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In the last half-century, the 'centre–periphery' model has become insufficient to describe the increasingly fragmented and multicentric Latin American metropolises. Frontiers between central and peripheral areas are shifting, in part, due to the emergence of new corporate centralities, usually located outside historical city centres and heavily equipped with private 'security' agents and devices. By examining the evolving governing practices taking place in and around the dynamic frontier of a business centrality in São Paulo, Brazil, this article discusses the connections between the transformation in centre–periphery relations and the reworking of prior forms of socio-spatial control since the 'security' turn of the 1990s. More specifically, it explores the effects of the production of securitised corporate centralities on the racialised differential governance of urban space. For this purpose, the article draws from empirical work involving fieldwork, interviews with public and private 'security' agents, the observation of meetings of the local Public Security Community Council (CONSEG), and the analysis of police statistics. In sum, the argument presented here is that the evolution of segregation mechanisms and governing practices in Latin-American metropolises reproduces centre–periphery relations under new spatial configurations, and increases the capacity of private agents to subject urban space to their own rules and regulations. [ABSTRACT FROM AUTHOR]

Prolonged and excessive use of chemical fertilizers has resulted in serious harm to soil health and ecosystems. This study aimed to reduce the cultivation costs for apricot trees, nearly 1/3rd of which are spent on fertilizers. The research was conducted on fully grown apricot trees of the cultivar "New Castle," in the Solan district of Himachal Pradesh, India. The experiment consisted of fourteen treatment combinations evaluated in triplicate and statistically analyzed using a randomized block design (RBD). Results revealed that treatment T12 [50% Nitrogen (Calcium Nitrate) + 50% Nitrogen (Urea) + Azotobacter + Phosphate Solubilizing Bacteria + Vermicompost] resulted in the highest percent increase in tree trunk girth (6.82%), highest leaf chlorophyll content (3.00 mg g−1 fresh weight), leaf area (58.29 cm), fruit set (61.00%) and total yield (61.9 kg tree−1). In terms of nutrient status, T12 had the highest leaf N (2.95%), leaf K (2.60%), soil N (386.33 kg ha−1), soil P (51.00 kg ha−1) and soil organic carbon (1.81%). The highest net return and profit over recommended dose of fertilizers (RDF) was also recorded in treatment T12. The results of this study show that judicious fertilizer use along with integrated organic manure and bio-fertilizers can reduce cultivation costs, improve soil health, and increase fruit production with minimum ecosystem damage. [ABSTRACT FROM AUTHOR]

Objective: To compare fixed‐time artificial insemination (FTAI) conception rates and serum progesterone concentrations at the time of FTAI for cows treated with the original Ovsynch program (OV) with those treated with a modified Ovsynch (MO) program. Design This was a randomised clinical trial. Methods: The study used five split‐calving, pasture‐based dairy herds in Southwest Victoria, Australia. Controls (n = 851) received the OV program: day 0 gonadotropin‐releasing hormone, day 7 prostaglandin F2α (PGF), day 9 gonadotropin‐releasing hormone and FTAI at day 10. The treatment group (n = 852) received a MO program with an additional prostaglandin injection on day 8. Subsets of cows from each group were sampled for blood progesterone at the time of FTAI. Results: The treatment group demonstrated FTAI conception rates that were 7% (95% confidence interval 2%–12%) greater than the control group. After adjusting for the effect of age, days in milk at Mating Start Date and herd, the odds of conception using FTAI was 1.36 (95% confidence interval 1.12–1.66) times greater for treatment group cows compared with control group cows. The variability of serum progesterone concentrations at the time of FTAI was significantly less for treatment group cows compared with control group cows. Conclusion: For Holstein‐Friesian and Holstein‐Friesian cross‐bred cows managed in pasture‐based dairy herds in southern Australia, a MO protocol, including a second injection of prostaglandin F2α on day 8, increased FTAI conception rates compared with cows receiving the OV protocol. [ABSTRACT FROM AUTHOR]

Case reports: Five dogs (4 with severe carpal contracture, 1 with a chronically infected carpal joint) underwent antebrachiometacarpal arthrodesis. Excision of all carpal bones, except the accessory carpal bone, was done, either because of persistent infection or to allow the manus to be arthrodesed in a functional position. All five dogs developed varying degrees of soft tissue swelling of the surgical site following surgery. All five arthrodeses achieved complete osseous union within 4–67 weeks. The immediate postoperative distal radiometacarpal frontal plane angulation ranged from 1° to 19° (mean ± SD: 7 ± 8°). The immediate postoperative distal radiometacarpal sagittal plane angulation ranged from 6° to 26° (mean ± SD: 17 ± 9°). Plate coverage of the secured metacarpal bone(s) ranged from 75% to 87% (mean ± SD: 80 ± 4%). Infection necessitated plate removal in four dogs, 3–17 (mean ± SD: 8 ± 6) months following surgery and 0–15 (mean ± SD: 5 ± 7) weeks following radiographic documentation of complete osseous union. Conclusion: Despite one dog having marked elbow incongruency and degenerative joint disease and one dog having an ipsilateral radial nerve deficit, all five dogs improved and had acceptable limb function at the time of the final evaluation, which ranged from 25 to 296 (mean ± SD: 99 ± 111) weeks following surgery. [ABSTRACT FROM AUTHOR]

Drug-dose modification in chronic kidney disease (CKD) utilizes glomerular filtration rate (GFR) with the implicit assumption that multiple renal excretory processes decline in parallel as CKD progresses. We compiled published pharmacokinetic data to evaluate if GFR predicts renal clearance changes as a function of CKD severity. For each drug, we calculated ratio of renal clearance to filtration clearance (Rnf). Of 21 drugs with Rnf >0.74 in subjects with GFR >90 mL/min (implying filtration and secretion), 13 displayed significant change in Rnf vs. GFR (slope of linear regression statistically different from zero), which indicates failure of GFR to predict changes in secretory clearance. The dependence was positive ( n = 3; group A) or negative ( n = 10; group B). Eight drugs showed no correlation (group C). Investigated drugs were small molecules, mostly hydrophilic, and ionizable, with some characterized as renal transporter substrates. In conclusion, dosing adjustments in CKD require refinement; in addition to GFR, biomarkers of tubular function are needed for secreted drugs. [ABSTRACT FROM AUTHOR]

Case report A 4-month-old female intact American Pit Bull Terrier was presented for right pelvic limb lameness 1 day after the dog had been hit by an all-terrain vehicle. Orthogonal radiographs of the right stifle revealed a Salter-Harris type IV fracture through the proximal tibial physis extending caudodistally through the proximal tibial metaphysis. The distal tibia was markedly displaced cranially, laterally and proximally, resulting in complete overriding of the fracture segments. An open approach was made in order to facilitate direct reduction, but the fracture could not be sufficiently distracted and the epiphyseal segment remained fixed caudal to the remainder of the tibia. Concerns regarding possible iatrogenic trauma to the epiphysis prompted the use of a transarticular circular fixator construct to distract the fracture segments to facilitate reduction. Distraction that facilitated reduction was performed using three TrueLok Rapid Quick Adjust Struts that were positioned between the two ring components. The struts also allowed for multiplanar adjustment of alignment, which allowed the fracture to be maintained in anatomic reduction as divergent interfragmentary Kirschner wires were placed. Radiographic union was confirmed 19 days after surgery. Conclusion/Clinical significance Transient intraoperative application of a circular construct incorporating the TrueLok components facilitated accurate fracture reduction without inflicting further iatrogenic trauma to the epiphysis, after traditional direct reduction techniques proved ineffective, and afforded a successful clinical outcome in the dog reported here. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) provides protection against the elevated blood pressure in overweight youth. Less is known regarding any similar protective effect of muscular fitness. We investigated how handgrip strength, an easy to implement measure of muscular strength, interacted with CRF and BMI to determine blood pressure in youth. We measured systolic (SBP) and diastolic (DBP) blood pressure, handgrip strength (HG), CRF and body mass index (BMI) in n=7329 10-16year-olds (47% girls). We defined elevated blood pressure as >91st percentile and Good HG as >33rd percentile. Participants were classified as Fit or Unfit and as Normal or Overweight/Obese based on international standards. The prevalence of elevated SBP was 23%, and 44% of participants had elevated DBP. In unfit participants Good HG was associated with lower SBP (z=0.41 (95%CI: 0.20-0.61) and DBP (z=0.29 (95%CI: 0.12-0.47). In Overweight/Obese participants, DBP was z=0.24 (95%CI: 0.14-0.34) lower in the Good (versus Low) HG group. Overweight/Obese participants with Good HG also had a 32% lower risk of elevated DBP (OR: 0.68, 95%CI: 0.57-0.82). This association was attenuated but remained important after adjusting for BMI (20% risk reduction, OR: 0.80, 95%CI: 0.63-1.01). Muscular fitness appears to play some protective role against the risk of elevated blood pressure; particularly for the more prevalent measure: elevated DBP (44%). Effects may be restricted to Overweight / Obese or unfit youth, who have an increased risk of elevated BP and also may be less likely to engage in traditional cardiorespiratory fitness training. Research to determine the effects of muscular fitness training on blood pressure is warranted in these subgroups. [ABSTRACT FROM AUTHOR]

Objective: To use propensity score methods to control for confounding by indication in the association between labour induction and caesarean delivery.Design: Cross-sectional analysis of administrative hospital discharge data supplemented by medical record information.Setting: Fourteen US member hospitals of the National Perinatal Information Center.Sample: A cohort of 166 559 singleton liveborn deliveries in the period 2007-2012.Methods: We used propensity scores (PSs) to balance 83 covariates between induced and non-induced women, and compared estimates with traditional covariate adjustment. We estimated PSs for labour induction versus expectant management of pregnancy each week from 34 to 42 weeks of gestation. We estimated risk ratios (RRs) for the association between labour induction and primary caesarean delivery from models with no adjustment, traditional adjustment of five covariates, matched PS, and adjustment for continuous PS.Main Outcome Measure: Caesarean delivery in current or subsequent week of gestation.Results: In crude models labour induction increased the risk of caesarean delivery in all weeks (RR 1.06-1.52), excepting 39 weeks of gestation (RR 0.89). After matching on PS, the analysis showed a significantly decreased risk of caesarean delivery with labour induction during weeks 35-39 (RR 0.77-0.92), and a significantly elevated risk at weeks 40 (RR 1.22) and 41 (RR 1.39). Traditional covariate and PS adjustment resulted in RRs between those from crude and PS-matched models.Conclusions: There is evidence of considerable confounding by indication in the association of labour induction and caesarean delivery, particularly for preterm deliveries. Using PS methods, we found a reduced risk of caesarean delivery with labour induction before 40 weeks of gestation, and an elevated risk for weeks 40-42.Tweetable Abstract: With confounding adjustment, labour induction does not increase the risk of caesarean at 34-39 weeks of gestation. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the distribution of CYP2C8 variants *3 and *5, as well as their effect on carbamazepine pharmacokinetic properties, in 40 epileptic pediatric patients on carbamazepine treatment. Genotyping was conducted using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and allele-specific (AS)-PCR methods, and steady-state carbamazepine plasma concentrations were determined by high performance liquid chromatography (HPLC). The CYP2C8 *3 and *5 polymorphisms were found at frequencies of 17.5 and 0.0%, respectively. After dose adjustment, there was a difference in daily dose in CYP2C8*3 carriers compared to non carriers [mean ± standard deviation (SD): 14.19 ± 5.39 vs. 15.46 ± 4.35 mg/kg; p = 0.5]. Dose-normalized serum concentration of carbamazepine was higher in CYP2C8*3 (mean ± SD: 0.54 ± 0.18 vs. 0.43 ± 0.11 mg/mL, p = 0.04), and the observed correlation between weight-adjusted carbamazepine dose and carbamazepine concentration after dose adjustment was significant only in CYP2C8*3 non carriers (r = 0.52, p = 0.002). However, the population pharmacokinetic analysis failed to demonstrate any significant effect of CYP2C8 *3 polymorphism on carbamazepine clearance [CL L/h = 0.215 + 0.0696*SEX+ 0.000183*DD]. The results indicated that the CYP2C8*3 polymorphism might not be of clinical importance for epilepsy treatment in pediatric populations. [ABSTRACT FROM AUTHOR]

Objective To prospectively compare the sensitivity and specificity of 16S rRNA PCR with culture for identifying the causative organism in synovial fluid obtained from dogs with suspected septic arthritis. Methods Synovial fluid cytology, PCR analysis and aerobic, anaerobic and Mycoplasma culture of samples from the affected joints of 18 dogs presenting with suspected septic arthritis were performed. Synovial fluid samples from the corresponding contralateral joints of 7 dogs were also analysed as negative controls. Results There was no significant difference between the sensitivity of bacterial detection via culture (63.2%) versus PCR (73.7%) of synovial fluid (P = 0.728) or between culture and combined PCR and culture (89.5%) of synovial fluid (P = 0.124). The specificity of PCR (42.9%) was significantly lower than culture specificity (100%) (P = 0.07). Conclusion Although 16S PCR may hold potential as an ancillary diagnostic test for identifying the causative organism in dogs with septic arthritis, our study failed to demonstrate improved accuracy compared with traditional synovial fluid culture. [ABSTRACT FROM AUTHOR]

In this chapter, an overview of some of the prominent risk factors that contribute to the pathophysiology of venous thrombosis will be discussed. In 1856, Dr Rudolf Virchow developed the concept outlining the genesis of intravascular thrombosis. Dr Virchow hypothesized that circulatory stasis due to interrupted blood flow, changes in the blood leading to blood coagulation, and irritation or damage to the vascular endothelium would initiate acute venous thrombus generation. Presently, it is known that these above-mentioned risk factors are influenced by increasing age, gender, and obesity. The current chapter will focus on recent preclinical and clinical investigations that will give the reader insight into the prothrombotic mechanisms that lead to acute venous thrombosis. [ABSTRACT FROM PUBLISHER]

The authors discuss challenges and opportunities concerning the implementation of sexual and reproductive health and rights in 2015. They mention the Millennium Development Goals (MDGs) which seeks to provide a mechanism to operationalise and monitor strategies as well as interventions towards eliminating poverty and addressing inequities. They also mention issues about people living in poverty and women dying from pregnancy-related causes.

The article focuses on the study which aims to show the correlation between measures of atherosclerosis and clinical ischemic heart disease in lupus patients. It states that the study was conducted on 103 systemic lupus erythematosus (SLE) patients. It mentions that the Carotid intima-media thickness (cIMT) correlates moderately with total plaque area (TPA) and suggest that they measure different phenotypes of atherosclerosis.

The article presents a study which was carried out to study the effect of short term heat and humidity on the levels of 10 acylcarnitines and seven amino acids used in newborn screening for inherited metabolic disorders. It mentions that acylcarnitines and amino acids in dried blood spots were analyzed by the tandem mass spectrometry. It concludes that low temperatures and humidity conditions were required for transportation and storage of dried blood spots.

Background This report describes the treatment of severe procurvatum because of distal femoral physeal fracture malunion in two skeletally immature dogs. Case reports Both dogs presented with severe right hindlimb lameness and markedly reduced stifle extension at less than 5 months of age. Severe distal femoral procurvatum and mild-to-moderate femoral shortening secondary to distal femoral physeal fracture malunion were evident on radiographs. The sagittal plane deformities were addressed with a caudal opening-wedge osteotomy in one dog and cranial closing wedge ostectomy in the other dog. String-of- Pearls locking plates were used to stabilise the osteotomies. Functional stifle extension range of motion and femoral length were improved post surgery in both dogs. Explantation of the plates was required in both dogs because of local soft tissue irritation. Both dogs had excellent outcomes based on subjective and objective measures (pressure sensitive walkway, force platform analysis) when assessed at skeletal maturity. Conclusions Corrective osteotomy stabilised with String-of- Pearls locking plates is a viable treatment option for improving limb function in dogs with severe procurvatum deformities caused by distal femoral physeal fracture malunion. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is a major cause of mortality in systemic lupus erythematosus (SLE). This ‘accelerated atherosclerosis’ is due to a combination of traditional risk factors such as hypertension and hyperlipidemia, and also disease-related factors such as chronic inflammation. Recent work has provided valuable insights into the relative contribution of various risk factors and also identified novel risk factors. An understanding of risk factors is fundamental to the prevention of CHD in SLE. In this review, we will discuss the role of risk factors for CHD in SLE and offer some strategies for their assessment and management. [ABSTRACT FROM PUBLISHER]

Background: The Radiation Therapy Oncology Group (RTOG) trial 97-14 revealed no difference between radiation delivered for painful bone metastases at a dose of 8 gray (Gy) in 1 fraction (single-fraction radiotherapy [SFRT]) and 30 Gy in 10 fractions (multifraction radiotherapy [MFRT]) in pain relief or narcotic use 3 months after randomization. SFRT for painful vertebral bone metastases (PVBM) has not been well accepted, possibly because of concerns about efficacy and toxicity. In the current study, the authors evaluated the subset of patients that was treated specifically for patients with PVBM.Methods: PVBM included the cervical, thoracic, and/or lumbar spine regions. Among patients with PVBM, differences in retreatment rates and in pain relief, narcotic use, and toxicity 3 months after randomization were evaluated.Results: Of 909 eligible patients, 235 (26%) had PVBM. Patients with and without PVBM differed in terms of the percentage of men (55% vs 47%, respectively; P = .03) and the proportion of patients with multiple painful sites (57% vs 38%, respectively; P < .01). Among those with PVBM, more patients who received MFRT had multiple sites treated (65% vs 49% for MFRT vs SFRT, respectively; P = .02). There were no statistically significant treatment differences in terms of pain relief (62% vs 70% for MFRT vs SFRT, respectively; P = .59) or freedom from narcotic use (24% vs 27%, respectively; P = .76) at 3 months. Significant differences in acute grade 2 through 4 toxicity (20% vs 10% for MFRT vs SFRT, respectively; P = .01) and acute grade 2 through 4 gastrointestinal toxicity (14% vs 6%, respectively; P = .01) were observed at 3 months, with lower toxicities seen in the patients treated with SFRT. Late toxicity was rare. No myelopathy was recorded. SFRT produced higher 3-year retreatment rates (5% vs 15%; P = .01).Conclusions: Results for the subset of patients with PVBM in the RTOG 94-17 randomized controlled trial were comparable to those for the entire population. SFRT produced less acute toxicity and a higher rate of retreatment than MFRT. SFRT and MFRT resulted in comparable pain relief and narcotic use at 3 months. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effect of body mass index (BMI) on magnesium levels for eclampsia prophylaxis.Methods: This is a retrospective study from 2004 to 2011, examining magnesium levels in women receiving seizure prophylaxis. Women received 6 g and then 2 g/h. Women had 4-hour and 12-hour levels drawn. Levels were considered subtherapeutic at less than 4.9 mg/dL, therapeutic from 4.9 to 8.4 mg/dL, and supratherapeutic at 8.5 mg/dL or more. If the 4-hour value was not therapeutic, the dose was adjusted and a 12-hour level was drawn. Levels at 4 and 12 hours were compared among the women with different BMI classifications and clinical characteristics.Results: During the study period,106,265 women delivered, and 7,799 (7.4%) had preeclampsia diagnosed and received magnesium sulfate for seizure prophylaxis. A total of 5,304 (68%) of these women had a recorded BMI. At 4 hours, 2,698 (51%) were subtherapeutic. These women were more likely to be older, parous, undergo cesarean delivery, have a higher systolic blood pressure, and have central nervous system manifestations. At 12 hours, 2,342 (90%) of therapeutic women remained therapeutic, and 5% became subtherapeutic (n=118) or supratherapeutic (n=140). Using logistic regression, we were able to predict being subtherapeutic in women with greater BMI and to predict being supratherapeutic if women had labor longer than 12 hours and worsening severity of preeclampsia.Conclusion: Women receiving seizure prophylaxis with a BMI of more than 30 may benefit from routine serum magnesium evaluation 4 hours after the loading dose.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency and the time to complete recovery identified by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the time to partial recovery identified by the SLEDAI-2K Responder Index 50 (SRI-50) in three laboratory systems over 10 years. Methods: This is a retrospective analysis of the data available from the Toronto Lupus Clinic over the last 10 years. Patients with SLEDAI-2K renal, immunological and hematologic active descriptors were identified. The percentage of descriptors with partial and complete recovery was studied at one year and over the study period. Descriptive analysis and the Kaplan-Meier estimator were applied to study the time to partial and complete recovery. Results: Of the 795 patients, 94% had an active system at some point during the study period. Partial recovery was shown in 66% of patients by SRI-50 for at least one descriptor over the study period. None of these partial findings identified would have been captured using SLEDAI-2K alone. The time to partial recovery identified by SRI-50 was shorter than the time to complete recovery identified by SLEDAI-2K. Conclusion: The SRI-50 is a valid responder index derived form SLEDAI-2K and is very helpful in identifying clinically important improvement in active laboratory descriptors in an efficient time. [ABSTRACT FROM PUBLISHER]

Disease progression of human immunodeficiency virus type 1 (HIV-1) is associated with immune activation. Activation indices are higher during coinfection of hepatitis C virus (HCV) and HIV. The effect of immune activation on interferon α (IFN-α) therapy response is unknown. We evaluated soluble CD14 (sCD14) and natural killer (NK)-cell subsets at baseline, and during pegIFN-α2a/ribavirin therapy in HCV-HIV coinfection. The sCD14 level increased during therapy. Baseline sCD14 positively correlated with baseline HCV level and CD16(+)56(-) NK-cell frequency, and both sCD14 and CD16(+)56(-) NK cells correlated negatively with magnitude of HCV decline. IL28B genotype was associated with therapy response but not sCD14 or CD16(+)56(-) NK frequency. Markers of innate immune activation predict poor host response to IFN-α-based HCV therapy during HCV-HIV coinfection. [ABSTRACT FROM AUTHOR]

Background Hinged circular external skeletal fixator constructs are used to perform sequential correction of angular limb deformities, often with resultant limb segment lengthening, via distraction osteogenesis. Although there are several reports describing the use of these constructs for correction of antebrachial deformities in dogs, there is little information regarding their use on other limb segments. This report describes the use of hinged circular fixator constructs for the correction of acquired crural deformities in three skeletally immature dogs. Case reports Two dogs had purely frontal plane deformities (one valgus, one varus) and the third dog had frontal (valgus) and sagittal (recurvatum) components to its deformity. At the time of long-term evaluation, frontal plane angulation relative to the contralateral limb improved from 40° to 22° of valgus, 30° to 5° of valgus, and 20° to 1° of varus in the three individual dogs. Tibial length discrepancies of 12% and 22% that were initially present in two dogs were improved to 6% and 10%, respectively, of the contralateral tibial length at the time of final evaluation; both dogs had compensatory growth of the ipsilateral femur and all dogs had an excellent functional outcome. Conclusion These cases illustrate the value of using hinged circular fixator constructs for correction of crural angular deformities, particularly when length discrepancies of the tibia are present. [ABSTRACT FROM AUTHOR]

Background: To accurately quantify polyethylene wear in retrieved arthroplasty components, the original geometry of the component must be estimated accurately using a reference geometry such as a computer-aided design (CAD) model or a never-implanted insert. However, differences may exist between the CAD model and manufactured inserts resulting from manufacturing tolerances.Questions/purposes: We quantified the deviations between CAD models and newly manufactured inserts and determined how these deviations compared with using a never-implanted insert as a reference geometry.Methods: We obtained five cruciate-retaining (CR) and five posterior-stabilizing (PS) tibial inserts and their CAD models. The inserts were scanned and reconstructed using microcomputed tomography (micro-CT). Differences in volume and surface geometry were measured among (1) the individual inserts; (2) between the inserts and a CAD model; and (3) between the inserts and a reference geometry constructed from multiple scanned inserts averaged together.Results: The micro-CT volumes were, on average, 0.4% smaller (34-178 mm(3)) than the CAD model volumes. The mean deviation between the CAD model and insert surface geometry was 25.7 μm smaller for CR and 36.8 μm smaller for PS. The mean deviation between the inserts and an averaged reference geometry was 1.4 μm larger for CR and 0.4 μm smaller for PS.Conclusions: Deviations exist between manufactured tibial inserts and CAD models that could cause errors in wear measurements. Scanned inserts may better represent the preimplantation geometry of worn inserts than CAD models, depending on the manufacturing variability between lots.Clinical Relevance: The magnitude of the error in estimation of the preimplantation geometry of a retrieved component could add or subtract the equivalent of 1 year of wear. [ABSTRACT FROM AUTHOR]

Background: Cataract is the most common age-related disorder amenable to surgical correction in persons 65 years or older in the United States. Persons who are eligible for benefits through both the Veterans Health Administration (VHA) and Medicare have a choice in which system to receive medical care.Methods: We examined factors that might influence the choice of having cataract surgery through the VHA and fee-for-service Medicare using a national database from the VHA Information Resource Center.Results: In 2007, 159,094 dually eligible veterans had cataract surgery, with 137,726 (86.6%) having surgery in the private sector. Strong associations with the use of VHA for surgery were living within 20 miles of a facility, severity of service-connected disability, and low income or Medicaid eligibility.Conclusion: The VHA remains an important safety net for many veterans who are dually enrolled in Medicare. Dependency on the VHA for quality of life surgery needs to be kept in mind if budgetary pressures lead to restrictions of VHA services for veterans with Medicare. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

Localized waves near the stress-free surface or the free edge of a solid with a thin nematic coating are investigated. The nematic media is described using an approximate linear low-frequency model. Being a non-traditional material this medium possesses a strong anisotropy of elastic and viscous properties and some additional freedom caused by the long polymer chain and molecules. As shown, the specific wave phenomena, observed earlier in the infinite nematic media, in the case of a coating with finite thickness lead to the appearance of the quasi-resonance zones where the phase speed and the attenuation of waves in heterogeneous composites are strongly perturbed. [ABSTRACT FROM PUBLISHER]

Background: We have reported a reduction in fatty acid oxidation (FAO) at the whole-body level and in skeletal muscle in severely obese (BMI ≥ 40 kg/m2) individuals; this defect is retained in cell culture suggesting an inherent component. The purpose of the current study was to determine if an impairment in whole-body fatty acid oxidation (FAO) was also evident in children with a severely obese parent. Methods: Substrate utilization during submaximal exercise (cycle ergometer) was determined in children ages 8-12 y with a severely obese parent (OP, n = 13) or two lean/non-obese (BMI range of 18 to 28 kg/m2) parents (LP, n = 13). A subgroup of subjects (n = 3/group) performed 4 weeks of exercise training with substrate utilization measured after the intervention. Results: The children did not differ in age (LP vs. OP, respectively) (10.7 ± 0.5 vs. 10.2 ± 0.5 y), BMI percentile (65.3 ± 5.2 vs. 75.9 ± 7), Tanner Stage (1.4 ± 0.2 vs. 1.5 ± 0.2), VO2peak (40.3 ± 2.7 vs. 35.6 ± 2.6 ml/kg/min) or physical activity levels (accelerometer). At the same absolute workload of 15 W (~38% VO2peak), RER was significantly (P≤ 0.05) lower in LP vs. OP (0.83 ± 0.02 vs. 0.87 ± 0.01) which was reflected in a reduced reliance on FAO for energy production in the OP group (58.6 ± 5.1 vs. 43.1 ± 4.0% of energy needs during exercise from FAO). At a higher exercise intensity (~65% VO2peak) there were no differences in substrate utilization between LP and OP. After exercise training RER tended to decrease (P = 0.06) at the 15 W workload, suggesting an increased reliance on FAO regardless of group. Conclusions: These findings suggest that the decrement in FAO with severe obesity has an inherent component that may be overcome with exercise training. [ABSTRACT FROM AUTHOR]

Objective: The primary goal of this study was to test the hypothesis that wearing the 3.7 kg vest portion of a radiological shielding garment (a "lead") significantly increases lower back and shoulder muscle activity in quasistatic erect and forward-flexed postures. Secondarily, the authors examined the effects of gender and forward-flexed posture as well as their interactions with lead use.Background: The use of a lead is mandatory for interventionalists during surgical procedures. Because the vest portion of a lead weighs considerably more than normal clothing, there is concern that its use increases the risk of developing back and shoulder pain.Method: In a repeated-measures study design, 19 young healthy male and female adults assumed standardized erect or forward-flexed postures, both with and without wearing the vest portion of a lead. Shoulder and lower back muscle activity was measured via surface electromyography, normalized by maximum voluntary contraction values. Data were analyzed using general linear models and repeated-measures ANOVA (significant for p < .05).Results: Use of the lead did not result in a significant increase in muscle activity in the lower back or shoulders, despite perceived increases in effort and discomfort. Posture proved to be the most significant secondary factor affecting activity in the lower back, and participant gender proved insignificant.Conclusion: Short-term use of the lead does not appear to contribute to the incidence of back pain or injury in interventionalists. Avoiding flexed postures could more directly reduce the likelihood of pain or injury.Application: Potential applications include assessing and improving operating room ergonomics for physicians. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines.Data Sources: MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery populations. Interventions and comparators included graduated compression stockings, intermittent pneumatic compression, unfractionated heparin, and low molecular weight heparin; placebo and routine postoperative care were allowed as comparators.Methods Of Study Selection: One thousand two hundred sixty-six articles were screened, and 14 randomized controlled trials (five benign gynecologic, nine gynecologic oncology) met eligibility criteria. In addition, nine prospective or retrospective studies with at least 150 women were identified and provided data on venous thromboembolism risk stratification, gynecologic laparoscopy, and urogynecologic populations.Tabulation, Integration, and Results: Two reviewers independently screened articles with discrepancies adjudicated by a third. Eligible randomized controlled trials were extracted for these characteristics: study, participant, surgery, intervention, comparator, and outcomes data, including venous thromboembolism incidence and bleeding complications. Studies were individually and collectively assessed for methodologic quality and strength of evidence. Overall incidence of clinical venous thromboembolism was 0-2% in the benign gynecologic population. With use of intermittent pneumatic compression for benign major procedures, venous thromboembolism incidence was less than 1%. No venous thromboembolisms were identified in prospective studies of benign laparoscopic procedures. Overall quality of evidence in the benign gynecologic literature was poor. Gynecologic-oncology randomized controlled trials reported venous thromboembolism incidence (including "silent" venous thromboembolisms) of 0-14.8% with prophylaxis and up to 34.6% without prophylaxis. Fair quality of evidence supports that unfractionated heparin and intermittent pneumatic compression are both superior to placebo or no intervention but insufficient to determine whether heparins are superior to intermittent pneumatic compression for venous thromboembolism prevention. Combining two of three risks (aged 60 years or older, cancer, or personal venous thromboembolism history) substantially elevated the risk of venous thromboembolism.Conclusion: Intermittent pneumatic compression provides sufficient prophylaxis for the majority of gynecology patients undergoing benign surgery. Additional risk factors warrant the use of combined mechanical and pharmacologic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Mounier-Kuhn syndrome (MKS) is a condition characterized by tracheobronchomegaly resulting from the loss or atrophy of musculoelastic fibers within the airway wall. Concomitant tracheobronchomalacia is seen in most patients with MKS, often leading to significant respiratory compromise due to bronchiectasis, increased dead space, and impaired secretion clearance.Methods: We report a series of 12 patients with MKS and tracheobronchomalacia who were evaluated at our institution for significant respiratory problems. Stent trials were conducted in 10 patients, with seven proceeding to operative tracheobronchoplasty (TBP) and one continuing with long-term stent placement. One patient underwent TBP without prior stent placement. Of the remaining three patients, two had no improvement with trials of stent placement, and a stent could not be placed in the third because of a large tracheal diameter.Results: Compared with baseline values, clinically significant improvements in health-related quality-of-life measures and pulmonary function testing were seen in patients who underwent central airway stabilization (n = 9). Complications of both stent placement and TBP were generally mild. However, one death was reported in the surgical group secondary to an exacerbation of preexisting interstitial pneumonia.Conclusions: An aggressive approach that targets central airway stabilization may improve outcomes for patients with MKS.Trial Registry: ClinicalTrials.gov; No.: NCT00550602; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Oral Diseases (2011) 17, 550-559 While treatment for cancer in terms of chemotherapy and radiation therapy have evolved significantly since their inception, both of these cancer treatment modalities, especially if used in combination (e.g., as with head and neck cancers), have a very real potential to result in painful and debilitating adverse effects that clearly decrease quality of life and, potentially, increase mortality due to cancer. Herein, we discuss the prevalence and etiology of three broad categories of oral complications found during the treatment of cancer patients: mucositis, dysgeusia, and infectious disease. Lastly, we present therapeutic options that may be helpful in ameliorating these uncomfortable and, sometimes, life-threatening oral complications. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a common worldwide problem and has been treated for many decades; however, there still remain uncertain areas about this disorder. Its involvement and impact on different parts of the human body remain underestimated due to lack of technology in imaging for objective assessment in the past. The advances in imaging technique and image analysis technology have provided a novel approach for the understanding of the phenotypic presentation of neuro-osseous changes in AIS patients as compared with normal controls. This review is the summary of morphological assessment of the skeletal and nervous systems in girls with AIS based on MRI. Girls with AIS are found to have morphological differences in multiple areas including the vertebral column, spinal cord, skull and brain when compared with age- and sex-matched normal controls. Taken together, the abnormalities in the skeletal system and nervous system of AIS are likely to be inter-related and reflect a systemic process of asynchronous neuro-osseous growth. The current knowledge about the anatomical changes in AIS has important implications with respect to the understanding of fundamental pathomechanical processes involved in the evolution of the scoliotic deformity. [ABSTRACT FROM AUTHOR]

Sparse data are available describing recent trends in the magnitude, clinical features, treatment practices, and outcomes of comparatively young adults hospitalized with acute myocardial infarction (AMI). The objectives of this population-based study were to describe 3 decade-long trends (1975 to 2005) in these end points in adults <55 years old who were hospitalized with an initial AMI. The study population consisted of 1,703 residents of the Worcester (Massachusetts) metropolitan area 25 to 54 years of age who were hospitalized with initial AMIs at all central Massachusetts medical centers during 15 annual periods from 1975 through 2005. Overall hospital incidence rate (per 100,000 residents) of initial AMI in our study population was 66 (95% confidence interval 63 to 69) and incidence rates of AMI decreased inconsistently over time. Patients hospitalized during the most recent study years were more likely to have important cardiovascular risk factors and co-morbidities present but were less likely to have developed heart failure during their index hospitalization. In-hospital and 30-day death rates decreased by approximately 50% (p = 0.04) during the years under study concomitant with increasing use of effective cardiac therapies. In conclusion, the results of this community-wide investigation provide insights into the magnitude, changing characteristics, and short-term outcomes of comparatively young patients hospitalized with a first AMI. Decreasing odds of developing or dying from an initial AMI during the 30 years under study likely reflect increased primary and secondary prevention and treatment efforts. [ABSTRACT FROM AUTHOR]