bluuebunny/crossref_metadata_2025 huggingface dataset:
Beta-Lactam Antibiotics: Is Continuous Infusion The Preferred Method of Administration?
Authors: Vondracek Thomas G
Published: January 2017

Objective:

To examine the pharmacodynamic properties of the beta-lactam class of antibiotics and the rationale for their continuous infusion (CI), and to explore reasons that this mode of administration has not replaced intermittent infusion as the standard of practice.

Data Sources:

A MEDLINE search of the English-language literature evaluating CI administration of beta-lactam antibiotics was conducted. Bibliographic searches of these articles also were performed.

Study Selection:

Because there were few human trials, all available trials were considered for review. A cross section of clinical trials, animal studies, and in vitro studies examining the impact of the route of antibiotic administration was selected for each pharmacodynamic variable addressed.

Data Synthesis:

The support for CI as the preferred method of beta-lactam administration comes primarily from in vitro and animal data. Most beta-lactam antibiotics do not demonstrate concentration-dependent killing and have an appreciable postantibiotic effect only against gram-positive cocci. Their efficacy appears to be optimized by maintaining suprainhibitory concentrations throughout the dosing interval. Therefore, CI of beta-lactams could potentially enhance the efficacy of treatment or allow less drug to be used on a daily basis. This has yet to be demonstrated convincingly in human clinical trials. Comparative trials need to continue to explore die impact of the method of administration on patient outcomes such as duration and cost of therapy, as well as morbidity and mortality.

Conclusions:

Results of many animal and in vitro studies suggest that CI may be the optimal method of beta-lactam administration. Clinical trials need to further document the impact of the method of beta-lactam administration on the incidence of adverse effects, emergence of bacterial resistance, and patient outcome. Pharmacodynamic studies defining target beta-lactam concentrations, the practicality of CI in patients requiring multiple intravenous fluids and medications, and the pertinence of this issue when beta-lactam antibiotics are used as sole agents or in combination with other antimicrobials require further exploration.
Predicting Unbound Phenytoin Concentrations in the Critically Ill Neurosurgical Patient
Authors: Mlynarek Mark E , Peterson Edward L , Zarowitz Barbara J
Published: January 2017

OBJECTIVE:

To assess the correlation of measured unbound Phenytoin concentration (dphF) to estimated unbound concentration (dphEF) using the Sheiner-Tozer equation in critically ill patients in the neurosurgical intensive care unit.

DESIGN:

The dphF and total phenytoin (dphT) trough serum concentrations were measured during the first week of therapy in 17 consecutive patients with albumin concentrations less than 3.5 g/dL. Serum albumin concentrations were measured within 24 hours of serum phenytoin concentration measurement.

SETTING:

A university-affiliated urban teaching hospital.

PARTICIPANTS:

The study population consisted of 17 neurosurgical patients who were at least 18 years old.

MAIN OUTCOME MEASURES:

The predictability of the Sheiner-Tozer equation was tested by measuring dphF, dphT, and serum albumin concentrations. Measured phenytoin concentrations were compared with phenytoin concentrations calculated from the Sheiner-Tozer equation. To estimate correlation between variables linear regression was calculated. Mean absolute value of error and mean error were estimated to assess precision and bias between measures, respectively.

RESULTS:

The mean ± SD dphT was 13.05 ± 5.15 μg/mL. The measured dphF was 1.89 ± 0.80 compared with 2.00 ± 0.8 μg/mL for the dphEF (NS). Regression analysis for dphEF versus dphF revealed a significant correlation (r2 = 0.94, ρ = 0.001). The mean absolute value of error for the Sheiner-Tozer equation to predict dphEF was 0.167, which was 9% of the mean value of dphF (1.89).

CONCLUSIONS:

These results indicate that, in this population, the Sheiner-Tozer estimate of dphEF provides an unbiased, precise clinical estimate of dphF in patients for whom measured dphF is unavailable or impractical.
Comparison of Cefprozil, Cefpodoxime Proxetil, Loracarbef, Cefixime, and Ceftibuten
Authors: Schatz Beth S , Karavokiros Kellie Tefakis , Taeubel Mary A , Itokazu Gail S
Published: January 2017

OBJECTIVE:

To discuss the pharmacokinetics, spectrum of activity, clinical trials, and adverse effects of cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and ceftibuten, an investigational cephalosporin.

DATA SOURCES:

Literature was identified by a MEDLINE search from 1986 to January 1995.

STUDY SELECTION:

Randomized, controlled studies were selected for evaluation; however, uncontrolled studies were included when data were limited for indications approved by the Food and Drug Administration.

DATA EXTRACTION:

Data were evaluated with respect to in vitro activity, study design, clinical and microbiologic outcomes, and adverse drug reactions.

DATA SYNTHESIS:

Cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and ceftibuten are active in vitro against organisms frequently involved in community-acquired infections such as Streptococcus pneumoniae, Escherichia coli, beta-lactamase-positive or -negative Haemophilus influenzae, and Moraxella catarrhalis. Except for cefixime and ceftibuten, they all are active against methicillin-susceptible Staphylococcus aureus. Even though there were problems in study design (discussed within the text), clinical data demonstrate that these new oral beta-lactam compounds are as efficacious as conventional therapies for a variety of community-acquired infections.

CONCLUSIONS:

Cefprozil, cefpodoxime, cefixime, loracarbef, and ceftibuten demonstrate in vitro activity against the major organisms that cause community-acquired infections. Clinical trials confirm that these agents are as effective as traditional therapies for the management of acute otitis media, pharyngitis/tonsillitis, sinusitis, bronchitis, pneumonia, urinary tract infections, and skin and skin-structure infections. In addition, cefixime and cefpodoxime are effective therapies for uncomplicated gonococcal infections. Selection of a specific agent will be influenced by susceptibility data and safety, as well as issues of compliance and cost.
Use of Baclofen to Suppress Cough Induced by Angiotensin-Converting Enzyme Inhibitors
Authors: Dicpinigaitis Peter V
Published: January 2017

OBJECTIVE:

To determine whether baclofen can suppress the cough induced by angiotensin-converting enzyme (ACE) inhibitors.

DESIGN:

Prospective, open-label, clinical trial of a 4-week course of low-dose oral baclofen (5 mg tid days 1–7, 10 mg tid days 8–28).

SUBJECTS:

Seven patients with severe, persistent ACE inhibitor-induced cough.

SETTING:

University-affiliated teaching hospital.

MAIN OUTCOME MEASURES:

Study participants kept daily diaries monitoring the frequency of cough during and after completion of baclofen therapy.

RESULTS:

All subjects demonstrated diminution of cough after initiation of baclofen. Initial improvement was noted by a mean of 4.0 days (range 3–6), and maximal improvement during treatment was achieved by a mean of 10.7 days (range 5–15). In addition, all subjects demonstrated persistent suppression of cough (range 25–74 d) after discontinuation of the study drug.

CONCLUSIONS:

Low-dose oral baclofen therapy caused a prolonged antitussive effect in all subjects without inducing any adverse reactions. Baclofen may offer an alternative to the discontinuation of ACE inhibitor therapy in patients for whom these drugs are required.
Acarbose: Its Role in the Treatment of Diabetes Mellitus
Authors: Campbell Lance K , White John R , Campbell R Keith
Published: January 2017

OBJECTIVES:

To review the clinical pharmacology of acarbose, an alpha-glucosidase inhibitor, and to summarize its role in the pharmacotherapy of diabetes mellitus.

DATA SOURCES:

A MEDLINE search identified all relevant articles, including reviews; Bayer Pharmaceuticals.

STUDY SELECTION:

Due to the large number of clinical trials available, specific criteria were used to narrow the focus of this review: (1) randomized, double-blind, placebo-controlled, parallel-group study design; (2) a minimum of 25 patients enrolled per treatment arm; (3) a treatment duration of 90 days or more; and (4) adherence to Food and Drug Administration Good Clinical Practice guidelines.

DATA EXTRACTION:

All clinical trials that were available up to December 1995 were reviewed. Preliminary trials and unpublished reports were not reviewed.

DATA SYNTHESIS:

Acarbose is effective in reducing postprandial hyperglycemia. It does not stimulate endogenous insulin secretion and, therefore, will not cause hypoglycemia when used as monotherapy. The enhanced glycemic control achieved with acarbose is additive to that of sulfonylureas. It lowers postprandial serum glucose and insulin concentrations and does not promote weight gain. Acarbose can be used as first-line therapy with diet and exercise, or it can be used in combination with sulfonylureas to lower hemoglobin Alc concentrations an additional 0.5–0.9%. Acarbose is not a cure for diabetes, nor is it a substitute for diet, exercise, oral hypoglycemic agents, or insulin. Adverse effects are gastrointestinal and can be diminished by starting with an initial dosage of 25 mg tid. Depending on patient response, the dosage can be increased up to a maximum of 100 mg tid over time.

CONCLUSIONS:

Acarbose, through its unique mechanism of action, appears to be a safe and effective adjunctive agent to diet/exercise therapy or sulfonylurea therapy for treatment of non-insulin-dependent diabetes mellitus.
Tibiotalocalcaneal Arthrodesis
Authors: Chou Loretta B. , Mann Roger A. , Yaszay Burt , Graves Stanley C. , McPeake William T. , Dreeben Sharon M. , Horton Greg A. , Katcherian David A. , Clanton Thomas O. , Miller Richard A. , Van Manen John W.
Published: January 2017

The purpose of this multicenter retrospective study of 55 patients (56 ankles) who underwent simultaneous tibiotalocalcaneal arthrodesis with severe disease involving the ankle and subtalar joints was to determine improvement of pain and function. The surgical indications included osteoarthritis, posttraumatic injury, failed previous surgery, talar avascular necrosis, osteoarthritis, and rheumatoid arthritis involving the ankle and subtalar joints. The average age at the time of the operation was 53 years. The average time of follow-up was 26 months after the operation. Fusion was achieved in 48 ankles, with an average time of fusion of 19 weeks. Forty-eight of the 55 patients were satisfied with the procedure. The average leg length discrepancy was 1.4 cm. The average amount of dorsiflexion was 2 degrees and plantar flexion was 5 degrees. Following surgery, 42 patients complained of pain, 40 patients required shoe modification or an orthotic device, and 34 patients had a limp. Fourteen patients described their activity as unlimited. Based on the AOFAS evaluation, the patients scored an average of 66 on the ankle-hind foot scale following surgery. The most common complications were nonunion (8 ankles) and wound infection (6 ankles). This study demonstrates that tibiotalocalcaneal arthrodesis is an effective salvage procedure for patients with disease both involving the ankle and subtalar joints.
Surgical Versus Non-Surgical Treatment of Calcaneal Fractures in Children: A Long-term Results Comparative Study
Authors: Ceccarelli Francesco , Faldini Cesare , Piras Franco , Giannini Sandro
Published: January 2017

This study compared surgical and non-surgical treatment of 46 calcaneal fractures in children aged 3-17 years. Patients were divided into: Group A ranging 3-14 years and Group B 15-17 years, and classified according to surgical or non-surgical treatment. Mean follow-up was 22.8 years. Extra-articular fractures were treated non-surgically and all results were satisfactory. Results of articular fractures in Group A were satisfactory regardless of the type of treatment. Articular fractures surgically treated in group B were satisfactory, and those non-surgically treated were mainly poor. Extra-articular fractures can be treated non-surgically. Articular fractures in skeletally immature children can be treated non-surgically; conversely, those in children with skeletal maturity must be treated surgically.
Biomechanical Evaluation of Calcaneocuboid Distraction Arthrodesis: A Cadaver Study of Two Different Fixation Methods
Authors: Kimball Hervey L. , Aronow Michael S. , Sullivan Raymond J. , Tarinelli Danyel J. , Nowak Michael D.
Published: January 2017

Calcaneocuboid distraction arthrodesis can be used to treat stage 2 posterior tibial tendon dysfunction. Nonunion, graft resorption, and implant failure have been reported after this procedure. This study compared two of the most commonly used methods for fixation of calcaneocuboid distraction arthrodesis. Twelve pairs of cadaver feet underwent simulated calcaneocuboid distraction arthrodesis. One specimen in each pair was fixed with two crossed 3.5 mm cortical lag screws. The contralateral specimen was fixed with a cervical H-plate. The calcaneus was fixed and a load was applied to the plantar aspect of the cuboid at a rate of 5mm/minute until joint separation of 3mm or fracture occurred. The average applied load to failure at 1.0 mm of joint separation was 30.5 +/−11.6 N for the crossed screws and 77.7 +/− 36.4 N for the cervical H-plate (p = 0.001). The average stiffness at 1.0 mm of joint separation was 27.5 +/− 10.9 N/mm for the crossed screws and 43 +/− 21.2 N/mm for the cervical H-plate (p = 0.036). The higher stiffness and load to failure may account for the decreased nonunion rate noted anecdotally by some surgeons with H-plate fixation over crossed screw fixation for calcaneocuboid distraction arthrodesis.
Cavernous Hemangioma Behaving Like Peroneal Tenosynovitis
Authors: Ürguüden Mustafa , Özdemir Hakan , Duygulu Erdeniz , Aydin Ahmet Turan
Published: January 2017

Hemangioma of the tendon sheath is rarely reported. In this case report, a 22-year-old man, who had been seen for peroneal tenosynovitis before (although symptoms remained) was reevaluated. A cavernous hemangioma was located in the peroneal muscle and the tendon. Complete excision was performed.
Future Directions for Work on Refinement of ADHD Assessment in Young Adults
Authors: Martel Michelle M. , Schimmack Ulrich , Nigg Joel T.
Published: January 2017

Sibley, Coxe, and Molina provide a thoughtful discussion of the implications of our study and highlight important future directions in this line of work. They helpfully amplify several themes that space did not allow discussion of in our article. In particular, they correctly emphasize the importance of theoretical as well as statistical considerations in model selection. We also agree that clinical tests of sensitivity and specificity, taking into account different base rates and types of samples, are essential before a final algorithm would be ready for dissemination. However, we are not convinced that such tests should be limited to populations of individuals with attention-deficit/hyperactivity disorder (ADHD). Rather, they should include those with and without diagnosed ADHD in order to provide comprehensive tests of reporter sensitivity and specificity across the entire continuum of ADHD symptomatology and in relation to different populations, including other disorders and typically developing populations.
Adaptive fuzzy sliding mode control for vibration suppression of a rotating carbon nanotube-reinforced composite beam
Authors: Rahmani Behrooz
Published: January 2017

In this paper, the robust vibration control of a rotating carbon nanotube reinforced composite beam subjected to a temperature rise is studied. The governing mathematical partial differential equations are derived by Hamilton’s principle based on Euler–Bernoulli beam theory. The Galerkin method is then used to obtain the temporal ordinary differential equations and therefore to perform vibration analysis. For the purpose of vibration control, piezoelectric patches are used as sensors to measure the displacement of the beam and as actuators to implement control forces. A model-free adaptive fuzzy sliding mode controller is utilized to suppress the vibration of the rotating carbon nanotube reinforced composite beam. Since the plant’s state vector cannot be measured for control purposes and only the piezoelectric sensor’s output is available, a model-free adaptive fuzzy sliding mode observer is proposed here. Simulation studies demonstrate the effectiveness of the proposed method.
Environmental and sound divergence effects on the performance of rectangular sonic crystals with Helmholtz resonators
Authors: Lee Hsiao Mun , Lim Kian Meng , Lee Heow Pueh
Published: January 2017

Environmental and sound divergence effects on the noise attenuation performance of rectangular sonic crystals with Helmholtz resonators were investigated using experimental methods. The experiments were conducted under indoor, semi-indoor, and outdoor conditions. The positions of the noise source and receiver were rotated to different angles to study the sound divergence effects on the sonic crystals. For a full array of sonic crystals, performance of the sonic crystals at indoor and semi-indoor were similar and poorer than outdoor at all frequencies. The presence of Helmholtz resonators caused a significant amount of insertion loss at 1000 Hz for experiments that were indoors and outdoors. 1000 Hz was the designed resonant frequency produced by the Helmholtz resonators. The reduction of the number of columns of the sonic crystals resulted in greater negative insertion loss in all three environment conditions. The sound divergence effects on the sonic crystals were greater for frequencies above 800 Hz and they were less significant for frequencies below 800 Hz. The types of noises had noticeable effects on insertion loss obtained by the sonic crystals. Numerical simulations were performed to investigate the dispersion properties of the sonic crystals. Numerical results with and without Helmholtz resonators generally showed similar trends with the corresponding experimental results.
Employers: Quality Takers or Quality Makers?
Authors: Fraser Irene , McNamara Peggy
Published: January 2017

This article provides a synthesis of past research to help understand the extent to which employers are using their considerable market power to drive health care quality. Are employers quality takers or quality makers? The literature provides some clues about aspects of quality employers are attempting to influence, strategies they are pursuing to influence quality, and their impact. Some employers are interested in some indicators of quality and are incorporating them in a variety of different purchasing strategies. The indicators most frequently used by employers, however, probably are not the ones that clinical experts and policy makers would select as most reflective of clinical quality. It appears that employers as a group are becoming more informed quality takers but are not yet quality makers—with the exception of a few well-resourced outliers. Recent events provide mixed signals about whether the future employer role in influencing quality will diminish, stall, or flourish.
Wrestling with Typology: Penetrating the “Black Box” of Managed Care by Focusing on Health Care System Characteristics
Authors: Brach Cindy , Sanches Linda , Young Donald , Rodgers James , Harvey Holly , McLemore Thomas , Fraser Irene
Published: January 2017

The health care system has undergone a fundamental transformation undermining the usefulness of the typology of the health maintenance organization, the independent practice association, the preferred provider organization, and so forth. The authors present a new approach to studying the health care system. In matrix form, they have identified a set of organizational and delivery characteristics with the potential to influence outcomes of interest, such as access to services, quality, health status and functioning, and cost. The matrix groups the characteristics by domain—financial features, structure, care delivery and management policies, and products—and by key roles in the health care system—sponsor, plan, provider intermediary organization, and direct services provider. The matrix is a tool for researchers, administrators, clinicians, data collectors, regulators, and other policy makers. It suggests a new set of players to be studied, emphasizes the relationships among the players, and provides a checklist of independent, control, and interactive variables to be included in analyses.
Mental Health Carve-Outs: Effects and Implications
Authors: Grazier Kyle L. , Eselius Laura L.
Published: January 2017

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a “carve-out.” Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy’s effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.
HEDIS Measures and Managed Care Enrollment
Authors: Scanlon Dennis P. , Chernew Michael
Published: January 2017

This article examines the relationship between 1996 health plan enrollment and both HEDIS-based plan performance ratings and individual HEDIS measures. Data were obtained from a large firm that collected, aggregated, and disseminated plan performance ratings to its employees. Plan market share regressions are estimated controlling for out-of-pocket price and model type in addition to the plan ratings and HEDIS measures. The results suggest that employees did not respond strongly to the provided ratings. There are several potential explanations for the lack of response, including difficulty understanding the ratings and never having seen them. In addition, employees may base their plan choices on information that is obtained from their own past experience, friends, family, and colleagues. The pattern of results suggests that such information is important. Counterintuitive signs most likely reflect an inverse correlation between some HEDIS ratings (or measures) and attributes employees observe informally.
Initiating a Clinical Trials Cooperative Group in an Increasingly Managed Care Environment: Successes and Problems in Establishing Collaboration
Authors: Baum Herbert M. , Logemann Jerilyn A. , Stenzel Barbara A.
Published: January 2017

The Communication Sciences and Disorders Clinical Trials Research Group (CSDRG) was organized in 1995 and funded in 1997 by the National Institute of Deafness and Other Communication Disorders (NIDCD) as a cooperative clinical trials group. It designs and conducts multiinstitutional randomized clinical trials focusing on treatments delivered by speech-language pathologists (SLPs) and audiologists for disorders of speech, language, hearing, balance, and voice/swallowing. Data are presented on a comparison of the number of site participants from the group’s onset in 1995 through 31 December 1997. Successes and problems experienced by CSDRG are defined with regard to organizing the group and designing and conducting clinical trials in a managed care environment with nonprimary care professionals. Different barriers to participation are identified at various levels of care/types of institutions and with various types of patient populations, for example, children receiving their health care through the schools versus elderly, demented individuals in nursing care facilities.
Self-Rationing Efficiency of Repeated Eating-Out Expenses
Authors: Sharma Amit
Published: January 2017

Individuals use self-imposed mental constraints as a guide to make frequent consumption choices. Recent studies, however, suggest that such mental self-rationing processes may be inefficient. The purpose of this real-life experimental study was to investigate the self-rationing efficiency of households’ repeated purchases. Eating-out expenditures take up over half of the food expenditures among families. This study investigated efficiency of eating-away-from-home budget. The results of this study show the classic response by households of adjusting up the eating-away-from-home budget over time when asked to explicitly declare their budgets, suggesting inefficiency in the mental self-rationing process. We also investigated whether repeated experiences could improve the efficiency of self-rationing and found results to the contrary. Experience was positively related to self-rationing inefficiency. We discuss contributions to the literature in regard to self-rationing of repeated expenses and the implications for practice and policy, especially given that experience could further increase inefficiencies.
Torsional analysis of hollow members with sandwich wall
Authors: Taheri Fatemeh , Hematiyan Mohammad R
Published: January 2017

This paper proposes an analytical formulation for torsional analysis of thin-walled and moderately thick-walled hollow members with sandwich wall. The sandwich rod can have a complicated cross-section including straight and curved edges. The material and thickness of the two faces of the sandwich are assumed the same. Prandtl’s stress function is used to formulate the problem for faces and core, while the continuity and compatibility conditions at the face–core interfaces are also used to complete the formulation. By the presented method, it is possible to find the torsional stiffness and the shearing stress in the cross-section. By presenting several numerical examples, the accuracy of the presented method is demonstrated. The accuracy of the solutions resulting from the proposed method is demonstrated by comparing the results with accurate solutions obtained from the finite element method with a fine mesh. The effects of different geometrical and material parameters on the accuracy of the solutions are studied too. The presented formulation is quite practical and is employable for analyzing the torsion of thin- and moderately tick-walled sandwich members.
The Microbiome and Complement Activation: A Mechanistic Model for Preterm Birth
Authors: Dunn Alexis B. , Dunlop Anne L. , Hogue Carol J. , Miller Andrew , Corwin Elizabeth J.
Published: January 2017

Preterm birth (PTB, <37 completed weeks’ gestation) is one of the leading obstetrical problems in the United States, affecting approximately one of every nine births. Even more concerning are the persistent racial disparities in PTB, with particularly high rates among African Americans. There are several recognized pathophysiologic pathways to PTB, including infection and/or exaggerated systemic or local inflammation. Intrauterine infection is a causal factor linked to PTB thought to result most commonly from inflammatory processes triggered by microbial invasion of bacteria ascending from the vaginal microbiome. Trials to treat various infections have shown limited efficacy in reducing PTB risk, suggesting that other complex mechanisms, including those associated with inflammation, may be involved in the relationship between microbes, infection, and PTB. The complement system, a key mediator of the inflammatory response, is an innate defense mechanism involved in both normal physiologic processes that occur during pregnancy implantation and processes that promote the elimination of pathogenic microbes. Recent research has demonstrated an association between this system and PTB. The purpose of this article is to present a mechanistic model of inflammation-associated PTB, which hypothesizes a relationship between the microbiome and dysregulation of the complement system. Exploring the relationships between the microbial environment and complement biomarkers may elucidate a potentially modifiable biological pathway to PTB.
No evidence of disease activity in patients receiving daclizumab versus intramuscular interferon beta-1a for relapsing-remitting multiple sclerosis in the DECIDE study
Authors: Kappos Ludwig , Havrdova Eva , Giovannoni Gavin , Khatri Bhupendra O , Gauthier Susan A , Greenberg Steven J , You Xiaojun , Wang Ping , Giannattasio Giorgio
Published: January 2017

Background:

No evidence of disease activity (NEDA) is a composite endpoint being increasingly applied as an outcome measure in clinical trials as well as proposed for individual therapeutic decisions in multiple sclerosis (MS).

Objective:

Assess the proportion of patients with relapsing-remitting MS achieving NEDA in the DECIDE study of daclizumab 150 mg subcutaneous versus intramuscular interferon beta-1a 30 µg for 96–144 weeks.

Methods:

NEDA was defined as no relapses, no onset of 12-week confirmed disability progression (CDP), no new/newly enlarging T2 hyperintense lesions (NET2), and no gadolinium-enhancing (Gd+) lesions. Logistic regression models adjusted for baseline covariates compared treatment groups for baseline to week 96, weeks 0–24, and weeks 24–96.

Results:

From baseline to week 96, more daclizumab versus intramuscular interferon beta-1a patients achieved NEDA (24.6% vs 14.2%; odds ratio (OR; 95% confidence interval): 2.059 (1.592−2.661); p < 0.0001). ORs for clinical NEDA (no relapses, no CDP) and magnetic resonance imaging (MRI) NEDA (no NET2, no Gd+ lesions) were 1.651 (1.357−2.007; p < 0.0001) and 2.051 (1.628−2.582; p < 0.0001), respectively. ORs in favor of daclizumab for weeks 24–96 were consistently higher than for weeks 0–24.

Conclusion:

More daclizumab versus intramuscular interferon beta-1a patients achieved NEDA early in DECIDE, with effects increasing over time.
Temperature dependence of multiple sclerosis mortality rates in the United States
Authors: Sun Hongbing
Published: January 2017

Background:

It is well known that multiple sclerosis (MS) patients are very sensitive to heat events. However, how MS patients respond to the significant temperature difference between the high- and low-latitude regions is not understood.

Objective:

The goal is to identify the primary factor responsible for the fact that MS mortality rates of the United States is more than three times higher in the northern states than in the southern states.

Methods:

Correlation coefficients between the age-adjusted mortality rate of MS as the underlying cause of death and the state average temperature, altitude, latitude, duration of sunshine hours, and solar radiation in the 48 contiguous states were compared.

Results:

MS mortality rates correlate significantly and inversely with temperatures in the 48 states (correlation coefficient r = −0.812 and significance p = 0.00). Durations of sunshine hours and solar radiation do not correlate significantly with MS mortality rates ( r = −0.245, −0.14, and p = 0.101, 0.342, respectively).

Conclusion:

High environmental temperature is the primary reason for the low MS mortality rates and likely the low MS prevalence in low-latitude regions. Implication of the study result is that benefits of long-term heat acclimation through gradual and prolonged exposure to environmental heat for MS patients may be greatly underappreciated.
Evaluating a complex research capacity-building intervention: Reflections on an evaluation of the African Institutions Initiative
Authors: Marjanovic Sonja , Cochrane Gavin , Robin Enora , Sewankambo Nelson , Ezeh Alex , Nyirenda Moffat , Bonfoh Bassirou , Rweyemamu Mark , Chataway Joanna
Published: January 2017

There is increasing policy demand for real-time evaluations of research and capacity-building programmes reflecting a recognition of the management, governance and impact gains that can result. However, the evidence base on how to successfully implement real-time evaluations of complex interventions in international development efforts is scarce. There is therefore a need for reflective work that considers methodologies in context. This article shares learning from the experience of conducting a participatory, real-time, ‘theory driven’ evaluation of the African Institutions Initiative, a Wellcome Trust-funded programme that aimed to build sustainable health research capacity in Africa at institutional and network levels, across seven research consortia. We reflect on the key challenges experienced and ways of managing them, highlight opportunities and critical success factors associated with this evaluation approach, compared with alternative evaluation approaches.
The Influence of Apolipoprotein E on the Interactions between Normal Human Very Low Density Lipoproteins and U937 Human Macrophages: Heterogeneity among Persons
Authors: Sacks Frank M , Krukonis Gregory P
Published: January 2017

Apolipoprotein E (apo E) can mediate the cell binding of normal human very low density lipoproteins (VLDL). However, the extent to which apo E is involved in the cell binding and uptake of VLDL from different normolipidemic persons is not well defined. The VLDL ( d< 1.006 g/I) of eight subjects were fractionated into VLDL with apo E and without apo E using a monoclonal antibody that binds to the LDL receptor recognition region of apo E. VLDL particles that expressed the 1D7 binding region of apo E comprised an average of 34% (range 7–51%) of the VLDL particles. Anti-apo E blocked an average of 43% (range 8–63%) of the binding of unfractionated VLDL to U937 cells. Anti-apo E blocked a similar proportion of binding to U937 cells of three VLDL subfractions of different density ranges (Sf20–60, Sf60–100, Sf100–400). The proportion of the VLDL particles that contained apo E correlated with the extent of uptake of the total VLDL by U937 cells, but not with stimulation by total VLDL of cholesterol ester formation. The binding to cells of VLDL without apo E varied by six-fold among persons, and caused most of the binding of the total VLDL of some subjects. Therefore, normolipidemic VLDL contains particles across its density range that use apo E to bind to U937 macrophages. In some VLDL samples, apo E provides most of the cell binding activity, whereas in others the binding activity occurs by other means.
Skeletal Muscle Metabolism as a Target for Drug Therapy in Peripheral Arterial Disease
Authors: Brass Eric P
Published: January 2017

Peripheral arterial disease (PAD) is an atherosclerotic disease which modifies lower extremity hemodynamics. There is considerable evidence that skeletal muscle metabolism is altered in PAD. Several studies have demonstrated altered mitochondrial enzyme content in PAD muscle as compared with controls, and enzyme activity may not increase normally in PAD with exercise training. A variety of metabolic intermediates, including acylcarnitines, accumulate in muscle of PAD patients, suggesting incomplete oxidative metabolism. Studies employing 31P-NMR (nuclear magnetic resonance) also suggest a metabolic myopathy in PAD. Strikingly, while hemodynamics do not predict claudication-limited performance, metabolic injury as evidenced by acylcarnitine accumulation is strongly correlated with patients' functional status in PAD. Further, exercise rehabilitation improves claudication-limited performance without modifying large vessel hemodynamics. The stress placed on skeletal muscle during exercise in PAD and the observed evidence of metabolic dysfunction is similar to ischemia/reperfusion injury in cardiac muscle. Recognition of the role of cellular metabolic injury and function in PAD has formed the basis for novel therapeutic strategies in this disease.
Prototypes of drinkers and accessibility of injunctive norms predict college drinking
Authors: Rhodes Nancy , Loiewski Christopher , Potocki Bridget , Ralston Rachel
Published: January 2017

A self-report survey of first-year college students ( n = 421; 46% female) included measures of perceived prototype, attitude and injunctive norm accessibility, past drinking behavior, and future drinking intention. Both norm accessibility and prototype perception were significant predictors of intention to drink in the future among first-year college students. The effect of prototypes on drinking diminished as pro-drinking norms became more accessible, indicating greater automaticity of drinking decision-making. Theoretical models of drinking intention should include both normative constructs and prototypes. Implications for interventions to reduce college student drinking are discussed.
Rethinking the relationship between socio-economic status and health: Making the case for sociological theory in health inequality research
Authors: Øversveen Emil , Rydland Håvard T. , Bambra Clare , Eikemo Terje A.
Published: January 2017

Aim: The aim of this study is to analyse previous explanations of social inequality in health and argue for a closer integration of sociological theory into future empirical research. Methods: We examine cultural-behavioural, materialist, psychosocial and life-course approaches, in addition to fundamental cause theory. Giddens’ structuration theory and a neo-materialist approach, inspired by Bruno Latour, Gilles Deleuze and Felix Guattari, are proposed as ways of rethinking the causal relationship between socio-economic status and health. Conclusions:Much of the empirical research on health inequalities has tended to rely on explanations with a static and unidirectional view of the association between socio-economic status and health, assuming a unidirectional causal relationship between largely static categories. We argue for the use of sociological theory to develop more dynamic models that enhance the understanding of the complex pathways and mechanisms linking social structures to health.
Does Rapid Intraoperative Parathyroid Hormone Analysis Predict Cure in Patients Undergoing Surgery for Primary Hyperparathyroidism?
Authors: Nilsen F. S. , Haug E. , Heidemann M. , Karlsen S. J.
Published: January 2017

Background and Aims:

Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia.

Material and Methods:

One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results.

Results:

The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively.

Conclusions:

A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.
Hip Fracture Treatment in Oulu — One-Year Survey with Four-Month Follow-Up
Authors: Saarenpää I. , Heikkinen T. , Partanen J. , Jalovaara P.
Published: January 2017

Backgrounds and Aims:

The standardized forms of the Standardized Audit of Hip Fractures in Europe (SAHFE) are aimed for the evaluation of hip fracture treatment in different hospitals and countries. The purpose was to evaluate and characterize a cohort of hip fracture patients with these forms and to evaluate their value in quality control.

Material and Methods:

The non-pathological hip fractures in patients over 49 years of age treated in the Oulu University Hospital were prospectively recorded during a one-year period using SAHFE forms.

Results:

There were 238 (52 male and 186 female) patients with a mean age of 78 (50–102) years. Fifty-nine percent of the patients were admitted from their own homes. Fifty-seven percent were able to walk alone outdoors and 48% could walk without walking aids before the fracture. A hundred and fifty patients had cervical fractures and 88 trochanteric fractures. The most frequent treatment of cervical fractures was Austin-Moore hemiarthroplasty (68%) and that of trochanteric fractures Gamma nail fixation (86%). At four months after the fracture, 50% lived in their own homes, 33% could walk alone out-doors and 13% could walk without any aids. Thirty-two percent had no pain in the hip. The overall mortality at four months was 17.6% and that of the operated patients 16.2%. The reoperation rate was 8.5%.

Conclusion:

SAHFE forms were very useful in the evaluation of the quality of the hip fracture treatment.
Pancreatic Injuries in the United Arab Emirates
Authors: Ahmad I. , Branicki F. J. , Ramadhan K. , El-Ashaal Y. , Abu-Zidan F. M.
Published: January 2017

Purpose:

To study the mechanism, management and outcome of patients who had sustained pancreatic trauma.

Methodology:

Patients who were treated for pancreatic trauma in Al-Ain hospital between October 2002 and August 2007 were retrospectively studied.

Results:

All eleven patients were males having a median age of 30 years (range 24–52 years). Nine had blunt trauma while two had suffered penetrating injury. Three presented with shock. Associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury. Early serum amylase was elevated in six patients. CT abdomen was diagnostic for pancreatic injury in seven patients. Two cases were missed by early CT scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater. All patients underwent laparotomy. Five patients were treated by drainage alone, four had distal pancreatectomy, abdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. Median hospital stay was 25 days (range 12–152 days). Two patients (18%) died.

Conclusions:

Blunt trauma is the main cause of pancreatic injury in our country. Early CT scan may miss pancreatic injury in almost a quarter of the patients. Thin sliced CT scan, with special views in a dedicated abdominal pancreatic study, is recommended. A high index of clinical suspicion, depending on the mechanism of injury, is important for diagnosis of pancreatic injury. Mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury, especially in haemodynamically unstable patients.
Haemodynamics and Acid-Base Equilibrium after Cardiac Surgery: Comparison of Rapidly Degradable Hydroxythyl Starch Solutions and Albumin
Authors: Niemi T. , Schramko A. , Kuitunen A. , Kukkonen S. , Suojaranta-Ylinen R.
Published: January 2017

Background:

Stable haemodynamics is often achieved by administration of colloids after cardiac surgery. We conducted a prospective, randomized, open-label study comparing haemodynamics and acid-base equilibrium after infusion of two rapidly degradable hydroxyethyl starch (HES) solutions or human albumin (HA) to cardiac surgical patients.

Materials and Methods:

45 patients received a predetermined fixed dose of 15 ml kg−1 of either 6% HES (MW 130 kDa, n=15), 6% HES (MW 200 kDa, n=15) or 4% HA (MW 69 kDa, n=15) after on-pump cardiac surgery.

Results:

Left ventricular filling pressures assessed using pulmonary artery catheter responded similarly in all groups. Mean (SD) cardiac index was higher in HES130 [3.5 1 min−1 m−2 (0.7)] and HES200 [3.5 1 min−1 m−2 (0.5)] than in HA [2.8 1 min−1 m−2 (0.6)] group after completion of infusion (P=0.002) but no differences were detected at 2 and 18 hours. Oxygen delivery increased in both HES groups but not in HA group. After cessation of infusion base excess was the most negative in HA group. At 2 hours mean (SD) base excess was higher in HWS130 [0 (1.32)] than in HES200 [-1.32 (2.27)] and HA [-2.3 (1.3)] group (P=0.002, between the groups).

Conclusions:

We conclude that the effect of albumin on cardiac performance is inferior than that of HES130 or HES200 in early postoperative phase after cardiac surgery. HES130 induces no alterations in acid-base equilibrium whereas a negative base excess was observed after HA infusion.
The Impact of Proximal Femur Geometry on Fracture Type — A Comparison between Cervical and Trochanteric Fractures with Two Parameters
Authors: Panula J. , Sävelä M. , Jaatinen P. T. , Aarnio P. , Kivelä S.-L.
Published: January 2017

Introduction:

Only a few studies have tested the ability of proximal femur geometry parameters to discriminate between cervical hip fractures and those of the trochanter. The main objective of this study was to evaluate the geometrical differences between these two fracture types by measuring the neck shaft angle (NSA) and the femoral neck axis length (FNAL). We also compared the distributions of these parameters and the distributions of fracture type by gender.

Material and Methods:

A retrospective analysis was made in a population-based material of 428 hip fractures collected during a two-year period from 1999 to 2000 (323 women and 105 men aged 65 years or older). NSA and FNAL were manually measured from pelvic radiographs.

Results:

No significant differences in NSA or FNAL were found between cervical and trochanteric hip fractures in women or in men. Men had significantly higher NSA and FNAL than women. Age was not related to these geometrical parameters. The distributions by fracture type were similar in both genders.

Conclusions:

The different pathogenesis of cervical and trochanteric hip fractures cannot be explained by NSA or FNAL. A standardized measurement setup is needed when evaluating the role of hip geometry in fracture patients.
The Optimal Timing of Baseline Radiostereometric Analysis of Uncemented Press Fit Cups
Authors: Wolf O. , Milbrink J. , Larsson S. , Mattsson P. , Mallmin H.
Published: January 2017

Background and Aims:

The baseline radiostereometric analysis (RSA) is usually performed during the first postoperative week. We investigated the micromotion of two uncemented press fit acetabular cups during the first week after total hip arthroplasty.

Material and Methods:

All study patients had unilateral osteoarthritis of the hip and received an uncemented THA combination consisting of a CLS stem and either an Allofit or an Interop acetabular cup. The study group consisted of 24 patients who underwent RSA within 1 hour after skin closure, and at 1 and 7 days after surgery.

Results:

The upper limit of the 95% confidence interval for micromotion was less than or close to the precision of the method for all studied directions during the first week after surgery. Mean values indicate proximal and medial translation of the uncemented cup at one week.

Conclusions:

We found only minimal micromotion, barely above the precision limit, measured as medial and proximal translations of these uncemented cups. This indicates that the first postoperative RSA measurement following a primary THA with an uncemented press fit acetabular cup should be made as early as possible after the first postoperative day.