduled for limited elective surgery requiring general anesthesia .


Patients were randomized to two groups to receive etomidate @ mg/kg ( single-drug group ) or propofol @ mg/kg + ketamine @ mg/kg + midazolam @ mg/kg ( three-drug group ) .


Hemodynamic responses ( systolic and diastolic blood pressure , and mean arterial pressure ) were examined at baseline and at one , three , and @ minutes after tracheal intubation .


Plasma catecholamine levels were measured at baseline , one , and @ minutes after tracheal intubation .


Heart rate ( HR ) changes differed significantly between the two groups at three minutes ( P = @ ) and @ minutes ( P = @ ) after tracheal intubation .


However , the HR increase in the three-drug group was in the acceptable range .


Percentage changes of epinephrine level differed between the two groups at @ minutes after tracheal intubation ( P = @ ) .


The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity .


Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability .


Systemic inflammation beyond the skin may provide an explanation of the increased cardiovascular risk observed in psoriasis .


It was hypothesized that neutrophil-to-lymphocyte ratio ( NLR ) and platelet-to-lymphocyte ratio ( PLR ) are potential predictors of subclinical atherosclerosis measured by aortic velocity propagation ( AVP ) and carotid intima-media thickness ( CIMT ) in psoriasis .


Fifty-one patients with psoriasis taking no antipsoriatic therapy and @ age - and sex-matched healthy controls were prospectively enrolled .


The Psoriasis Area and Severity Index ( PASI ) was calculated .


Complete blood counts were obtained .


Measurements of AVP and CIMT were performed .


The baseline clinical and demographic features , and white blood cell , platelet , neutrophil , lymphocyte , monocyte , and PLR were similar in both groups .


NLR and high-sensitivity C-reactive protein ( hs-CRP ) were higher in the psoriasis group than the control group ( P = @ , P < @ ; respectively ) .


The psoriasis group had lower AVP and higher CIMT values than those of controls ( AVP : @ vs. @ cm/sec ; P < @ , CIMT : @ vs. @ mm ; P = @ , respectively ) .


PASI was positively correlated with NLR and hs-CRP ( r = @ , P = @ ; r = @ , P = @ , respectively ) .


There was an inverse association between AVP and CIMT ( r = -@ , P < @ ) .


Binary logistic regression analysis demonstrated that NLR was the only variable able to predict lower AVP ( @cm/sec ) and higher CIMT ( > @ mm ) values ( P = @ and @ ; respectively ) .


NLR is potentially an unrecognized predictor of subclinical atherosclerosis in patients with psoriasis .


Future studies assessing the prognostic significance of NLR on cardiovascular event rates in psoriasis patients would be of great interest .


To analyze , using in vivo laser scanning confocal microscopy ( LSCM ) , the conjunctival features in glaucomatous patients receiving prostaglandin analogues ( PGA ) .


Eighty eyes of @ consecutive glaucomatous patients naive for therapy were enrolled ; @ eyes of @ healthy subjects served as a control .


Patients were randomized to : preservative-free ( PF ) and preserved latanoprost ( groups @ and @ , respectively ) , PF and preserved timolol ( groups @ and @ ) , and controls to vehicle of latanoprost or physiological buffered saline solution ( groups @ and @ ) .


All subjects underwent LSCM of bulbar conjunctiva at baseline and @ months after initiating therapy .


The main outcomes were : mean density ( MMD : cysts/mm ( @ ) ) and mean area ( MMA : cysts/mm ( @ ) ) of epithelial microcysts .


The relations between MMA and MMD with intraocular pressure ( IOP ) , age , and mean defect ( MD ) , were analyzed .


At baseline , microcysts were found in all subjects .


At month three , MMD did not change in all groups ( p > @ ) .


MMA significantly increased only in group @ from @,@ to @,@ , and in group @ from @,@ to @,@,@ , with values significantly higher in group @ ( p < @ ) .


Significant relations were not found between MMD and MMA with IOP , MD , and age ( p > @ ) .


PGA increased MMA in therapy-naive glaucomatous patients , indicating a possible enhancement of the trans-conjunctival aqueous humor outflow .


Therefore , conjunctiva seems an additional target tissue to evaluate the hydrodynamic pathways in glaucoma and modifications induced by medical therapy .


Healthcare providers play an important role in encouraging healthy behaviors and improving health-related quality of life ( HRQoL ) .


They are most effective when they partner with informed , engaged patients .


To examine the impact of a new health-information technology intervention ( FAST-Feedback ) that provides patients with immediate , personalized , guideline-based feedback regarding tobacco use , physical activity , and HRQoL , and encourages patients to initiate discussions regarding these topics with their primary care physician .


A pilot , randomized controlled trial clustered by resident physician , with patients as the unit of analysis .


Resident physicians and their out-patients in a single academic health center between May and October @ .


Patients received ( intervention ) or did not receive ( control ) FAST-Feedback prior to the clinical encounter .


Primary outcomes were patient reports of initiating any discussions regarding tobacco use , physical activity , and HRQoL .


Subgroup analyses examined patient reports of discussions regarding tobacco use , physical activity , and HRQoL , respectively .


Thirty of the @ eligible resident physicians ( @ % ) agreed to participate ; @ of their @ eligible patients ( @ % ) expressed interest in the study and @ ( @ % ) consented to participate .


Compared to controls , a higher percentage of intervention patients reported initiating any discussion with their resident physician , although this difference was not statistically significant ( @ % vs. @ % ; p = @ ) .


For subgroup analyses regarding specific topics of discussion , patients in the intervention group reported initiating more discussions regarding mental HRQoL than controls ( @ % vs. @ % ; p = @ ) .


There was no difference in patient reports of initiating discussions regarding smoking , physical activity or physical HRQoL .


Providing patients with immediate , personalized , guideline-based feedback prior to the clinical encounter can increase patient-initiated discussions regarding mental HRQoL .


Future work should test FAST-Feedback in a larger population and evaluate the impact on tobacco cessation , increased physical activity , and improvements in HRQoL .


Rheumatoid arthritis ( RA ) is chronic systematic disease that affects people during the most productive period of their lives .


Web-based health interventions have been effective in many studies ; however , there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients ' behavioral and health outcomes .


The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity , health care utilization , medication overuse , empowerment , and RA knowledge of RA patients .


The effect of gamification on website use was also investigated .


We conducted a @-arm parallel randomized controlled trial for RA patients in Ticino ( Italian-speaking part of Switzerland ) .


A total of @ patients were recruited through brochures left with physicians and were randomly allocated to @ of @ experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website .


Data were collected at @ time points through questionnaires at baseline , posttest @ months later , and at follow-up after another @ months .


Primary outcomes were physical activity , health care utilization , and medication overuse ; secondary outcomes included empowerment and RA knowledge .


All outcomes were self-reported .


Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time .


The best-fit multilevel models ( growth curve models ) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors .


The growth curve analyses of experimental conditions were compared to the control group .


Physical activity increased over time for patients having access to social support sections plus gaming ( unstandardized beta coefficient -LSB- B -RSB- = @ , P = @ ) .


Health care utilization showed a significant decrease for patients accessing social support features ( B = -@ , P = @ ) and patients accessing both social support features and gaming ( B = -@ , P = @ ) .


Patients who had access to either social support sections or the gaming experience of the website gained more empowerment ( B = @ , P = @ ; B = @ , P = @ ; respectively ) .


Patients who were offered a gamified experience used the website more often than the ones without gaming ( t@ = -@ , P = @ ; U = @ , P = @ ) .


The Web-based intervention had a positive impact ( more desirable outcomes ) on intervention groups compared to the control group .


Social support sections on the website decreased health care utilization and medication overuse and increased empowerment .


Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization .


This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes .


Assessment of flow-mediated dilation ( FMD ) and nitroglycerin-mediated dilation ( NMD ) in the brachial artery by a new device ( UNEXEF@G ) has been reported to be excellent for evaluating endothelial function , and sympathetic overdrive can accelerate the atherosclerotic process .


The purpose of this study was to investigate and confirm whether anti-sympathetic beta-blocking action can enhance the pleiotropic effects of statins .


FMD and NMD were measured using the UNEXEF@G before and after @-week treatment of rosuvastatin ( @ mg/day ) with or without atenolol ( @ mg/day ) in @ hypercholesterolemic patients ( @ years old , LDL-C > @ mg/dL ) with hypertension .


Patients were randomly allocated to two treatment arms : rosuvastatin alone ( R-group , N. = @ ) and rosuvastatin with atenolol ( RA-group , N. = @ ) .


Baseline FMD was not different between the two treatment arms , and both groups showed improvement in FMD ( R-group , @ % to @ % , P < @ ; RA-group , @ % to @ % , P < @ ) , while there were no differences in NMD .


The effects on lipid profiles were identical in the two groups .


In addition , FMD improvement was greater in the RA-group than in the R-group ( change @ % vs. @ % , P < @ ) .


Beta-blockade enhances the pleiotropic effects of statins on endothelial function .


The mechanism should be confirmed by further studies .


Women-initiated HIV-prevention products are urgently needed .


To address this need , a trial was conducted to assess the safety and pharmacokinetics of a silicone elastomer matrix vaginal ring containing @ mg of the antiretroviral drug dapivirine when used continuously for @ consecutive days .


A double-blind , randomized , placebo-controlled trial was conducted in @ healthy , HIV-negative women , @-@ years of age , who were randomized @:@ to use either the active or matching placebo ring for @ days .


Participants were followed during and for @ days after ring use for safety and pharmacokinetic evaluations .


The dapivirine vaginal ring was safe and well tolerated with no differences in safety endpoints between the active and placebo ring .


The concentration-time plots of dapivirine in vaginal fluid were indicative of a sustained release of dapivirine over the @ days of use .


Dapivirine vaginal fluid concentrations were highest near the ring , followed by the cervix and introtus ( mean Cmax of @ , @ and @ g/g , respectively ) .


Vaginal fluid concentrations of dapivirine on the day of ring removal ( day @ ) at all three collection sites exceeded by more than @-fold the IC@ for dapivirine in a tissue explant infection model .


Plasma dapivirine concentrations were low ( < @ ng/ml ) and remained well below those observed at the maximum tolerated dose for oral treatment ( mean Cmax of @ ng/ml ) .


The dapivirine vaginal ring has a safety and pharmacokinetic profile that supports its use as a sustained-release topical microbicide for HIV-@ prevention in women .


Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking .


To assess the cost-effectiveness of collaborative care in a UK primary care setting .


An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression ( n = @ ) .


Costs , quality-adjusted life-years ( QALYs ) , and incremental cost-effectiveness ratios ( ICER ) were calculated over a @-month follow-up , from the perspective of the UK National Health Service and Personal Social Services ( i.e. Third Party Payer ) .


Sensitivity analyses are reported , and uncertainty is presented using the cost-effectiveness acceptability curve ( CEAC ) and the cost-effectiveness plane .


The collaborative care intervention had a mean cost of @ per participant .


Health and social care service use , excluding collaborative care , indicated a similar profile of resource use between collaborative care and usual care participants .


Collaborative care offered a mean incremental gain of @ ( @ % CI : -@ , @ ) quality-adjusted life-years over @ months , at a mean incremental cost of @ ( @ % CI : -@ , @ ) , and resulted in an estimated mean cost per QALY of @,@ .


Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective , thereby dominating treatment as usual .


Collaborative care offers health gains at a relatively low cost , and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of @,@ per QALY gained .


Results here support the commissioning of collaborative care in a UK primary care setting .


Benefits of recombinant human growth hormone ( rhGH ) alone or combined with glutamine in patients with intestinal failure because of short-bowel syndrome remain controversial .


We explored effects of rhGH on whole-body protein metabolism in patients with short-bowel syndrome with intestinal failure ( SBS-IF ) to gain insight into its mechanism of action .


Eight stable hyperphagic patients with severe SBS-IF received , in a double-blind , randomized crossover study , low-dose rhGH ( @ mg kg d ) and a placebo for two @-wk periods .


Leucine and glutamine kinetics under fasting and fed conditions , fat-free mass ( FFM ) , and serum insulin were determined on the final day of each treatment .


rhGH increased FFM and nonoxidative leucine disposal ( NOLD ; an index of protein synthesis ) ( P < @ ) , whereas FFM and NOLD were correlated in the fed state ( r = @ , P = @ ) .


With rhGH administration , leucine release from protein breakdown ( an index of proteolysis ) decreased in the fed compared with fasting states ( P = @ ) , which was not observed with the placebo .


However , the fast-to-fed difference in leucine release from protein breakdown was not significantly different between rhGH and placebo ( P = @ ) .


With rhGH , the intestinal absorption of leucine and glutamine increased ( P = @ ) and correlated with serum insulin ( r = @ , P = @ ) .


rhGH increased glutamine de novo synthesis ( P < @ ) and plasma concentrations ( P < @ ) in both fasting and fed states .


In SBS-IF patients , feeding fails to decrease proteolysis in contrast to what is physiologically observed in healthy subjects .


rhGH enhances FFM through the stimulation of protein synthesis and might decrease proteolysis in response to feeding .


Improvements in de novo synthesis and intestinal absorption increase glutamine availability over the physiologic range , suggesting that beneficial effects of rhGH in hyperphagic patients might be achieved without glutamine supplementation .


Preliminary research shows ginger may be an effective adjuvant treatment for chemotherapy-induced nausea and vomiting but significant limitations need to be addressed before recommendations for clinical practice can be made .


In a double-blinded randomised-controlled trial , chemotherapy-nave patients will be randomly allocated to receive either @ g of a standardised ginger extract or placebo per day .


The study medication will be administrated as an adjuvant treatment to standard anti-emetic therapy and will be divided into four capsules per day , to be consumed approximately every @hours ( @mg per capsule administered q.i.d ) for five days during the first three cycles of chemotherapy .


Acute , delayed , and anticipatory symptoms of nausea and vomiting will be assessed over this time frame using a valid and reliable questionnaire , with nausea symptoms being the primary outcome .


Quality of life , nutritional status , adverse effects , patient adherence , cancer-related fatigue , and CINV-specific prognostic factors will also be assessed .


Previous trials in this area have noted limitations .


These include the inconsistent use of standardized ginger formulations and valid questionnaires , lack of control for anticipatory nausea and prognostic factors that may influence individual CINV response , and the use of suboptimal dosing regimens .


This trial is the first to address these issues by incorporating multiple unique additions to the study design including controlling for CINV-specific prognostic factors by recruiting only chemotherapy-nave patients , implementing a dosing schedule consistent with the pharmacokinetics of oral ginger supplements , and independently analysing ginger supplements before and after recruitment to ensure potency .


Our trial will also be the first to assess the effect of ginger supplementation on cancer-related fatigue and nutritional status .


Chemotherapy-induced nausea and vomiting are distressing symptoms experienced by oncology patients ; this trial will address the significant limitations within the current literature and in doing so , will investigate the effect of ginger supplementation as an adjuvant treatment in modulating nausea and vomiting symptoms .


ANZMTG @ WBRTMel is a phase @ randomized trial to address the role of whole brain radiation therapy ( WBRT ) after local treatment of @-@ melanoma brain metastases .


Modern radiation therapy technologies can now conformally spare the hippocampus during WBRT and therefore potentially reduce the risk of neurocognitive deficit .


The aims of this study were to report the prevalence of melanoma metastases within the hippocampal sparing region and to identify variables that correlate with the presence of metastases within the hippocampal sparing region .


The pre-local treatment MRI scans of @ eligible WBRTMel patients were used to contour the individual metastasis and the hippocampus .


The volume , location and closest distance of each metastasis to the hippocampus were recorded .


Binary logistic regression was performed to assess the influence of factors on the location of a metastasis within @mm of the hippocampus .


The median age was @ and @ % were male .


The distribution of the @ metastases was frontal ( @ , @ % ) , parietal ( @ , @ % ) , temporal ( @ , @ % ) , occipital ( @ , @ % ) , cerebellum ( @ , @ % ) and pineal gland ( @ , @ % ) .


The median aggregate volume of the metastasis was @mm ( @ ) .


None of the metastases were within the hippocampus .


Four patients ( @ % ) had metastases within @mm of the hippocampus .


The median distance from metastasis to the nearest hippocampus was @ mm .


Only the total volume of metastases was a significant predictor for the risk of a metastasis within the hippocampal sparing region ( OR @ , @ % CI : @-@ @ , p = @ ) .


This study confirmed a low incidence of melanoma metastasis in the hippocampal sparing region at diagnosis .


Given the lack of randomized data on the safety and benefit of hippocampal sparing WBRT , the current WBRTMel trial provides the opportunity to explore the feasibility of this technique .


To evaluate if a feasible , low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine ( IOM ) recommendations on gestational weight gain ( GWG ) compared with standard maternity care .


A randomised controlled interventional design .


Antenatal clinics ( n = @ ) in rebro county , Sweden , participated .


Healthy women with a body mass index ( BMI ) @ kg/m ( @ ) , age @ years and adequate knowledge of Swedish language who signed in for maternity care at @ weeks of gestation .


Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM , application of personalised weight graph , formalised prescription of exercise and regular monitoring of GWG at every antenatal visit .


The proportion of women gaining weight above IOM guidelines ( @ ) and mean GWG ( kg ) was compared between groups .


In all , @ women were randomised and @ women remained for analysis after delivery .


A majority of the women analysed were normal weight ( @ % ) .


The intervention reduced the proportion of women who exceeded the IOM guidelines ( @ % versus @ % ) .


The reduction was , however , not statistically significant ( P = @ ) .


Mean GWG was significantly lower among women receiving the intervention , @ kg ( SD @ ) versus @ kg ( SD @ ) in the standard care group ( P = @ ) .


The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower .


ClinicalTrials.gov Id NCT@ http://clinicaltrials.gov .


To evaluate the effectiveness of the Play and Language for Autistic Youngsters ( PLAY ) Project Home Consultation model , in combination with usual community services ( CS ) , to improve parent-child interaction , child development , and autism symptomatology in young children with autism spectrum disorders ( ASDs ) compared with CS only .


Children ( N = @ ) with autism or PDD-NOS ( DSM-@ criteria ) aged @ years @ months to @ years @ months and recruited from @ disability agencies in @ US states were randomized in two @-year cohorts .


Using videotape and written feedback within a developmental framework , PLAY consultants coached caregivers monthly for @ months to improve caregiver-child interaction .


CS included speech/language and occupational therapy and public education services .


Primary outcomes included change in parent-child interactions , language and development , and autism-related diagnostic category/symptoms .


Secondary outcomes included parent stress and depression and home consultant fidelity .


Data were collected pre - and post-intervention .


Using intent-to-treat analysis ( ITT ) , large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales .


Child language and developmental quotient did not differ over time by group , although functional development improved significantly .


PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule ( ADOS ) .


PLAY caregivers ' stress did not increase , and depressive symptomatology decreased .


Home consultants administered the intervention with fidelity .


PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents ' stress/depression .


ADOS findings must be interpreted cautiously because results do not align with clinical experience .


PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents .


To assess the long-term effects of positive airway pressure ( PAP ) therapy on the ocular surface and eyelid in patients with obstructive sleep apnea hypopnea syndrome ( OSAHS ) .


Single-centred , prospective , and double-blinded study .


Fifty-one patients with OSAHS .


Fifty-one patients with OSAHS were treated with PAP for a period of @ months .


The pre - and post-PAP values for eye examination scores ( presence of floppy eyelid syndrome -LSB- FES -RSB- , results of the Ocular Surface Disease Index -LSB- OSDI -RSB- questionnaire , Schirmer I test , tear film break-up time -LSB- TBUT -RSB- values , and corneal staining stages ) were compared .


Based on the apnea-hypopnea index , @ patients were followed with moderate and @ patients were followed with severe OSAHS .


The presence of FES before and after PAP was @ % and @ % ( p < @ ) .


FES stage was determined as @ @ before PAP and @ @ after PAP ( p < @ ) .


Pre-PAP and post-PAP OSDI results were @ @ and @ @ , respectively ( p < @ ) .


Schirmer values before and after PAP were @ @ and @ @ mm , respectively ( p < @ ) .


TBUT values before and after PAP were @ @ and @ @ seconds , respectively ( p < @ ) .


Scores of the corneal staining stages before and after PAP were @ @ and @ @ , respectively ( p < @ ) .


OSAHS is associated with low Schirmer and TBUT values , and high scores in OSDI questionnaire , and high corneal staining stage .


An appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns .


We believe that long-term ( at least @ year ) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP .


Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery .


Use of anti-fibrinolytics is well documented in adults , but recently there are questions raised about safety and effectiveness of their use on routine use .


Tranexamic acid is a potent anti-fibrinolytic , but its role is not fully understood in children .


This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients .


Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin ( Group A ; n = @ ) or tranexamic acid ( Group B ; n = @ ) from September @ to February @ were studied .


Primary end points were early mortality , postoperative drainage , reoperation for bleeding and complications .


Mean age and body weight was smaller in Group A ( Age : @ vs. @ months ; weight @ vs. @ kg ) respectively .


Group A had more cyanotic heart disease than Group B ( @ % vs. @ % ) .


Mean cardiopulmonary bypass time ( @ vs. @ min ) and aortic cross-clamp time ( @ vs. @ min ) were significantly higher in group A.


While the blood and products usage was significantly higher in Group A , there was no difference in indexed postoperative drainage in first @ , @ and @ h and postoperative coagulation parameters .


Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A ( @ % vs. @ % ) .


Mortality in Group A was @ % and @ % in Group B.


Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery .


Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality .


An open-label , multicenter , randomized phase II trial was conducted from July @ , @ to March @ , @ to compare two protocols for treating children with frequently relapsing nephrotic syndrome using microemulsified cyclosporine .


Ninety-three children with frequently relapsing nephrotic syndrome were randomly assigned to group A ( n = @ ) or group B ( n = @ ) .


In both groups , the @-hour postdose cyclosporine level was monitored .


For group A , the cyclosporine target was set to @-@ ng/ml for the first @ months and @-@ ng/ml for the next @ months ; for group B , it was set to @-@ ng/ml for the first @ months and @-@ ng/ml for the next @ months .


The primary end point was the sustained remission rate .


At the end of the study , if there was no difference in safety profile between the two groups and the sustained remission rate in group A was superior to group B with a decision threshold of @ % , then the regimen for group A would be determined the better treatment .


Eight children from an ineligible institution , where cyclosporine levels were not measured , were excluded from all analyses .


At @ months , the sustained remission rate was nonsignificantly higher in group A ( n = @ ) than group B ( n = @ ; @ % versus @ % ; hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) , and the progression-free survival rate was significantly higher ( @ % versus @ % ; hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


The relapse rate was significantly lower in group A than group B ( @ versus @ times/person-year ; hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


The rate and severity of adverse events were similar in both treatment groups .


The sustained remission rate was not significantly different between the two treatment groups , but the regimen with the higher @-hour postdose cyclosporine level target improved progression-free survival and reduced the relapse rate .


To compare the clinical usefulness of constant rate infusion ( CRI ) protocols of romifidine with or without butorphanol for sedation of horses .


Prospective ` blinded ' controlled trial using block randomization .


Forty healthy Freiberger stallions .


The horses received either intravenous ( IV ) romifidine ( loading dose : @gkg ( -@ ) ; infusion : @gkg ( -@ ) hour ( -@ ) ) ( treatment R , n = @ ) or romifidine combined with butorphanol ( romifidine loading : @gkg ( -@ ) ; infusion : @gkg ( -@ ) hour ( -@ ) , and butorphanol loading : @gkg ( -@ ) ; infusion : @gkg ( -@ ) hour ( -@ ) ) ( treatment RB , n = @ ) .


Twenty-one horses underwent dentistry and ophthalmic procedures , while @ horses underwent only ophthalmologic procedure and buccal examination .


During the procedure , physiologic parameters and occurrence of head/muzzle shaking or twitching and forward movement were recorded .


Whenever sedation was insufficient , additional romifidine ( @gkg ( -@ ) ) was administered IV .


Recovery time was evaluated by assessing head height above ground .


At the end of the procedure , overall quality of sedation for the procedure was scored by the dentist and anaesthetist using a visual analogue scale .


Statistical analyses used two-way anova or linear mixed models as relevant .


Sedation quality scores as assessed by the anaesthetist were R : median @ , range : @-@ @ cm , RB : @ , @-@ @ cm , and by the dentist R : @ , @-@ @ cm , RB : @ , @-@ @ cm .


Horses receiving RB showed clinically more effective sedation as demonstrated by fewer poor scores and a tendency to reduced additional drug requirements .


More horses showed forward movement and head shaking in treatment RB than treatment R. Three horses ( two RB , one R ) had symptoms of colic following sedation .


The described protocols provide effective sedation under clinical conditions but for dentistry procedures , the addition of butorphanol is advantageous .


To evaluate the effects of systemic doxycycline on clinical and microbiological parameters of diabetic subjects with chronic periodontitis .


This @-month multi-center , randomized , parallel , single-blinded study was conducted from different hospitals in Riyadh , Saudi Arabia between April @ and December @ .


A total of @ diabetic subjects with chronic periodontitis were randomized into @ groups : control group ( CG ) received only scaling and root planing ( SRP ) , and the treatment group ( TG ) receiving systemic doxycycline during the reevaluation visit @ days after the completion of SRP .


Probing pocket depth , clinical attachment level , gingival index , plaque index , and bleeding on probing were collected at baseline , @ days after SRP , and one , @ , and @ months after the use of systemic doxycycline .


Microbiological analysis comprised the detection of Tannerella forsythia ( Tf ) , Aggregatibacter actinomycetemcomitans ( Aa ) , Porphyromonas gingivalis ( Pg ) , and Prevotella intermedia ( Pi ) by polymerase chain reaction method .


Sixty-eight ( @ CG and @ TG ) subjects completed the study .


Greater reduction in the population of Tf , Pg , and Pi were observed in TG compared with CG in the first month after the administration of systemic doxycycline .


The TG showed a significant improvement in gingival index scores compared with the CG ( p < @ ) by the end of the first and @ months after the administration of doxycycline .


Adjunct systemic doxycycline can be associated with a reduction of Tf , Pg , and Pi in the first month after the administration of doxycycline with an improvement in the GI .


This study sought to evaluate the impact of anatomic and procedural variables on the outcome of the unprotected left main coronary artery ( uLMCA ) itself after drug-eluting stent ( DES ) implantation .


There is a controversial debate regarding when and how to perform percutaneous coronary intervention ( PCI ) for an uLMCA stenosis .


This analysis is based on a randomized study of @ patients undergoing PCI for uLMCA , randomized @:@ to receive paclitaxel - or sirolimus-eluting stents .


We evaluated the impact of the SYNTAX score , uLMCA anatomy , and stenting technique on in-stent restenosis ( ISR ) , target lesion revascularization ( TLR ) , and the @-year outcomes .


The @-year cardiac mortality rate was @ % ; @ ( @ % ) patients had a true bifurcation lesion ( TBL ) , and the median SYNTAX score was @ .


TBL was associated with a higher need for multiple stents ( @ % vs. @ % , p < @ ) .


TBL was a significant predictor of ISR ( @ % vs. @ % , p = @ ) and for TLR ( @ % vs. @ % , p < @ ) .


The need for multiple stents was a predictor of ISR ( @ % vs. @ % , p = @ ) and for TLR ( @ % vs. @ % , p = @ ) .


Culotte stenting showed better results compared with T-stenting for ISR ( @ % vs. @ % , p = @ ) and for TLR ( @ % vs. @ % , p < @ ) .


We observed a significant association between uLMCA-TLR and SYNTAX scores ( @ % for scores @ , @ % for scores @ to @ , and @ % for scores @ , p = @ ) .


PCI of uLMCA lesions with DES is safe and effective out to @ years .


TBL and multiple stents were independent predictors for ISR .


In the multivariate analysis , independent predictors for TLR were TBL , age , and EuroSCORE ( European System for Cardiac Operative Risk Evaluation ) .


( Drug-Eluting-Stents for Unprotected Left Main Stem Disease -LSB- ISAR-LEFT-MAIN -RSB- ; NCT@ ) .


To evaluate the lipid-altering efficacy and safety of ezetimibe monotherapy in young children with heterozygous familial hypercholesterolemia ( HeFH ) or nonfamilial hypercholesterolemia ( nonFH ) .


One hundred thirty-eight children @-@ years of age with diagnosed HeFH or clinically important nonFH ( low-density lipoprotein cholesterol -LSB- LDL-C -RSB- @ mg/dL -LSB- @ mmol/L -RSB- ) were enrolled into a multicenter , @-week , randomized , double-blind , placebo-controlled study .


Following screening/drug washout and a @-week single-blind placebo-run-in with diet stabilization , subjects were randomized @:@ to daily ezetimibe @ mg ( n = @ ) or placebo ( n = @ ) for @ weeks .


Lipid-altering efficacy and safety were assessed in all treated patients .


Overall , mean age was @ years , @ % were girls , @ % were white , mean baseline LDL-C was @ mg/dL ( @ mmol/L ) , and @ % had HeFH .


After @ weeks , ezetimibe significantly reduced LDL-C by @ % after adjustment for placebo ( P < @ ) and produced significant reductions in total cholesterol ( @ % ) , nonhigh-density lipoprotein cholesterol ( @ % ) , and apolipoprotein B ( @ % ) ( P < @ for all ) .


LDL-C lowering response in sex , race , baseline lipids , and HeFH/nonFH subgroups was generally consistent with overall study results .


Ezetimibe was well tolerated , with a safety profile similar to studies in older children , adolescents , and adults .


Ezetimibe monotherapy produced clinically relevant reductions in LDL-C and other key lipid variables in young children with primary HeFH or clinically important nonFH , with a favorable safety/tolerability profile .


To examine if @ weekly sessions of supervised progressive resistance training ( PRT ) in combination with @ weekly sessions of unsupervised home-based exercise is more effective than @ weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg @ weeks after total hip replacement ( THR ) in patients with lower pre-operative function .


A total of @ patients scheduled for THR were randomised ( @:@ ) to intervention group ( IG , home based exercise @ days/week and PRT @ days/week ) or control group ( CG , home based exercise @ days/week ) .


The primary endpoint was change in leg extension power at @ week follow up .


Secondary outcomes were isometric hip muscle strength , sit-to-stand test , stair climb test , @ m walking speed and patient-reported outcome ( HOOS ) .


Sixty-two completed the trial ( @ % ) .


Leg extension power increased from baseline to the @ week follow up in both groups ; mean -LSB- @ % CI -RSB- IG : @ -LSB- @ ; @ -RSB- and CG : @ -LSB- @ ; @ -RSB- W/kg , with no between-group difference ( primary outcome ) ( P = @ ) .


Maximal walking speed ( P = @ ) and stair climb performance ( P = @ ) improved more in the IG compared to CG , no other between-group differences existed .


In this trial , supervised PRT twice a week in addition to @ weekly sessions of unsupervised exercise for @ weeks was not superior to @ weekly sessions of unsupervised home-based exercise for @ weeks in improving the primary outcome , leg-extension power of the operated leg , at the primary endpoint @ weeks after surgery in THR patients with lower pre-operative function .


Candidate predictive biomarkers for epidermal growth factor receptor inhibitors ( EGFRi ) , skin rash and serum proteomic assays , require further qualification to improve EGFRi therapy in non-small cell lung cancer ( NSCLC ) .


In a phase II trial that was closed to accrual because of changes in clinical practice we examined the relationships among candidate biomarkers , quantitative changes in tumor size , progression-free and overall survival .


@ patients with progressive NSCLC after platinum therapy were randomized to receive ( Arm A ) cetuximab , followed by pemetrexed at progression , or ( Arm B ) concurrent cetuximab and pemetrexed .


All received cetuximab monotherapy for the first @ days .


Pre-treatment serum and weekly rash assessments by standard and EGFRi-induced rash ( EIR ) scales were collected .


@ patients ( @-Arm A , @-Arm B ) completed the @-day run-in .


Median survival was @ months .


Arm B had better median overall ( Arm B = @ -LSB- @ % CI @ , @ -RSB- ; Arm A = @ -LSB- @ , @ -RSB- months P = @ ) and progression-free survival ( Arm B = @ -LSB- @ , @ -RSB- ; Arm A = @ -LSB- @ , @ -RSB- months P = @ ) .


The EIR scale distributed ratings among @ rather than @ categories but ordinal scale rash severity did not predict outcomes .


The serum proteomic classifier and absence of rash after @ days of cetuximab did .


Absence of rash after @ days of cetuximab therapy and the serum proteomic classifier , but not ordinal rash severity , were associated with NSCLC outcomes .


Although in a small study , these observations were consistent with results from larger retrospective analyses .


L-Asparaginase is an effective drug in the treatment of childhood acute lymphoblastic leukemia ( ALL ) .


The use of L-asparaginase may be limited by serious adverse events of which allergy is the most frequent .


The objective of this study was to describe the clinical aspects of PEG-asparaginase allergy in children treated according to the Nordic Society of Paediatric Haematology and Oncology ( NOPHO ) ALL@ protocol .


Children ( @-@ years ) enrolled in the NOPHO ALL@ protocol between July @ and August @ , who developed PEG-asparaginase allergy were identified through the NOPHO ALL@ toxicity registry .


In the NOPHO ALL@ protocol , patients are randomized to @ or @ doses of intramuscular PEG-asparaginase ( Oncaspar ) @,@ IU/m ( @ ) / dose administered at @ or @ weeks intervals during a total period of @ weeks .


( Clinical trials.gov no : NCT@ ) .


Of @ evaluable patients , @ patients developed clinical PEG-asparaginase allergy ( cumulative risk ; @ % ) and discontinued PEG-asparaginase therapy for that reason .


PEG-asparaginase allergy occurred after a median of two doses ( @ % range @-@ , max @ ) .


In @ % of PEG-asparaginase hypersensitive patients , the clinical allergic reactions appeared within @hr after PEG-asparaginase administration and ranged from mild symptoms to systemic anaphylaxis .


Nine patients experienced an anaphylactic reaction within @hr and @min from asparaginase administration ; none were fatal .


Four of @ patients ( @ % ) who subsequently received Erwinase therapy also reacted allergic to Erwinase .


Clinical allergy to PEG-asparaginase occurred early in treatment , was in general moderate in severity , and mostly developed within @hr after PEG-asparaginase administration .


The risk of subsequent Erwinase allergic reactions was low .


Abundant evidence on Xpert MTB/RIF accuracy for diagnosing tuberculosis ( TB ) and rifampicin resistance has been produced , yet there are few data on the population benefit of its programmatic use .


We assessed whether the implementation of Xpert MTB/RIF in routine conditions would ( @ ) increase the notification rate of laboratory-confirmed pulmonary TB to the national notification system and ( @ ) reduce the time to TB treatment initiation ( primary endpoints ) .


We conducted a stepped-wedge cluster-randomized trial from @ February to @ October @ in @ primary care laboratories in two Brazilian cities .


Diagnostic specimens were included for @,@ baseline ( smear microscopy ) and @,@ intervention ( Xpert MTB/RIF ) patients presumed to have TB .


Single-sputum-sample Xpert MTB/RIF replaced two-sputum-sample smear microscopy for routine diagnosis of pulmonary TB .


In total , @,@ ( @ % ) tests in the baseline arm and @,@ ( @ % ) in the intervention arm were positive ( p < @ ) , resulting in an increased bacteriologically confirmed notification rate of @ % ( @ % CI = @ % , @ % ) .


However , the overall notification rate did not increase ( @ % , @ % CI = -@ % , @ % ) , and we observed no change in the notification rate for those without a test result ( -@ % , @ % CI = -@ % , @ % ) .


Median time to treatment decreased from @ d ( interquartile range -LSB- IQR -RSB- = @-@ @ ) to @ d ( IQR = @-@ @ ) ( p = @ ) , although not among confirmed cases ( median @ -LSB- IQR = @-@ @ -RSB- versus @ -LSB- IQR = @-@ @ -RSB- , p = @ ) .


Prevalence of rifampicin resistance detected by Xpert was @ % ( @ % CI = @ % , @ % ) among new patients and @ % ( @ % CI = @ % , @ % ) among retreatment patients , with a @ % ( @ % CI = @ % , @ % ) positive predictive value compared to phenotypic drug susceptibility testing .


Missing data in the information systems may have biased our primary endpoints .


However , sensitivity analyses assessing the effects of missing data did not affect our results .


Replacing smear microscopy with Xpert MTB/RIF in Brazil increased confirmation of pulmonary TB .


An additional benefit was the accurate detection of rifampicin resistance .


However , no increase on overall notification rates was observed , possibly because of high rates of empirical TB treatment .


To evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant ( PS ) in term neonates with severe meconium aspiration syndrome ( MAS ) .


A total of @ full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January @ and June @ were randomly and equally divided into PS lavage and PS injection groups .


In the PS lavage group , patients were treated with endotracheal lavage using @-@ mL of diluted PS ( @ mg/mL ) each time , and the PS injection group was given PS by intratracheal injection at the first dose of @ mg/kg .


Blood gas , oxygenation index ( OI ) , and PaO@/FiO@ ( P/F ) of the two groups were evaluated before and @ , @ , @ , and @ hours after the treatment , and the duration of mechanical ventilation , complication rate , and cure rate were compared between the two groups .


Compared with the PS injection group , the PS lavage group had significantly higher PaO@ and P/F ration and significantly lower PaCO@ and OI at @ , @ , and @ hours post-treatment ( P < @ ) , a significantly shorter duration of mechanical ventilation ( P < @ ) , a significantly smaller amount of PS ( P < @ ) , a significantly lower complication rate ( P < @ ) , and a significantly higher cure rate ( @ % vs @ % ; P < @ ) .


Compared with the intratracheal injection of PS , endotracheal lavage with diluted PS in term neonates with severe MAS can increase ventilation and oxygenation efficiency , shorten the duration of mechanical ventilation , reduce the complication rate , and increase the cure rate , indicating that this method is a safe and effective therapeutic strategy .


To determine whether a combination modified-live bovine respiratory syncytial virus ( BRSV ) vaccine could stimulate protective immunity in young BRSV-seropositive calves following intranasal administration and determine the duration of clinical immunity .


Controlled challenge study .


Animals-@ dairy calves ( @ to @ days old ) .


Responses to BRSV challenge of seronegative calves vaccinated under licensing trial conditions were compared with those of seropositive calves @ times after vaccination .


In experiment @ , young BRSV-seronegative calves were vaccinated intranasally with a minimum immunizing dose of BRSV and challenged with BRSV approximately @ weeks later .


In experiments @ and @ , young BRSV-seropositive calves were vaccinated intranasally with a commercially available combination modified-live virus vaccine containing the commercial dose of the BRSV fraction and challenged with BRSV @ weeks or approximately @ weeks later , respectively .


In experiments @ and @ , BRSV-vaccinated calves had significantly higher Pao@ , significantly fewer lung lesions , and significantly lower mortality rate than did unvaccinated calves subsequent to BRSV challenge .


In contrast , in experiment @ , there were no differences in Pao@ , lung lesions , or mortality rate between vaccinated and control calves after BRSV challenge approximately @ weeks after vaccination .


Protected calves in experiment @ consistently had significant anamnestic mucosal and systemic antibody responses after challenge , whereas in experiments @ and @ , antibody responses after challenge were more variable .


A combination BRSV vaccine administered intranasally to young calves induced protective immunity in the presence of maternal antibodies .


The duration of immune responses induced by intranasal vaccination was short ( @ months ) .


Boosting immunity iatrogenically , or by natural exposure , is probably required to obtain optimal responses to neonatal intranasal vaccination .


To describe female lumbar spine motion and posture characteristics during coitus and compare these characteristics across five common coital positions .


Exacerbation of low back pain during coital movements and positions is a prevalent issue reported by female low back pain ( LBP ) patients .


To address this problem , the first study to examine lumbar spine biomechanics during coitus was conducted .


Ten healthy males and females performed coitus in the following pre-selected positions and variations : QUADRUPED ( fQUAD@ and fQUAD@ where the female is supporting her upper body with her elbows and hands , respectively ) , MISSIONARY ( fMISS@ and fMISS@ where the female is minimally and more flexed at the hips and knees , respectively ) , and SIDELYING .


An electromagnetic motion capture system was used to measure three-dimensional lumbar spine angles that were normalized to maximum active range of motion-a transmitter and receiver were affixed to the skin overlying the lateral aspect of the pelvis and the spinous process of the twelfth thoracic vertebra , respectively .


To determine if each coital position had distinct spine kinematic profiles ( i.e. , amplitude probability distribution function and total range of lumbar spine motion ) , separate univariate general linear models followed by Tukey 's honestly significant difference post hoc analysis were used .


The presentation of coital positions was randomized .


Female lumbar spine movement varied depending on the coital position ; both variations of QUADRUPED , fQUAD@ and fQUAD@ , were found to use a significantly greater range of spine motion than fMISS@ ( p = @ and p = @ , respectively ) .


With the exception of both variations of MISSIONARY , fMISS@ and fMISS@ , the majority of the range of motion used was in extension .


These findings are most pertinent to patients with LBP that is exacerbated by motions or postures .


Based on the spine kinematic profiles of each position , the least-to-most recommended positions for a female flexion-intolerant patient are : fMISS@ , fMISS@ , fQUAD@ , fSIDE , and fQUAD@ .


These recommendations would be contraindicated for the extension-intolerant patient .


The findings provided here may guide the clinician 's specific recommendations , including alternative coital positions and/or movement patterns or suggesting a lumbar support , depending on the female LBP patient 's specific motion and posture intolerances .


Tremor in Charcot-Marie-Tooth disease ( CMT ) can be disabling .


Cerebellar abnormalities are thought to underpin neuropathic tremor .


Here , we aim to clarify the potential role of the cerebellum in CMT tremor .


We assessed prevalence of tremor by questionnaire in @ patients with CMT .


Of those , @ patients with CMT with and without arm tremor and healthy controls underwent a clinical assessment , classical eyeblink conditioning , electro-oculography , visuomotor adaptation test , tremor recording with surface EMG and accelerometry , and retrospective correlation with nerve conduction studies to investigate the possible mechanisms of tremor generation .


The prevalence study revealed tremor in @ % of patients and in @ % of those it caused impairment of function .


Tremor recordings revealed a mild-to-moderate amplitude tremor with a weight load-invariant @ Hz frequency component .


Performance on classical eyeblink conditioning , visuomotor adaptation and electro-oculography were no different between tremulous and non-tremulous patients and healthy controls .


These results argue against a prominent role for an abnormal cerebellum in tremor generation in the patients studied with CMT .


Rather , our results suggest an enhancement of the central neurogenic component of physiological tremor as a possible mechanism for tremor in the patients studied .


This study is the first to propose differing pathogenic mechanisms for subtypes of neuropathic tremor .


The effect of dexmedetomidine on evoked potentials ( EPs ) has not been elucidated .


We aimed to investigate the effect of dexmedetomidine on somatosensory , motor , and visual EPs .


After IRB approval , @ adult patients scheduled for elective spine surgery using total IV anesthesia with propofol and remifentanil were randomly assigned to receive either dexmedetomidine ( n = @ ) or placebo ( n = @ ) in a double-blind , placebo-controlled trial .


After obtaining informed consent , positioning , and baseline EPs recording , patients were randomly assigned to either IV dexmedetomidine @ g/kg infused over @ minutes , followed by @ g/kg/h , or a corresponding volume of IV normal saline ( placebo ) .


EP measures at @ @ minutes after initiation of study drug were defined as T@ and at @ @ minutes were defined as T@ .


Changes from baseline to T@ ( primary end point ) and from baseline to T@ ( secondary end point ) in EP latencies ( milliseconds ) and amplitudes ( microvolts ) were compared between groups .


Data presented as mean SD ( @ % confidence interval ) .


Data from @ patients ( dexmedetomidine : n = @ ; age , @ @ years ; @ males ; placebo : n = @ ; age , @ @ years ; @ males ) were analyzed .


There was no difference between dexmedetomidine versus placebo groups in primary end points : change of somatosensory EPs at T@ , latency : @ @ ( -@ , @ ) vs @ @ ( -@ , @ ) , P = @ ( -@ , @ ) ; amplitude : @ @ ( -@ , @ ) vs -@ @ ( -@ , @ ) , P = @ ( -@ , @ ) ; motor EPs amplitude at T@ : @ @ ( -@ , @ ; n = @ ) vs @ @ ( -@ , @ ; n = @ ) , P = @ ( -@ , @ ) ; visual EPs at T@ ( right eye ) , amplitude : @ @ ( -@ , @ ; n = @ ) vs @ @ ( -@ , @ ; n = @ ) , P = @ ( -@ , @ ) ; latency N@ : @ @ ( -@ , @ ) vs @ @ ( -@ , @ ) , P = @ ( -@ , @ ) ; latency P@ : -@ @ ( -@ , @ ) vs -@ @ ( -@ , @ ) , P = @ ( -@ , @ ) or secondary end points .


There were no differences between right and left visual EPs either at T@ or at T@ .


In clinically relevant doses , dexmedetomidine as an adjunct to total IV anesthesia does not seem to alter EPs and therefore can be safely used during surgeries requiring monitoring of EPs .


Teaching in the presence of the patient is an acceptable model in medical settings .


Questions have been raised about the appropriateness of this type of teaching ( exam room teaching ) with patients with mental health issues .


This prospective randomized controlled study examined outpatient exam room teaching in a psychiatric setting .


In @-@ , patients in the adult outpatient psychiatry clinic at the University of Iowa were randomized to have faculty-learner presentations either in the presence of the patient or in the conference room .


Teaching encounters were timed and faculty , learners , and patients completed post encounter surveys .


Participation included @ patients , nine faculty , and @ residents .


Comparison of patient encounters randomized to exam room ( n = @ ) or conference room ( n = @ ) demonstrated that exam room teaching was roughly twice as time efficient as conference room teaching ( p @ ) .


Patients expressed a preference for exam room teaching during future visits ( p @ ) for those patients who experienced exam room teaching during the study .


Faculty were generally comfortable with exam room teaching and felt it had some advantages for patient decision making .


Learners felt they had to choose their words more carefully in exam room teaching and expressed some concerns about depth of teaching .


Once exposed to exam room teaching , this model is acceptable and feasible to faculty , learners , and patients in a psychiatry clinic setting .


Over @ % of patients with head and neck squamous cell carcinoma ( HNSCC ) present with locoregionally advanced disease .


Those at intermediate-to-high risk of recurrence after definitive therapy exhibit advanced disease based on tumour size or lymph node involvement , non-oropharynx primary sites , human papillomavirus ( HPV ) - negative oropharyngeal cancer , or HPV-positive oropharynx cancer with smoking history ( > @-pack-years ) .


Non-surgical approaches include concurrent chemoradiotherapy , induction chemotherapy followed by definitive radiotherapy or chemoradiotherapy , or radiotherapy alone .


Following locoregional therapies ( including surgical salvage of residual cervical nodes ) , no standard intervention exists .


Overexpression of epidermal growth factor receptor ( EGFR ) , an ErbB family member , is associated with poor prognosis in HNSCC .


EGFR-targeted cetuximab is the only targeted therapy that impacts overall survival and is approved for HNSCC in the USA or Europe .


However , resistance often occurs , and new approaches , such as targeting multiple ErbB family members , may be required .


Afatinib , an irreversible ErbB family blocker , demonstrated antiproliferative activity in preclinical models and comparable clinical efficacy with cetuximab in a randomized phase II trial in recurrent or metastatic HNSCC .


LUX-Head & Neck @ , a phase III study , will assess adjuvant afatinib versus placebo following chemoradiotherapy in primary unresected locoregionally advanced intermediate-to-high-risk HNSCC .


Patients with primary unresected locoregionally advanced HNSCC , in good clinical condition with unfavourable risk of recurrence , and no evidence of disease after chemoradiotherapy will be randomized @:@ to oral once-daily afatinib ( @ mg starting dose ) or placebo .


As HPV status will not be determined for eligibility , unfavourable risk is defined as non-oropharynx primary site or oropharynx cancer in patients with a smoking history ( > @ pack-years ) .


Treatment will continue for @ months or until recurrence or unacceptable adverse events occur .


The primary endpoint measure is duration of disease-free survival ; secondary endpoint measures are disease-free survival rate at @ years , overall survival , health-related quality of life and safety .


Given the unmet need in the adjuvant treatment of intermediate-to-high-risk HNSCC patients , it is expected that LUX-Head & Neck @ will provide new insights into treatment in this setting and might demonstrate the ability of afatinib to significantly improve disease-free survival , compared with placebo .


Topical tretinoin is considered the gold standard to treat photoaged skin , but it is associated with side effects and only available upon prescription .


To compare the efficacy , tolerance , and perception of a fixed proprietary combination ( Retinol @ % / LR@ @ % ) vs. tretinoin @ % cream in women with photoaged skin .


In this randomized , parallel , double-blind , controlled clinical study , women applied to the entire face for @months in the morning a SPF @ sunscreen and in the evening either the association of Retinol @ % / LR@ @ % or tretinoin @ % .


Clinical and instrumental parameters were assessed at days @ , @ , @ , and @ .


Subject perception of the efficacy , tolerance and cosmeticity of the tested products were assessed at days @ , @ , and @ .


A total of @ women ( @ to Retinol @ % / LR@ @ % cream and @ to tretinoin @ % cream ) were included in the study .


Both products improved considerably wrinkles , mottled pigmentation , pores , and global photodamage .


No statistically significant differences were noted between Retinol @ % / LR@ @ % cream and tretinoin @ % cream .


Adverse effects were mostly graded mild .


Overall , Retinol @ % / LR@ @ % cream was better tolerated than tretinoin @ % cream .


At all visits , subject perception of the association of Retinol @ % / LR@ @ % was either comparable to or better than tretinoin @ % cream .


The treatment outcome of Retinol @ % / LR@ @ % cream does not differ from the one of tretinoin @ % cream .


Clinical results were not statistically different .


Furthermore , Retinol @ % / LR@ @ % cream is better tolerated and better perceived by women used to rejuvenation procedures .


Central blood pressure ( BP ) , an important measure of cardiovascular risk , has been shown to be effectively reduced by calcium channel blockade with amlodipine ( AML ) plus renin-angiotensin system blockade by the angiotensin-converting enzyme inhibitor , perindopril ( PER ) .


The aim of the SEVITENSION study was to compare the central effects of PER/AML against renin-angiotensin system blockade with the angiotensin II receptor blocker olmesartan ( OLM ) plus AML .


In this multicenter , parallel group , non-inferiority study , patients received AML @ mg during a @ - to @-week run-in before randomization to @ weeks of double-blind treatment with the fixed-dose combination of OLM/AML @/@ mg or PER/AML @/@ mg .


Hydrochlorothiazide was added at Weeks @ , @ , or @ in patients with inadequate BP control .


The primary efficacy variable was the absolute change in central systolic BP ( CSBP ) from baseline to the final examination , measured by radial artery applanation tonometry and analyzed by parametric analysis of covariance .


Secondary variables included @-h ambulatory and seated BP measurements as well as BP normalization .


Of @ patients enrolled , @ were randomized ( @ to OLM/AML @/@ mg , @ to PER/AML @/@ mg ) .


The reduction in CSBP was larger with OLM/AML ( @ @ mmHg ) than with PER/AML ( @ @ mmHg ) .


The between-group difference was -@ @ mmHg with @ % confidence intervals ( -@ to -@ mmHg ) within the predefined non-inferiority margin ( @ mmHg ) .


An integrated superiority test confirmed that OLM/AML was superior to PER/AML ( p < @ ) in reducing CSBP .


The superiority of OLM/AML over PER/AML was also established for the majority of secondary efficacy variables ; at the final examination , @ % of OLM/AML recipients achieved BP normalization ( mean seated systolic BP/diastolic BP < @/@ mmHg ) compared with @ % of PER/AML recipients ( p < @ ) .


The combination of OLM/AML was superior to PER/AML in reducing CSBP and other efficacy measures , including a significantly higher rate of BP normalization .


The objective of this study was to compare the effectiveness of using a virtual environment ( VE ) versus traditional paper floor plans ( FPs ) to prepare nurses for wayfinding in a new hospital building .


This study was designed to control for variables such as task complexity and individual ability that have been missed in other media comparison studies .


Thirty nurses were assigned to the VE or FP condition using a randomized block experimental design .


Subjects were blocked by alternate ranks on spatial/navigational ability and computer attitude/experience and randomly assigned to conditions .


Nurses received instruction with either a VE or FP condition .


Wayfinding tasks were then completed with trained observers at the new hospital under construction .


The investigators found no significant differences between the wayfinding performance or postintervention confidence levels of subjects .


Instruction using both media improved wayfinding and navigation skills .


Qualitative findings suggest that interactions of the instructional style , media , and learner influence information retention and transfer .


Although the virtual media did not prove to be more effective than FPs , it was equally effective for learning wayfinding and navigation skills in a new hospital .


Nursing leaders may want to consider use of @-dimensional VEs as an early method to provide repetitive practice for learning how to navigate a new large-scale space .


PSA and PSA velocity ( PSAV , rate of PSA change over time ) are biomarkers for diagnosis and prognosis of prostate cancer .


Men who are at high risk for prostate cancer also have associated comorbidities for which they are taking NSAIDs and statins for long periods ; therefore , it is important to understand the effect of these medications on markers used to assess prostate cancer risk .


Using a population of @ men , multiple linear regressions were used to investigate the associations between PSA and concomitant medications , and mixed-effects models were used to investigate these associations with PSAV .


After adjusting for selenium use , age , race , body mass index , and pack-years of smoking , aspirin , other NSAIDs , or statins did not demonstrate statistically significant associations with PSA ( P = @ , @ , and @ , respectively ) or PSAV ( P = @ , @ , and @ , respectively ) .


Results were not altered upon stratifying the sample between men who developed prostate cancer during the course of the study and those who did not .


Results from this study indicate that chronic use of aspirin , other NSAIDs , or statins did not affect PSA levels or PSAV in men at high risk for prostate cancer .


Larger prospective studies designed to investigate these relationships are needed to confirm this result .


Long-term use of NSAIDs or statins in men at high risk for prostate cancer may not interfere with the diagnosis or prognosis of this disease , and supports appropriate use of these medications with regard to prostate cancer risk .


Exogenous GLP-@ slows gastric emptying in health and diabetes leading to diminished glycemic excursions .


Gastric emptying is markedly accelerated by hypoglycemia .


The primary objective was to determine whether GLP-@ attenuates the acceleration of gastric emptying induced by hypoglycemia .


Ten healthy volunteers were studied on four separate days in a randomized double-blind fashion .


Blood glucose was stabilized using a glucose/insulin clamp at hypoglycemia ( @ mmol/L on two occasions -LSB- hypo -RSB- ) or euglycemia ( @ mmol/L on two occasions -LSB- eu -RSB- ) between T = -@ and @ min before clamping at @ mmol/L until @ min .


During hypoglycemia and euglycemia , subjects received intravenous GLP-@ ( @ pmol/kg/min ) or placebo .


At T = @ min , subjects ingested @ g beef mince labeled with @ MBq ( @m ) Tc-sulfur-colloid and @ g of @-O-methyl-glucose ( @-OMG ) , a marker of glucose absorption .


Gastric emptying was measured scintigraphically from T = @ to @ min and serum @-OMG taken at @-min intervals .


The areas under the curve for gastric emptying and @-OMG concentration were analyzed using one-way repeated-measures ANOVA with Bonferroni-Holm adjusted post hoc tests .


Gastric emptying was accelerated during hypoglycemia ( hypo/placebo vs. eu/placebo ; P < @ ) , as was glucose absorption ( P < @ ) .


GLP-@ slowed emptying during euglycemia ( eu/placebo vs. eu/GLP -@ ; P < @ ) .


However , hypoglycemia-induced acceleration of gastric emptying on placebo was markedly diminished by GLP-@ ( hypo/placebo vs. hypo/GLP -@ ; P < @ ) , as was glucose absorption ( P < @ ) .


Acute administration of exogenous GLP-@ attenuates , but does not abolish , the acceleration of gastric emptying by insulin-induced hypoglycemia in healthy subjects .


For future etiologic cohort studies in runners it is important to identify whether ( hyper ) pronation of the foot , decreased ankle joint dorsiflexion ( AJD ) and the degree of the extension of the first Metatarsophalangeal joint ( MTP@ ) are risk factors for running injuries and to determine possible sex differences.These parameters are frequently determined with the navicular drop test ( NDT ) Stance and Single Limb-Stance , the Ankle Joint Dorsiflexion-test , and the extension MTP@-test in a healthy population .


The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners , using minimal equipment in order to make them applicable in large cohort studies .


Furthermore , we aimed to determine possible sex differences of these tests .


The three orthopaedic tests were administered by two sports physiotherapists in a group of @ ( @ male and @ female ) recreational runners .


The intra-class correlation ( ICC ) for interrater and intrarater reliability and the standard error of measurement ( SEM ) were calculated .


Bland and Altman plots were used to determine the @ % limits of agreements ( LOAs ) .


Furthermore , the difference between female and male runners was determined .


The ICC 's of the NDT were in the range of @ to @ , with a SEM in the range of @ to @ mm .


The AJD-test had an ICC of @ and @ ( SEM @ and @ ) , with a @ % LOA of -@ to @ and -@ to @ , and the MTP@-test had an ICC of @ and @ ( SEM @ and @ ) , with a @ % LOA of -@ to @ and -@ to @ for the interrater and intrarater reproducibility , respectively.Females had a significantly ( p < @ ) lower navicular drop score and higher range of motion in extension of the MTP@ , but no sex differences were found for ankle dorsiflexion ( p @ ) .


The reproducibility for the AJD test in runners is good , whereas that of the NDT and extension MTP@ was moderate or low .


We found a difference in NDT and MTP@ mobility between female and male runners , however this needs to be established in a larger study with more reliable test procedures .


There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy .


We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women .


We did an open-label , randomised controlled trial , in seven academic hospitals and @ non-academic hospitals in the Netherlands .


Women with non-severe hypertensive disorders of pregnancy between @ and @ weeks of gestation were randomly allocated to either induction of labour or caesarean section within @ h ( immediate delivery ) or a strategy aimed at prolonging pregnancy until @ weeks of gestation ( expectant monitoring ) .


The primary outcomes were a composite of adverse maternal outcomes ( thromboembolic disease , pulmonary oedema , eclampsia , HELLP syndrome , placental abruption , or maternal death ) , and neonatal respiratory distress syndrome , both analysed by intention-to-treat .


This study is registered with the Netherlands Trial Register ( NTR@ ) .


Between March @ , @ , and Feb @ , @ , @ women were invited to participate , of whom @ were enrolled and randomly assigned to immediate delivery ( n = @ ) or expectant monitoring ( n = @ ) .


The composite adverse maternal outcome occurred in four ( @ % ) of @ women allocated to immediate delivery versus @ ( @ % ) of @ women allocated to expectant monitoring ( relative risk -LSB- RR -RSB- @ , @ % CI @-@ ; p = @ ) .


Respiratory distress syndrome was diagnosed in @ ( @ % ) of @ neonates in the immediate delivery group versus six ( @ % ) of @ neonates in the expectant monitoring group ( RR @ , @ % CI @-@ ; p = @ ) .


No maternal or perinatal deaths occurred .


For women with non-severe hypertensive disorders at @-@ weeks of gestation , immediate delivery might reduce the already small risk of adverse maternal outcomes .


However , it significantly increases the risk of neonatal respiratory distress syndrome , therefore , routine immediate delivery does not seem justified and a strategy of expectant monitoring until the clinical situation deteriorates can be considered .


Evaluate the impact of concomitant enzyme ( CYP@A@ ) - inducer antiepileptic drugs ( EIAEDs ) on the efficacy and safety of perampanel in patients from the @ phase-III clinical trials .


Patients with pharmacoresistant partial-onset seizures in the @ phase-III clinical studies were aged @ years and older and receiving @ to @ concomitant antiepileptic drugs .


Following @-week baseline , patients were randomized to once-daily , double-blind treatment with placebo or perampanel @ or @ mg ( studies @ and @ ) or placebo or perampanel @ , @ , or @ mg ( study @ ) .


Treatment response assessed by median percent reduction in seizure frequency and responder rates improved with perampanel compared with placebo .


However , at @ and @ mg , the treatment response was significantly greater in patients receiving non-EIAEDs .


The treatment effect ( perampanel-placebo ) also demonstrated a dose-dependent increase in all patients .


The overall incidence of treatment-emergent adverse events was similar regardless of the presence of EIAEDs .


Occurrence of some adverse events , such as fatigue , somnolence , dizziness , irritability , was greater in patients receiving non-EIAEDs , as was discontinuation because of adverse events .


Perampanel shows efficacy and safety in the presence and absence of EIAEDs .


As systemic exposure to perampanel increases , so does efficacy .


Given the extensive metabolism of perampanel , systemic exposure is clearly reduced with concomitant administration of CYP@A@ inducers .


This supports the strategy of dosing perampanel to clinical effect .


Recognition of these pharmacokinetic interactions will be important in the optimization of this novel medication .


This study provides Class II evidence that @ to @ mg/d doses of perampanel reduced seizure frequency and improved responder rate in the presence and absence of EIAEDs .


Optimum duration of dual antiplatelet treatment ( DAPT ) after coronary stenting remains uncertain , with an unknown efficacy to safety ratio of extended treatment leading to discrepancies between international guidelines and clinical practice .


We assessed whether DAPT continuation beyond @ year after coronary stenting is beneficial .


This analysis was a planned extension of the previously published ARCTIC-Monitoring trial , in which we randomly allocated @ patients to a strategy of platelet function testing with antiplatelet treatment adjustment or a conventional strategy after coronary stenting with drug-eluting stent ( DES ) .


We recruited patients ( aged @ years or older ) scheduled for planned DES implantation at @ centres in France .


After @ year of follow-up , patients without contraindication to interruption of DAPT were eligible for a second randomisation to this second phase of the study ( ARCTIC-Interruption ) .


Using a computer-generated randomisation sequence ( @:@ ; stratified by centre ) , we allocated patients to a strategy of interruption of DAPT where the thienopyridine was interrupted and single aspirin antiplatelet treatment was maintained ( interruption group ) or a strategy of DAPT continuation for @-@ months ( continuation group ) .


The primary endpoint was the composite of death , myocardial infarction , stent thrombosis , stroke , or urgent revascularisation , analysed by intention to treat .


This trial is registered with ClinicalTrials.gov , number NCT@ .


Between Jan @ , @ , and March @ , @ , @ eligible patients were randomly allocated to treatment in ARCTIC-Interruption : @ to the interruption group and @ to the continuation group .


After a median follow-up of @ months ( IQR @-@ ) , the primary endpoint occurred in @ ( @ % ) patients in the interruption group and @ ( @ % ) patients in the continuation group ( hazard ratio -LSB- HR -RSB- @ -LSB- @ % CI @-@ -RSB- ; p = @ ) .


STEEPLE major bleeding events occurred more often in the continuation group ( seven -LSB- @ % -RSB- patients ) compared with the interruption group ( one -LSB- < @ % -RSB- patient ; HR @ -LSB- @-@ -RSB- ; p = @ ) .


Major or minor bleedings were also more common in the continuation group compared with the interruption group ( @ -LSB- @ % -RSB- patients vs three -LSB- @ % -RSB- patients ; HR @ -LSB- @-@ -RSB- ; p = @ ) .


Our finding suggests no apparent benefit but instead harm with extension of DAPT beyond @ year after stenting with DES when no event has occurred within the first year after stenting .


No conclusion can be drawn for high-risk patients who could not be randomised .


The consistency between findings from all trials of such interruption suggests the need for a reappraisal of guidelines for DAPT after coronary stenting towards shorter duration of treatment .


To evaluate the effect of different bracket types on the levels of Streptococcus mutans ( SM ) and Lactobacillus ( LB ) in saliva , in plaque , and on the periodontal condition .


Forty patients aged @ to @ years , who had Angle Class I malocclusion with minimal crowding , were nonsmokers , were without systematic disease , and did not use antibiotics or oral mouth rinses during the @-month period before the study were randomly selected .


The patients were subdivided into two groups with random allocation of bracket type : conventional brackets ( CB ; Avex Mx , OPAL orth . )


with steel wire ligature or self-ligating brackets ( SLB ; F@ , Leone S.p.A. ) .


Microbial and periodontal records were obtained before bonding ( T@ ) and @ month after bonding ( T@ ) .


Microbial samples were collected from the stimulated saliva and the plaque from the labial surfaces of the upper and lower lateral incisors .


To estimate the number of colony-forming units of SM and LB , Dentocult SM and LB kits were used .