bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term effects of delayed-release dimethyl fumarate in multiple sclerosis: Interim analysis of ENDORSE, a randomized extension study
Authors: Gold Ralf , Arnold Douglas L , Bar-Or Amit , Hutchinson Michael , Kappos Ludwig , Havrdova Eva , MacManus David G , Yousry Tarek A , Pozzilli Carlo , Selmaj Krysztof , Sweetser Marianne T , Zhang Ray , Yang Minhua , Potts James , Novas Mark , Miller David H , Kurukulasuriya Nuwan C , Fox Robert J , Phillips Theodore J
Published: May 2016

Background:

Delayed-release dimethyl fumarate (DMF) demonstrated strong efficacy and a favorable benefit–risk profile for patients with relapsing–remitting multiple sclerosis (RRMS) in phase 3 DEFINE/CONFIRM studies. ENDORSE is an ongoing long-term extension of DEFINE/CONFIRM.

Objective:

We report efficacy and safety results of a 5-year interim analysis of ENDORSE (2 years DEFINE/CONFIRM; minimum 3 years ENDORSE).

Methods:

In ENDORSE, patients randomized to DMF 240 mg twice (BID) or thrice daily (TID) in DEFINE/CONFIRM continued this dosage, and those initially randomized to placebo (PBO) or glatiramer acetate (GA) were re-randomized to DMF 240 mg BID or TID.

Results:

For patients continuing DMF BID (BID/BID), annualized relapse rates were 0.202, 0.163, 0.139, 0.143, and 0.138 (years 1–5, respectively) and 63%, 73%, and 88% were free of new or enlarging T2 hyperintense lesions, new T1 hypointense lesions, and gadolinium-enhanced lesions, respectively, at year 5. Adverse events (AEs; serious adverse events (SAEs)) were reported in 91% (22%; BID/BID), 95% (24%; PBO/BID), and 88% (16%; GA/BID) of the patients. One case of progressive multifocal leukoencephalopathy was reported in the setting of severe, prolonged lymphopenia.

Conclusion:

Treatment with DMF was associated with continuously low clinical and magnetic resonance imaging (MRI) disease activity in patients with RRMS. These interim data demonstrate a sustained treatment benefit and an acceptable safety profile with DMF.
Integrating genome-wide association studies and gene expression data highlights dysregulated multiple sclerosis risk pathways
Authors: Liu Guiyou , Zhang Fang , Jiang Yongshuai , Hu Yang , Gong Zhongying , Liu Shoufeng , Chen Xiuju , Jiang Qinghua , Hao Junwei
Published: May 2016

Background:

Much effort has been expended on identifying the genetic determinants of multiple sclerosis (MS). Existing large-scale genome-wide association study (GWAS) datasets provide strong support for using pathway and network-based analysis methods to investigate the mechanisms underlying MS. However, no shared genetic pathways have been identified to date.

Objective:

We hypothesize that shared genetic pathways may indeed exist in different MS-GWAS datasets.

Methods:

Here, we report results from a three-stage analysis of GWAS and expression datasets. In stage 1, we conducted multiple pathway analyses of two MS-GWAS datasets. In stage 2, we performed a candidate pathway analysis of the large-scale MS-GWAS dataset. In stage 3, we performed a pathway analysis using the dysregulated MS gene list from seven human MS case–control expression datasets.

Results:

In stage 1, we identified 15 shared pathways. In stage 2, we successfully replicated 14 of these 15 significant pathways. In stage 3, we found that dysregulated MS genes were significantly enriched in 10 of 15 MS risk pathways identified in stages 1 and 2.

Conclusion:

We report shared genetic pathways in different MS-GWAS datasets and highlight some new MS risk pathways. Our findings provide new insights on the genetic determinants of MS.
Cortical functional modifications following optic neuritis
Authors: Benoliel Tal , Raz Noa , Ben-Hur Tamir , Levin Netta
Published: May 2016

Background:

We have recently suggested that delayed visual evoked potential (VEP) latencies in the fellow eye (FE) of optic neuritis patients reflect a cortical adaptive process, to compensate for the delayed arrival of visual information via the affected eye (AE).

Objective:

To define the cortical mechanism that underlies this adaptive process.

Methods:

Cortical activations to moving stimuli and connectivity patterns within the visual network were tested using functional magnetic resonance imaging (MRI) in 11 recovered optic neuritis patients and in 11 matched controls.

Results:

Reduced cortical activation in early but not in higher visual areas was seen in both eyes, compared to controls. VEP latencies in the AEs inversely correlated with activation in motion-related visual cortices. Inter-eye differences in VEP latencies inversely correlated with cortical activation following FE stimulation, throughout the visual hierarchy. Functional correlation between visual regions was more pronounced in the FE compared with the AE.

Conclusion:

The different correlation patterns between VEP latencies and cortical activation in the AE and FE support different pathophysiology of VEP prolongation in each eye. Similar cortical activation patterns in both eyes and the fact that stronger links between early and higher visual areas were found following FE stimulation suggest a cortical modulatory process in the FE.
Effects of smoking on central blood pressure and pressure amplification in hypertension of the young
Authors: Saladini Francesca , Benetti Elisabetta , Fania Claudio , Mos Lucio , Casiglia Edoardo , Palatini Paolo
Published: May 2016

The aim of this study was to investigate the effect of cigarette smoking on peripheral and central blood pressure (BP) in a group of young stage I hypertensives. A total of 344 untreated subjects from the HARVEST study were examined (mean age 37±10 years). Patients were divided into three groups based on smoking status: non-smokers, light smokers (⩽5 cigarettes/day) and moderate-to-heavy smokers (>5 cigarettes/day); and into three groups by age: 18–29, 30–39 and ⩾40 years. Central BP measurements and augmentation index (AIx) were calculated from brachial pressure waveform, with applanation tonometry, by means of the Specaway DAT System plus a Millar tonometer. The central waveform was derived from peripheral BP using the same software system of the SphygmoCor System pulse wave analysis. In addition, two indirect measurements of arterial stiffness were calculated: pulse pressure (PP) and systolic BP amplification. Central systolic BP and PP were higher in smokers than in non-smokers (systolic BP: 121.9±13.1 mmHg in non-smokers, 127.2±16.5 mmHg in light smokers, 126.7±15.3 mmHg in those who smoked >5 cigarettes/day, p=0.009; PP: 37.7±9.8 mmHg, 41.5±13.1 mmHg, 41.9±10.5 mmHg, respectively, p=0.005). Lower systolic BP amplification ( p<0.001) and PP amplification ( p=0.001) were observed in smokers compared to non-smokers. In a two-way ANCOVA analysis, systolic BP amplification markedly declined across the three age groups ( p=0.0002) and from non-smokers to smokers ( p=0.0001), with a significant interaction between smoking and age group ( p=0.05). The AIx was higher in smokers compared to non-smokers ( p=0.024). In young hypertensives, smoking has a detrimental effect on central BP, accelerating the age-related decline in BP amplification.
Preserving medical correctness, readability and consistency in de-identified health records
Authors: Pantazos Kostas , Lauesen Soren , Lippert Soren
Published: May 2016

A health record database contains structured data fields that identify the patient, such as patient ID, patient name, e-mail and phone number. These data are fairly easy to de-identify, that is, replace with other identifiers. However, these data also occur in fields with doctors’ free-text notes written in an abbreviated style that cannot be analyzed grammatically. If we replace a word that looks like a name, but isn’t, we degrade readability and medical correctness. If we fail to replace it when we should, we degrade confidentiality. We de-identified an existing Danish electronic health record database, ending up with 323,122 patient health records. We had to invent many methods for de-identifying potential identifiers in the free-text notes. The de-identified health records should be used with caution for statistical purposes because we removed health records that were so special that they couldn’t be de-identified. Furthermore, we distorted geography by replacing zip codes with random zip codes.
Remodeling of Neuronal Circuits After Reach Training in Chronic Capsular Stroke
Authors: Cho Jongwook , Kwon Dae-Hyuk , Kim Ra Gyung , Song Hanlim , Rosa-Neto Pedro , Lee Min-Cheol , Kim Hyoung-Ihl
Published: May 2016

Background. Subcortical capsular stroke has a poor prognosis, and it is not yet fully understood how and under what circumstances reach training contributes to motor recovery. Objective. This study was performed to investigate changes in neuronal circuits and motor recovery in a chronic capsular stroke model in the presence or absence of reach training. Method. We generated photothrombotic capsular lesions in 42 Sprague-Dawley rats and evaluated motor recovery with or without daily training in a single-pellet reaching task (SPRT). We used 2-deoxy-2-[18F]-fluoro-D-glucose-microPET (positron emission tomography) to assess remodeling of neuronal circuits. Results. SPRT training was selectively beneficial only for the group with incomplete capsular destruction ( P < .05), suggesting the relevance of plasticity in the remaining capsular fibers for motor recovery. Groups that did not receive SPRT training showed no motor recovery at all. The microPET analysis demonstrated that motor recovery was correlated with a reduction in cortical diaschisis in ipsilesional motor and sensory cortices and in the contralesional sensory cortex (Pearson’s correlation, P < .05). We also observed training-dependent subcortical activation in the contralesional red nucleus, the internal capsule, and the ventral hippocampus ( P < .0025; false discovery rate q < 0.05). The groups without reach training did not show the same degree of reduction in diaschisis or activation of the red nucleus. Conclusions. Our results suggest that motor recovery and remodeling of neuronal circuits after capsular stroke depend on the magnitude of the capsular lesion and on the presence or absence of reach training. Task-specific training is strongly indicated only when there is incomplete destruction of the capsular fibers.
Special dynamic behavior of an aluminum alloy and effects on energy absorption in train collisions
Authors: Yang Chao , Li Duo , Zhu Tao , Xiao Shoune
Published: May 2016

Dynamic tension tests and compression tests were carried out for 5083-H111 aluminum alloy to investigate the dynamic mechanical behavior and its effect on energy absorption characteristics of an energy-absorbing device. The material constitutive relations were obtained at various levels of strain rates by means of tests. Three material models were performed on the energy-absorbing device of railway vehicles. We investigated the influence of the material dynamic behavior on the energy absorption capability. The results indicate that 5083-H111 aluminum alloy is endowed with negative strain rate sensitivity at medium–low strain rates and possesses the feature of negative and then positive strain rate sensitivity in the range of medium strain rates. The material presents obvious strain rate strengthening effect at high strain rates. Moreover, the order of magnitudes of the strain rate in the train collision is 0–2. It belongs to the medium strain rate. The practical absorbed energy of the structure made of 5083-H111 alloy is less than that of the same structure without regard to the strain rate effect in design phases.
Applying the guidelines for pharmacists integrating into primary care teams
Authors: Barry Arden R. , Pammett Robert T.
Published: May 2016

Background:

In 2013, Jorgenson et al. published guidelines for pharmacists integrating into primary care teams. These guidelines outlined 10 evidence-based recommendations designed to support pharmacists in successfully establishing practices in primary care environments. The aim of this review is to provide a detailed, practical approach to implementing these recommendations in real life, thereby aiding to validate their effectiveness.

Methods:

Both authors reviewed the guidelines independently and ranked the importance of each recommendation respective to their practice. Each author then provided feedback for each recommendation regarding the successes and challenges they encountered through implementation. This feedback was then consolidated into agreed upon statements for each recommendation.

Results and Discussion:

Focusing on building relationships (with an emphasis on face time) and demonstrating value to both primary care providers and patients were identified as key aspects in developing these new roles. Ensuring that the environment supports the practice, along with strategic positioning within the clinic, improves uptake and can maximize the usefulness of a pharmacist in primary care. Demonstrating consistent and competent clinical and documentation skills builds on the foundation of the other recommendations to allow for the effective provision of clinical pharmacy services. Additional recommendations include developing efficient ways (potentially provider specific) to communicate with primary care providers and addressing potential preconceived notions about the role of the pharmacist in primary care.

Conclusion:

We believe these guidelines hold up to real-life integration and emphatically recommend their use for new and existing primary care pharmacists.
A Crowded Stage: The Legitimate Borrowings of Henry Milner’s Mazeppa
Authors: Barnes Lucy
Published: May 2016

In this article, I examine Henry M. Milner’s remarkably successful 1831 equestrian adaptation of Lord Byron’s poem, Mazeppa (1819). The play is not only an adaptation of Byron, since it also draws upon Shakespearean plays including Romeo and Juliet and Macbeth to realign Byron’s poem for a popular audience. Milner uses hippodramatic techniques, and allusions to Romeo and Macbeth, in order to transform Mazeppa’s story from a representation of isolated endurance to a portrayal of his social rise from page to prince. By paying careful attention to the dramatic inventiveness and cultural resonance of Milner’s use of hippodramatic effects and Shakespearean allusions to adapt Byron’s poem for the popular stage, I shall argue that this play challenges assumptions that nineteenth-century theatrical adaptations are purely derivative and lack merit. Rather, I suggest that the value of such adaptive work lies in its capacity to reveal broader cultural shifts within nineteenth-century theatre.
Blood Pressure Monitoring for the Anesthesiologist: A Practical Review
Authors: Bartels Karsten , Esper Stephen A. , Thiele Robert H.
Published: May 2016

Periodic, quantitative measurement of blood pressure (BP) in humans, predating the era of evidence-based medicine by over a century, is a component of the American Society of Anesthesiologists standards for basic anesthetic monitoring and is a staple of anesthetic management worldwide. Adherence to traditional BP parameters complicates the ability of investigators to determine whether particular BP ranges confer any clinical benefits. The BP waveform is a complex amalgamation of both antegrade and retrograde (reflected) pressure waves and is affected by vascular compliance, distance from the left ventricle, and the 3D structure of the vascular tree. Although oscillometry is the standard method of measuring BP semicontinuously in anesthetized patients and is the primary form of measurement in >80% of general anesthetics, major shortcomings of oscillometry are its poor performance at the extremes and its lack of information concerning BP waveform. Although arterial catheterization remains the gold standard for accurate BP measurement, 2 classes of devices have been developed to noninvasively measure the BP waveform continuously, including tonometric and volume clamp devices. Described in terms of a feedback loop, control of BP requires measurement, an algorithm (usually human), and an intervention. This narrative review article discusses the details of BP measurement and the advantages and disadvantages of both noninvasive and invasive monitoring, as well as the principles and algorithms associated with each technique.
Asceticism, Dissent, and the Tudor State: Richard Whitford's Rule for Lay Householders
Authors: Appleford Amy
Published: May 2016

Richard Whitford's A Work for Householders constructs a model of household governance organized around the contemplative life of the lay householder and his pastoral command over his familia. A Work for Householder's companion text, A Daily Exercise of Death, centers on willed self-negation, teaching the householder monastic ascetic practices that emphasize rejection of the world and direct obedience to God. Together the manuals, which circulated widely during England's violent 1530s, work to interrupt the absorption of the Christian pastorate by secular state power. They do this by describing the household as a distinct locus of spiritual counsel, a self-enclosed unit that has only generalized interactions with other sites of religious authority. Lay piety in these texts does not aim to shelter its audience from the turmoil of surrounding events. Instead, the contemplative turn in Whitford's compilation explicitly absorbs the political, using it as fodder for potentially activist and resistant praxes.
Meiotic onset is reliant on spatial distribution but independent of germ cell number in the mouse ovary
Authors: Arora Ripla , Abby Emilie , Ross Adam D. J. , Cantu Andrea V. , Kissner Michael D. , Castro Vianca , Ho Hsin-Yi Henry , Livera Gabriel , Laird Diana J.
Published: May 2016

Mouse ovarian germ cells enter meiosis in a wave that propagates from anterior to posterior, but little is known about contribution of germ cells to initiation or propagation of meiosis. In a Ror2 mutant with diminished germ cell number and migration, we find that overall timing of meiotic initiation is delayed at the population level. We use chemotherapeutic depletion to exclude a profoundly reduced number of germ cells as a cause for meiotic delay. We rule out sex reversal or failure to specify somatic support cells as contributors to the meiotic phenotype. Instead, we find that anomalies in the distribution of germ cells as well as gonad shape in mutants contribute to aberrant initiation of meiosis. Our analysis supports a model of meiotic initiation via diffusible signal(s), excludes a role for germ cells in commencing the meiotic wave and furnishes the first phenotypic demonstration of the wave of meiotic entry. Finally, our studies underscore the importance of considering germ cell migration defects while studying meiosis to discern secondary effects resulting from positioning versus primary meiotic entry phenotypes.
Counting calories in cormorants: dynamic body acceleration predicts daily energy expenditure measured in pelagic cormorants
Authors: Stothart Mason R. , Elliott Kyle H. , Wood Thomas , Hatch Scott A. , Speakman John R.
Published: May 2016

The integral of the dynamic component of acceleration over time has been proposed as a measure of energy expenditure in wild animals. We tested that idea by attaching accelerometers to free-ranging pelagic cormorants (Phalacrocorax pelagicus) and simultaneously estimating energy expenditure using doubly-labelled water. Two different formulations of dynamic body acceleration, VeDBA and ODBA, correlated with mass specific energy expenditure (both R2=0.91). VeDBA models combining and separately parameterizing flying, diving, activity on land and surface swimming were consistently considered more parsimonious than time budget models and showed less variability in model fit. Additionally, we observed provisional evidence for the presence of hypometabolic processes (i.e. reduced heart rate and body temperature; shunting of blood away from non-essential organs) that suppressed metabolism in cormorants while diving, which was the most metabolically important activity. We concluded that a combination of VeDBA and physiological processes accurately measured energy expenditure for cormorants.
Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit
Authors: Kripke Daniel F.
Published: May 2016

This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.
Social and design activity in the sphere of the state educational policy in the Russian Federation
Authors: Кузнецова  , Kuznetsova Lada
Published: May 2016

In this article specifics of social and design activity in a modern education system as one of the most important institutes of the state are considered. The analysis of tools of social design is provided in the educational sphere. The author has revealed the main directions of modernization of Russian education via mechanisms of social and design activity. The main priorities of development of this technology in system of Russian education are defined.
Nutrition and the young performance horse
Authors: Mitchell Briony
Published: May 2016

Briony Mitchell MSc (Hons) senior nutritionist at Baileys Horse Feeds discusses the impact nutrition when feeding the weanling to five year old
Have a royal celebration
Authors: Chapman Ailsa
Published: May 2016

Creating a display to mark the Queen's 90th birthday is a way to explore national identity. By Ailsa Chapman.
The Call to Terrorism and Other Weak Narratives: Identification As Disruptive Technique
Authors: Maan Ajit
Published: May 2016

This paper explores the relationship between narrative, identity, and violent action, and will offer techniques for disrupting the relationship between violence and identity. The argument proceeds by first demonstrating the non-universality of Western narrative structure and the relevance of that non-universality, then documenting the correlation between narrative and identity and between identity and action, and ends with a suggestion that a successful anti-terrorism strategy should encompass conflict rather than engage it.
Media Coverage of the Arctic National Wildlife Refuge Drilling Controversy
Authors: Golden Kroner Rachel Elizabeth
Published: May 2016

Protected areas are often subject to legal changes that allow natural resource extraction to occur within their boundaries. It is important to understand how the media covers these legal changes in order to inform science communication, environmental policy, and practice. As a case study, the oil drilling controversy in the Arctic National Wildlife Refuge (ANWR), the largest protected area in the United States, was examined. ANWR contains both environmental and potential economic value, including billions of barrels of oil. Controversy over whether to drill in the 1002 region of ANWR has been ongoing since the late 1970s and has been covered extensively in the media. A content analysis of media coverage of US national and Alaskan local newspapers was conducted for 100 news articles. Contrary to expectations, it was found that on average, media coverage tended to focus more on reasons to oppose drilling. When comparing local and national sources, it was found that local news articles also focused more on opposition to drilling. Arguments against drilling included risk of oil spills and other damage to wildlife and the environment, native Eskimo perspectives, and uncertainty about the amount and value of oil in ANWR. This analysis may inform future studies on environmental controversies and public land, especially related to the influence of the media on political decisions.
Properties of Juvenile and Mature Wood and Their Effects on the Bending Properties of Lumber in Pinus taeda Growing in Tochigi, Japan
Authors: Tanabe Jun , Ishiguri Futoshi , Nakayama Miki , Ohshima Jyunichi , Iizuka Kazuya , Yokota Shiso
Published: May 2016

Five 40-year-old Pinus taeda trees growing in Tochigi, Japan, were used to evaluate juvenile wood (JW) and mature wood (MW) properties and the bending properties of lumber. The boundary between JW and MW existed from the 14th to the 19th ring from pith in the sample trees. There were obvious differences in wood properties between the JW and MW: the MW had higher values in the latewood percentage and basic density and lower values in the microfibril angle. The microfibril angle and the air-dry density were closely related to the bending properties of the JW lumber and the MW lumber, respectively.
Selected Medication Safety Risks to Manage in 2016–Part I Intravenous Fat Emulsion Needs a Filter
Authors: Cohen Michael R. , Smetzer Judy L.
Published: May 2016

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Unequal Sized Pupils Due to Escitalopram Adverse Events to Dietary Supplements Causing Emergency Department Visits Compulsive Masturbation Due to Pramipexole Metformin-Induced Lactic Acidosis Masquerading as an Acute Myocardial Infarction
Authors: Mancano Michael A.
Published: May 2016

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MEDWATCH program (800-FDA-1088). If you have reported an interesting, preventable ADR to MEDWATCH, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: mmancano@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MEDWATCH program and Temple University School of Pharmacy. ISMP is an FDA MEDWATCH partner.
Pyridostigmine: Postpoliomyelitis Syndrome
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2016

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu .
Efficacy and Safety of High-Dose Subcutaneous Unfractionated Heparin Prophylaxis for the Prevention of Venous Thromboembolism in Obese Hospitalized Patients
Authors: Beall Jeffrey , Woodruff Ashley , Hempel Carolyn , Wovkulich Margaret , Zammit Kimberly
Published: May 2016

Background

Obese patients experience a higher risk of venous thromboembolism (VTE) than their nonobese counterparts, which may warrant a more aggressive approach to thromboprophylaxis in this population.

Objective

The purpose of this study was to compare rates of nosocomial VTE in obese patients treated with high-dose versus conventional-dose subcutaneous unfractionated heparin sodium (UFH) for thromboprophylaxis.

Methods

A retrospective, single-center, cohort study was conducted to evaluate obese, adult, hospitalized patients admitted between April 2011 and April 2014 who received heparin 5,000 or 7,500 units subcutaneously every 8 hours for thromboprophylaxis. The primary outcome assessed the rate of nosocomial VTE in obese patients treated with high-dose heparin (7,500 units subcutaneously q 8 h) versus conventional-dose heparin (5,000 units subcutaneously q 8 h). Additionally, a secondary outcome assessed safety by quantifying bleeding events.

Results

Nosocomial VTE occurred in 2/196 (1.02%) patients who received high-dose heparin thromboprophylaxis and in 5/2,182 (0.23%) patients who received conventional-dose heparin ( p = .05). Bleeding occurred in 0/196 (0%) patients in the high-dose heparin group and in 2/2,182 (0.09%) patients in the conventional-dose heparin group ( p = .67). All bleeding events were minor.

Conclusions

This study failed to demonstrate a statistically significant reduction in the rate of nosocomial VTE in obese patients who received high-dose heparin thromboprophylaxis. Despite receiving a higher heparin dose, no increased risk of bleeding was observed in the high-dose group. Further investigation is needed to identify the optimal heparin dose for thromboprophylaxis in obese patients.
Stability of an Extemporaneously Compounded Oral Suspension of Bosentan
Authors: Malik Alina , Gorman Gregory , Coward Lori , Arnold John J.
Published: May 2016

Purpose

To assess the stability of an extemporaneously compounded oral suspension of bosentan from commercially available tablets for a period of 1 month.

Methods

A 6.25 mg/mL oral suspension of bosentan monohydrate was prepared from Tracleer tablets. The bosentan suspension was then evenly divided between 2 light-resistant prescription bottles and stored in the dark either under refrigeration (4–8°C) or at controlled room temperature (21–26°C). The suspensions were assessed for physical changes (ease of resuspendability, change in color, change in odor), and samples were drawn immediately after preparation and on days 0, 1, 3, 7, 10, 14, 21, 28, and 31. Samples were analyzed at each time point by high-performance liquid chromatography (HPLC) utilizing a reversed-phase column with chemical stability defined as the retention of at least 90% of the initial intact bosentan concentration measured.

Results

No change in suspendability, color, or odor of the compounded bosentan suspensions was noted throughout the storage period. Furthermore, regardless of storage conditions, the oral suspension of bosentan retained at least 94% of the active pharmaceutical ingredient for 31 days after preparation.

Conclusion

The results of our study indicate that a 6.25 mg/mL bosentan oral suspension stored in the dark under refrigeration and at room temperature maintains physical and chemical stability for 1 month.
Mepolizumab
Authors: Cada Dennis J. , Bindler Ross J. , Baker Danial E.
Published: May 2016

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866–397–3433. The May 2016 monograph topics are sugammadex, lesinurad, selexipag, sebelipase alfa, and alectinib. The Safey MUE is on sugammadex.
A Primer on Clinical Pathways
Authors: Hipp Rachel , Abel Erik , Weber Robert J.
Published: May 2016

Leaders in health-system pharmacy are challenged to maintain the highest quality pharmacy service at the lowest cost. Clinical pathways are evidence-based road maps that assist in reducing variations in clinical practice. Integration of clinical pathways within the electronic health record further helps to facilitate evidence-based practice. This article reviews the evolution of the clinical pathways, describes their clinical and economic impact, and identifies ways pharmacy directors can successfully implement these pathways into their institutions. Pharmacy directors can utilize their skills in this area or task clinical pharmacists to serve as members of the clinical pathway development team to further enhance patient-centered pharmacy services.
Patient-Centered Technology to Enhance Population Health Management
Authors: Felkey Bill G. , Fox Brent I.
Published: May 2016

Take a little walk with us this month as we explore how things such as reimbursement systems are changing. Health systems are adopting population health strategies and performing experiments in rendering this type of care. Many health systems start with the care of their own employees, if they are self-insured. Perhaps you are already seeing this change and experiencing how your care is being impacted.
Crime, Community, and Human Rights in Southeastern Nigeria, Then and Now
Authors: Jell-Bahlsen Sabine
Published: May 2016

This article addresses crime and punishment in relation to community and human rights in southeastern Nigeria based on thirty years of observations complemented by additional research. A 1987 crime and its punishment in a rural community are providing a contrast to four violent incidents, their punishment, the absence of a trial, and other human rights violations prevalent in the area. Igbo culture and its socioeconomic and political institutions as well as its religious beliefs and ethics once provided the basis for a person’s identity, economic security, and communal safety; the culture enabled prevention and punishment of crime within the community. This situation has changed drastically; the community has lost its clout; the people are disempowered by transnational corporations in collaboration with the nation-state and within the political economy of oil; the indigenous culture is dismantled, indigenous beliefs and ethics are depreciated, and violent crime is now prevalent and committed without impunity and on all levels of society. Human Rights Watch and other international organizations are pointing to potential solutions on the governmental and administrative levels. However, the socioeconomic situation, political economy, cultural-spiritual and individual issues must also be taken into account and addressed, calling for further research towards finding a way out of the current dilemma.
Consumer Health Informatics: Past, Present, and Future of a Rapidly Evolving Domain
Authors: Demiris G.
Published: May 2016

Objectives: Consumer Health Informatics (CHI) is a rapidly growing domain within the field of biomedical and health informatics. The objective of this paper is to reflect on the past twenty five years and showcase informatics concepts and applications that led to new models of care and patient empowerment, and to predict future trends and challenges for the next 25 years.

Methods: We discuss concepts and systems based on a review and analysis of published literature in the consumer health informatics domain in the last 25 years.

Results: The field was introduced with the vision that one day patients will be in charge of their own health care using informatics tools and systems. Scientific literature in the field originally focused on ways to assess the quality and validity of available printed health information, only to grow significantly to cover diverse areas such as online communities, social media, and shared decision-making. Concepts such as home telehealth, mHealth, and the quantified-self movement, tools to address transparency of health care organizations, and personal health records and portals provided significant milestones in the field. Conclusion: Consumers are able to actively participate in the decision-making process and to engage in health care processes and decisions. However, challenges such as health literacy and the digital divide have hindered us from maximizing the potential of CHI tools with a significant portion of underserved populations unable to access and utilize them. At the same time, at a global scale consumer tools can increase access to care for underserved populations in developing countries. The field continues to grow and emerging movements such as precision medicine and the sharing economy will introduce new opportunities and challenges.
The Blanking Period Following Pulmonary Vein Isolation – Relevance and Duration
Authors: Das Moloy , Gupta Dhiraj ,   Freeman Hospital, Newcastle upon Tyne, UK,   Liverpool Heart and Chest Hospital, Liverpool, UK
Published: May 2016

Early recurrences of atrial tachyarrhythmia (ERAT) commonly occur in the initial months following catheter ablation of atrial fibrillation. Patients with ERAT are at increased risk of later recurrence, but the presence of ERAT does not necessarily indicate longer-term procedural failure. International consensus guidelines accordingly recommend a three-month ‘blanking period’. Such ERAT episodes may be related to post-ablation pro-arrhythmic factors, such as inflammation, autonomic dysregulation and lesion maturation. However, studies suggest that these transient factors have a limited duration and ERAT occurring beyond this point may be more predictive of both pulmonary vein reconnection and further recurrence. This review examines the need for a blanking period and its most appropriate duration.
Prognostic Implications of ‘Paced’ and ‘Native’ QRS Durations Following Cardiac Resynchronization Therapy
Authors: Karaca Oguz ,   Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
Published: May 2016

Current evidence strongly suggests that the extent of electrical dyssynchrony within the left ventricle is determined by the delayed intraventricular conduction time reflected by a prolonged QRS duration (QRSd) on the surface (ECG). However, in cardiac resynchronization therapy (CRT) follow-up algorithms, the QRSd on the post-operative ECG has been relatively less frequently addressed, although the baseline QRSd is accepted as an essential ‘pre-operative’ marker for patient selection and prediction of response to therapy. In this review, we discuss the clinical impact of post-implantation electrocardiographic parameters, such as the ‘paced’ QRSd and ‘native’ QRSd (assessed when the device is temporarily switched off) on the efficacy of therapy and on prediction of future outcomes after CRT.
Malignant Ventricular Arrhythmic Storm Triggered by Short-coupled Premature Ventricular Contractions Arising from the Anterolateral Papillary Muscle
Authors: Kabunga Peter , Medi Caroline , Yeates Laura , Sy Raymond W ,   Department of Cardiology, Royal Prince Alfred Hospital, New South Wales, Australia,   Department of Cardiology, Royal Prince Alfred Hospital, New South Wales, Australia,   Agnes Ginges centre for Molecular Cardiology, Centenary Institute, New South Wales, Australia,   Department of Cardiology, Royal Prince Alfred Hospital, New South Wales, Australia,   Sydney Medical School, University of Sydney, New South Wales, Australia
Published: May 2016

A case of idiopathic ventricular fibrillation (VF), triggered by ectopic beats originating from the anterolateral papillary muscle, is presented. The arrhythmia was characterised by short-coupled premature ventricular contractions (PVCs), which were resistant to isoproterenol, and ultimately treated with catheter ablation.
A utilização de lavras desativadas como laboratórios naturais para ensino de Geociências: exemplos de Diamantina
Authors: Kuchenbecker Matheus , Fragoso Daniel Galvão Carnier , Sanglard Júlio Carlos Destro , Fantinel Lúcia Maria
Published: May 2016

O fechamento inconsequente de empreendimentos de mineração constitui um tema atual de preocupação ambiental e social, o que tem levado à crescente discussão a respeito dos "usos futuros de áreas mineradas". Neste trabalho, apresenta-se o grande potencial didático de algumas lavras desativadas, e propõe-se sua utilização enquanto labratórios naturais para o ensino de Geociências. Utiliza-se, para tanto, o exemplo de Diamantina (MG), onde abundam antigas lavras de diamante, há muito desativadas. No interior de lavras desativadas é frequente a instalação de sistemas sedimentares dinâmicos, onde vários processos diferentes atuam simultaneamente. Nestes sistemas, observam-se processos e produtos sedimentares em diferentes ambientes e contextos, o que configura a situação ideal para o ensino básico e avançado de temas relacionados à sedimentologia, estratigrafia e geomorfologia. Através das feições observadas, é possível a realização de uma profunda análise escalar, discutindo-se diferenças e similaridades com ambientes de sedimentação em tamanho real. Além disso, a existência simultânea nas lavras de processos, produtos recentes e estruturas sedimentares antigas oferece uma excelente oportunidade para a discussão dos princípios do atualismo.
Ontology optimization tactics via distance calculating
Authors: Gao Yun , Farahani Mohammad Reza , Gao Wei
Published: May 2016

In this article, we propose an ontology learning algorithm for ontology similarity measure and ontology mapping in view of distance function learning techniques. Using the distance computation formulation, all the pairs of ontology vertices are mapped into real numbers which express the distance of their corresponding vectors. The more distance between two vertices, the smaller similarity between their corresponding concepts. The stabilities of our learning algorithm are defined and several bounds are yielded via stability assumptions. The simulation experimental conclusions show that the new proposed ontology algorithm has high efficiency and accuracy in ontology similarity measure and ontology mapping in certain engineering applications.
Contact Impact Forces at Discontinuous 2-DOF Vibroimpact
Authors: Bazhenov V.A. , Pogorelova O.S. , Postnikova T.G.
Published: May 2016

Dynamic behaviour of contact impact forces in strongly nonlinear discontinuous vibroimpact system is studying. Contact impact force is one of the most significant vibroimpact system characteristics. We investigate the 2-DOF vibroimpact system by numerical parameter continuation method in conjunction with shooting and Newton-Raphson methods. We simulate the impact by nonlinear contact interactive force according to Hertz’s contact law. This paper is the continuation of the previous works [1,2]. We have determined the instability zones and bifurcations points for loading curves [1] and frequency-amplitude response [2] under variation of excitation amplitude and frequency. In this paper we investigate the behaviour of contact forces at bifurcation points particularly at discontinuous bifurcation points where set-valued Floquet multipliers cross the unit circle by jump that is their moduli becoming more than unit by jump. It is phenomenon unique for nonsmooth systems with discontinuous right-hand side. We observe also the contact forces increase at nT -periodical multiple impacts regimes. We also learn the change of contact forces behaviour when the impact between system bodies became the soft one due the change of system parameters.
Finite Element Analysis of Influence of Non-homogenous Temperature Field on Designed Lifetime of Spatial Structural Elements under Creep Conditions
Authors: Pyskunov S.O. , Maksimyk Yu.V. , Valer V.V.
Published: May 2016

The techniques of modeling of continual fracture process for spatial bodies under long-term static force loading condition in non-homogenous temperature field are presented. The scalar damage parameter is used to describe the material continual fracture process. A stress-strain problem solution made with semianalytic finite element method (SFEM). Results of lifetime determination of responsible parts are presented.
Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage
Authors: Buchmueller Thomas C. , Levinson Zachary M. , Levy Helen G. , Wolfe Barbara L.
Published: May 2016

Objectives. To document how health insurance coverage changed for White, Black, and Hispanic adults after the Affordable Care Act (ACA) went into effect.

Methods. We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status.

Results. In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs.

Conclusions. The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so.
Emotional Feedback and the Viral Spread of Social Media Messages About Autism Spectrum Disorders
Authors: Bail Christopher A.
Published: May 2016

Objective. To determine whether exchanges of emotional language between health advocacy organizations and social media users predict the spread of posts about autism spectrum disorders (ASDs).

Methods. I created a Facebook application that tracked views of ASD advocacy organizations' posts between July 19, 2011, and December 18, 2012. I evaluated the association between exchanges of emotional language and viral views of posts, controlling for additional characteristics of posts, the organizations that produced them, the social media users who viewed them, and the broader social environment.

Results. Exchanges of emotional language between advocacy organizations and social media users are strongly associated with viral views of posts.

Conclusions. Social media outreach may be more successful if organizations invite emotional dialogue instead of simply conveying information about ASDs. Yet exchanges of angry language may contribute to the viral spread of misinformation, such as the rumor that vaccines cause ASDs.