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This article presents an exploration of mathematical modeling and performance enhancement of a casting system in the steel industry. The study employs the implementation of Markov processes and genetic algorithm to achieve these objectives. The system comprises of four subsystems namely transfer laddle, continuous casting machine, shot blasting machine and grinding machine. These are arranged in a way that failing of a single subsystem halts the working of overall system. Using probabilistic approach, differential equations have been developed from transition diagram based on Markov process. Failure and repair rates follow exponential distribution. To ascertain steady state availability, differential equations are solved using normalizing conditions. Further, genetic algorithm is applied to find optimal values of failure/repair rates to estimate the optimal plant availability. [ABSTRACT FROM AUTHOR]

Janus kinase inhibitor (JAKi) medications are small-molecule drugs that affect intracellular signal transduction. They are highly effective oral medications that have been approved for the treatment of various rheumatic diseases, with rheumatoid arthritis being a key example of an autoimmune rheumatic disease. JAKi are oral-route medications that are alternatives to injectable biologic therapies, launched in the late 1990s. While most safety concerns with JAKi are similar to the biologics, there are many differences. New data on comparative safety of JAKi versus tumor necrosis factor inhibitors (TNFi) were recently published that led to new black box warnings by the US Food and Drug Administration (FDA) about cardiovascular and cancer risks and a label change for JAKi. This review summarizes the current published data with regards to the safety of JAKi, focused on rheumatic diseases. Specifically, any risk differences between agents or across different indications are discussed, as well as the risk factors for these adverse outcomes. [ABSTRACT FROM AUTHOR]

In recent decades, gait has become an important topic in biometric. Gait attains popularity in human authentication because of its non-cooperation and sensing of gait patterns from a distance. However, in the real-time environment, recognizing based on gait is a challenging task when multiple people walk in a group. Therefore, this paper focused on recognizing people in a multi-gait (MG) scenario. Multi-gait means that more than one person are walking in a group. Here, our work is divided into two phases. In the first phase, we reconstruct the occluded regions. Here, we present a model-based approach to recognize a person in a multi-gait scenario. Therefore, five dynamic regions of interest (ROIs), such as Ankle, Knee, Wrist, Elbow, and Shoulder, are taken, and a numerical interpolation approach is applied to regenerate the occluded ROIs. Then, in the second phase, we extract linear kinematic features and propose a hybrid classifier for model-based multi-gait identification. Finally, the experimental results of the hybrid classifier, i.e., PSO-NN, demonstrate that the proposed classifier performs better in multi-gait identification than the state-of-the-art classifier, such as k-NN and ANN. [ABSTRACT FROM AUTHOR]

Biofuel covers major parts of the transportation sector in the global economic scenarios. Therefore, the impact assessment parameters like environmental, economic, and social are necessary to evaluate for better understanding. Keeping in mind, a life cycle assessment of biodiesel has been done using Jatropha curcas as feedstock. All the steps from cradle (cultivations, pre-treatment, and transesterification) to gate (biodiesel production) have been evaluated. The functional unit of one ton of biodiesel has been taken as reference, and environmental impacts are assessed accordingly using SimaPro. In the current paper, the conventional and room temperature process for biodiesel production is compared in terms of mid-point categories like greenhouse gas (GHG) emission and other endpoint categories like human health, ecosystems, and resources. The results from the life cycle assessment (LCA) indicates that the room temperature process is more energy-saving than the conventional process. Room temperature biodiesel produced around 1195 kg CO2 eq of emission contributing to global warming, whereas the conventional biodiesel contributed around 1228 kg CO2 eq to GHG emission. Further, the Monte Carlo analysis was carried out to quantify the uncertainty in the process in terms of normalized global warming potential. The biodiesel production from the room temperature process can be explored at the industrial level in future. [ABSTRACT FROM AUTHOR]

A study published in Clinical Rheumatology analyzed data from the Nationwide Readmissions Database to examine the risk of readmission and in-hospital mortality in female patients who undergo elective primary total hip arthroplasty (THA) for osteoarthritis (OA). The study found that female sex was associated with a lower risk of readmission within 90 days after THA for OA, but not with in-hospital mortality during readmission. The study identified other risk factors for readmission, such as older age and comorbidity. The findings can help healthcare providers identify patients at higher risk of readmission and develop strategies to reduce readmission rates, but further research is needed to understand the reasons for the increased risk in males. [Extracted from the article]

In real-time situations such as airports, railway stations, and shopping complexes, etc. people walk in a group, and such a group of walking persons termed as multi-gait (MG). In these situations, occlusion is a serious issue that affects gait recognition performance. This issue of occlusion of body regions affects the extraction of gait features for the correct recognition of an object. The objective of this article is to reconstruct occluded regions at the preprocessing stage, which can be used for human recognition in the MG scenario. The article is divided into two folds. Firstly, we segment five regions of interest such as ankle, knee, wrist, elbow, and shoulder. We propose a particle swarm optimization (PSO) based neural network (NN) called hybrid NN to solve this problem. The performance of the proposed model is validated on our constructed dataset (SMVDU-MG), considering two view directions i.e. lateral (left to right) and oblique (left to right diagonal). Experimental results show that the proposed model gives better performance compared to an artificial neural network and alternating least square (ALS) method based on mean square error (MSE) and mean absolute percentage error (MAPE) as a performance measure function. [ABSTRACT FROM AUTHOR]

A solvent cast 3D printing (SC-3DP) technique was explored comprehensively to fabricate bioresorbable polymer matrix composite stent in the present study. The developed methodology was assessed by printing the customized shape stent on the rotating mandrel. The polymeric composite was developed by blending bioresorbable carbonyl iron powder (CIP) and polycaprolactone (PCL). The process parameter's effect on percentage shrinkage in strut width and strut thickness, radial compression load and flexibility of stents was evaluated. Response surface methodology (RSM) was used for designing the experiments utilizing the process parameters like material compositions, printing speed and layer thickness. Analysis of variance was used to find out the significant parameters. The regression analysis was performed to obtain statistical equations with significant terms. It was noted that the reinforcement of CIP improved the fluidity of the material for better deposition as compared to pure PCL. The printing speed and layer thickness were observed to have a significant effect on the process. The significant interaction between layer thickness and printing speed parameters was also observed for shrinkage in width and thickness, compression and flexibility properties. Moreover, multi-objective optimization was performed using a genetic algorithm technique to minimize the percentage shrinkage of strut width and thickness, and load for bending to evaluate flexibility and maximize radial compression load. The method opens a unique way to fabricate patient-specific bioresorbable composite stents with customized properties. [ABSTRACT FROM AUTHOR]

Musculoskeletal diseases (MSDs) are common in the general population, frequently associated with pain, functional limitation, and reduction in quality of life. Similarly, drug/substance use disorders are common in the general population. Recently, opioid drug use disorder has gained a lot of attention as a public health problem. To our knowledge, limited data exist regarding the non-opioid drug/substance use disorders in musculoskeletal diseases. This study's objective was to examine the frequency and rates of common drug/substance use disorder hospitalizations in five MSDs, namely gout, osteoarthritis, fibromyalgia, rheumatoid arthritis, and low back pain. This was achieved by using the diagnostic codes for cocaine, hallucinogen, amphetamine, or ASH use disorder hospitalization in five MSDs in the US National Inpatient Sample from 1998 to 2014. Cocaine, hallucinogen, amphetamine, or ASH use disorder hospitalizations per 1 million NIS total hospitalizations for five MSDs in 2013–2014 were as follows, respectively: gout, 10.2, 0.1, 2.8, and 1.5; osteoarthritis, 21.4, 0.4, 5.9, and 7.7; fibromyalgia, 5.5, 0.1, 2.0, and 2.3; rheumatoid arthritis, 8.7, 0.4, 4.5, and 7.7, and low back pain, 16.2, 0.5, 7.3, and 7.5. The frequency and the rate of each drug use disorder hospitalization increased in each of the five MSDs from 1998 to 2014. Key Points • Cocaine or hallucinogen use disorder hospitalization rates increased several-fold in people with MSDs from 1998 to 2014. • Amphetamine and anxiolytic, sedative, or hypnotic (ASH) use disorder hospitalization rates increased 9- to 23-fold vs. 4- to 7-fold, respectively, in people with common MSDs in the USA from 1998 to 2014. [ABSTRACT FROM AUTHOR]

To assess rheumatologists' views and practices related to shared decision-making (SDM) in gout treatment. We performed a cross-sectional electronic survey of rheumatologists at U.S. Veterans Affairs (VA) medical centers, assessing views and practices related to SDM in gout. Of the 154 VA rheumatology providers eligible, 90 responded (response rate, 58%). Fifty-eight percent were female, the mean age was 51 years (standard deviation, 9.6), 42% had > 20 years of experience in medical practice. Rheumatologists reported routinely offering a choice to their patients for (1) starting urate-lowering therapy (ULT) for gout vs. doing nothing (70%); (2) choosing NSAIDs, corticosteroids, or colchicine for the treatment of acute flares (67%); and (3) choosing NSAIDs, corticosteroids, or colchicine for anti-inflammatory prophylaxis when starting ULT (51%). Very few rheumatologists offered choice regarding (4) choosing allopurinol vs. febuxostat as the first ULT (16%) and (5) taking daily ULT long-term vs. intermittently (15%). Rheumatologists perceived that a large proportion of patients were often or sometimes unsure of the best choice for these five decisions, 34%, 76%, 76%, 52%, and 54%, respectively. Similar proportions of rheumatologists felt that patients were uninformed about both medication benefits and risks, unclear about the personal importance of the benefits and risks, and unsupported in decision-making. For the five decisions respectively, rheumatologists supported SDM with patients in 76%, 56%, 58%, 27%, and 25%. The majority of VA rheumatologists incorporated SDM in several gout treatment decisions. Rheumatologists also recognized that patients need better support to participate in SDM in gout. Key Points: • Rheumatologists offered shared decision-making to gout patients for 3 key treatment decisions. • Rheumatologists perceived that many patients were unsure of the best choice for these decisions. • Rheumatologists felt that patients were uninformed about medication benefits/risks and unsupported in decision-making. [ABSTRACT FROM AUTHOR]

In today digital society, vulnerability to person authentication is a serious issue in real time scenarios like (airport, hospital, metro stations, etc.). This issue has increased the growth of video surveillance security systems. In recent decades behavioral biometric trait gait has emerged as a potential surveillance monitoring system because of its inconspicuous and unperceivable nature. Even more human gait has a benefit that it can be tracked at a distance and under low resolution videos. Finally, it is difficult to impersonate gait features. In this article, we comprehensively investigate the past and current research development in vision-based (VB) gait recognition. We give a brief description of feature selection and classification techniques used in gait recognition. The article extensively investigates feature representation techniques, classified into model-based and model-free. The article also provides a detail description of databases that are available for research purposes classified into two categories: VB and sensor-based. We extensively examine factors that affect gait recognition, and current research was done to cope with these factors. Moreover, this article proposes future perspectives after investigating state-of-art literature that can be more helpful to experts and new comers in gait recognition. In last, we also give a brief description of the proposed workflow. [ABSTRACT FROM AUTHOR]

Objective: To assess incidence, time-trends, and outcomes of serious infections in people with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA). Methods: We examined the 1998–2016 US National Inpatient Sample for serious infections in PMR or GCA, namely, opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia. Multivariable-adjusted logistic regressions assessed association of the type of infection, demographics, comorbidity, and hospital characteristics with healthcare utilization and mortality. Results: Hospitalized with serious infections, those with PMR or GCA were 2 decades older than people without PMR or GCA, and more likely to be female or white or have higher Deyo-Charlson index score or higher income. Sepsis rates in the general population, PMR, and GCA cohorts were 10.2%, 17.7%, and 18.9% in 2015–2016, respectively. Incidence rates of serious infections/100,000 NIS claims in PMR and GCA in 2015–2016 were as follows (rounded off): OI, < 1 and < 1; SSTI, 4 and 1; UTI, 4 and 1; pneumonia, 9 and 2; and sepsis, 20 and 4, respectively. Sepsis surpassed pneumonia as the most common serious infection in 2011–2012. In multivariable-adjusted analyses in the PMR cohort, sepsis, female sex, Deyo-Charlson comorbidity score ≥ 2, Medicare or Medicaid insurance, urban hospital location, and large hospital bed size were associated with significantly higher healthcare utilization and/or in-hospital mortality. Similar associations were noted in the GCA cohort. Conclusions: Incidence of serious infections, especially sepsis, increased in both PMR and GCA cohorts over time. Interventions to improve serious infection outcomes in PMR/GCA are needed. Key Points •PMR/GCA patients with hospitalized serious infections were 2 decades older than the general population. •Sepsis surpassed pneumonia as the commonest hospitalized serious infection in PMR/GCA in 2011–2012. •Sepsis, female sex, comorbidity, Medicare/Medicaid insurance, and urban location were associated with higher healthcare utilization and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Our objective was to assess healthcare utilization and complication rates after primary total knee/hip arthroplasty (TKA/THA) in people with spondyloarthritis (SpA) compared with people without SpA. We performed multivariable-adjusted logistic regression using the 1998–2014 US National Inpatient Sample (NIS), adjusted for age, race/ethnicity, gender, income, Deyo-Charlson comorbidity index, insurance payer, and the underlying diagnosis. The primary THA cohort consisted of 4,116,484 THAs (1.7% with SpA) and primary TKA cohort of 8,127,282 TKAs (1% with SpA). Compared with people without SpA, people with SpA had higher odds ratio (OR (95% confidence interval (CI)) of the following post-THA and post-TKA, respectively: (1) discharge to care facility, 1.16 (1.12, 1.21) and 1.14 (1.11, 1.18); (2) hospital stay > 3 days, 1.15 (1.11, 1.20) and 1.05 (1.01, 1.10); and (3) transfusion, 1.16 (1.12, 1.21) and 1.10 (1.05, 1.14); but lower odds of (1) mortality, 0.78 (0.64, 0.96) and 0.40 (0.19, 0.84); and (2) hospital charges above the median, 0.49 (0.46, 0.53) and 0.48 (0.45, 0.51). SpA was associated with higher odds of implant infection, 3.02 (2.27, 4.03) post-TKA, not post-THA. In-hospital revision rate did not differ. People with SpA utilize more healthcare services and have more complications post-THA/TKA. Interventions to reduce complications and associated utilization are needed. Key Points • People with spondyloarthritis utilized more healthcare services and had a higher risk of transfusion post-THA/TKA, compared with people without spondyloarthritis. • Spondyloarthritis was associated with lower in-hospital mortality rates after THA/TKA. • Spondyloarthritis was associated with a higher risk of implant infection after TKA, but not THA. • A pre-operative discussion with people with spondyloarthritis of possibly higher implant infection after TKA could lead to a more informed consent. [ABSTRACT FROM AUTHOR]

In this paper, a new and simple method for the construction of Girth-6 (J,L) Quasi-Cyclic Low-Density Parity-Check (QC-LDPC) codes is proposed. The method is further extended to the search of Girth-8 QC-LDPC codes with base matrices of order 3 × L and 4 × L. The construction is based on three different forms of exponent matrices and the parameters α, p, and q which satisfy the necessary algebraic conditions for a QC-LDPC code having girth 6 and 8. The proposed (J,L) QC-LDPC codes with girth at least six have optimal circulant permutation matrix (CPM) size for the cases where q = α + 1. Moreover, most of the girth-8 QC-LDPC codes searched by the proposed method have smaller CPM size than the existing codes of the same girth. In several cases, the method gives more than one exponent matrices for a code, as most of the existing methods cannot do so. Besides this, the proposed method not only search the QC-LDPC codes with smaller CPM size but also takes much less time than the existing search based methods to search code. [ABSTRACT FROM AUTHOR]

Occlusion is an important factor for analysis of human gait recognition in real-time scenarios. In multi-person gait (MPG) or dynamic occlusion, gait recognition is affected due to occluded body parts known as region of interests (ROIs). The aim of this article is to reconstruct the occluded ROIs and measure the errors associated with the reconstruction methods. The contribution of this article is threefold: firstly, we segment five dynamic ROIs; secondly, reconstruction of ROIs using Lagrange, piecewise cubic hermite (PCH) and cubic spline and thirdly, a comparison among the above methods in MPG scenario. We consider the human body into two parts, i.e., lower and upper body. In lower body, we have considered ankle, while knee in upper body: wrist, elbow, and shoulder have been considered. The dataset used in this study consists of dynamic occlusion scenarios. The quantitative assessment of the above methods are based on four parameters such as mean square error, root mean square error, mean absolute error and mean absolute percentage error. Results show that PCH consistently outperforms the other methods in the reconstruction of occluded ROIs in MPG scenario. [ABSTRACT FROM AUTHOR]

Objective: To assess whether age, race/ethnicity, comorbidity, and insurance payer status are associated with outcomes after total ankle arthroplasty (TAA). Methods: Using the US National Inpatient Sample (NIS) data and multivariable-adjusted logistic regression, we assessed the association of age, race/ethnicity, comorbidity ,and insurance payer status, with healthcare utilization and in-hospital complications (infection, transfusion, and revision surgery) after TAA. We calculated odds ratio (OR) and 95% confidence intervals (CI). Results: The cohort consisted of 6280 TAAs with a mean age of 62 years; 52% were female, 70% White, and 62% had osteoarthritis as the underlying diagnosis. Compared to age < 50 years, older age categories had higher ORs of total hospital charges above the median, length of hospital stay above the median (>2 days) and discharge to a rehabilitation facility, 1.26–19.41, and a lower OR of in-hospital infection, 0.07–0.09. Compared to Whites, Blacks had higher OR (95% CI) of: discharge to a rehabilitation facility, 1.45 (1.06, 1.98); length of hospital stay >2 days, 2.21 (1.37, 3.57); in-hospital transfusion, 4.39 (1.87, 10.30); and in-hospital revision, 8.25 (1.06, 64.21); and Hispanics were more likely to have total hospital charges above the median, OR 1.49 (1.10, 2.02), and infection, 9.30 (1.27, 68.05). Higher comorbidity and Medicare payer status were each associated with higher ORs of healthcare utilization, ORs ranging 1.20–2.57 and 1.74–2.19, respectively. Conclusions: Age, race/ethnicity, comorbidity, and insurance payer status were independently associated with post-TAA outcomes. Further insight into modifiable mediators of these associations can pave the way for improving these outcomes in the future. Key Points • Older age was associated with higher healthcare utilization post-ankle arthroplasty. • Compared to Whites, Blacks or Hispanics had higher healthcare utilization and in-hospital complications post-ankle arthroplasty. • Higher comorbidity and Medicare payer status were each associated with higher healthcare utilization post-ankle arthroplasty. [ABSTRACT FROM AUTHOR]

To assess whether polymyositis is associated with more complications and higher healthcare utilization after total knee or hip arthroplasty (TKA/THA). Using the 1998–2014 U.S. National Inpatient Sample data, we performed multivariable-adjusted logistic regression analyses to assess the association of polymyositis with in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), controlling for important covariates and confounders. Sensitivity analyses additionally adjusted the main models for hospital location/teaching status, bed size, and region. Of the 4,116,485 THAs and 8,127,282 TKAs, 853 people with polymyositis had THAs (0.02%) and 1038 had TKAs (0.01%). In multivariable-adjusted analyses, compared to people without polymyositis, people with polymyositis had similar odds of hospital charges above the median, hospital stay > 3 days, and discharge to non-home setting post-TKA and post-THA. Polymyositis was associated with significantly lower odds ratio (OR; 95% confidence interval [CI]) of revision and mortality post-THA, 0.44 (0.36, 0.55) and 0.63 (0.48, 0.84), but not post-TKA, 2.98 (0.47, 18.95) and 4.40 (0.61, 31.64), respectively. Findings from the main analyses were confirmed in the sensitivity analyses. People with polymyositis had no increase in healthcare utilization post-TKA/THA. A lower revision rate and mortality post-THA in people with polymyositis need further confirmation. Study findings should reassure the key stakeholders about the benefits of TKA/THA, including people with polymyositis. Key Points • Polymyositis was not associated with higher healthcare utilization after THA or TKA. • Polymyositis was associated with lower adjusted odds of implant revision and in-hospital mortality after THA, but not after TKA. [ABSTRACT FROM AUTHOR]

Objective: To assess whether systemic sclerosis (SSc) is associated with total knee arthroplasty (TKA) outcomes. Methods: We used the 1998–2014 US National Inpatient Sample. We conducted multivariable-adjusted logistic regression analyses to examine the association of a diagnosis of SSc with post-TKA in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, hospital stay, non-home vs. home discharge). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. Results: Our cohort included 8,123,388 people without SSc and 3894 people with SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher odds of transfusion, hospital stay > 3 days and non-home discharge with higher OR of 1.42 (95 % CI, 1.20, 1.69), 1.29 (95 % CI, 1.11, 1.49), and 1.29 (95 % CI, 1.11, 1.49), respectively. No differences were seen in revision, 0.68 (95 % CI, 0.10, 4.69) or hospital charges above the median, 1.01 (95 % CI, 0.70, 1.46). Differences in implant infection or mortality were not estimable, since none of the patients with SSc had implant infection or died. Sensitivity analyses that adjusted the main analysis additionally for hospital-level variables confirmed study findings with minimal or no attenuation of OR. Conclusion: SSc was associated with higher risk of transfusion and increased healthcare utilization after TKA. Future studies should examine if interventions can address modifiable factors to further optimize these outcomes. Key Points • Systemic sclerosis was independently associated with higher healthcare utilization after TKA. • The adjusted odds of transfusion was higher in people with systemic sclerosis compared to those without systemic sclerosis who underwent TKA. [ABSTRACT FROM AUTHOR]

In this paper, a new method for the construction of the exponent matrix of quasi-cyclic low-density parity-check (QC-LDPC) codes is proposed. The entries of the exponent matrix are based on the column multipliers. To find the column multipliers, a parameter S α is defined which gives the value of column multiplier of the α th column. The proposed method reduced the complexity related to the formation of the exponent matrix and results in (3,L)-QC-LDPC codes with girth at least eight, for L > 3 . Also, a lower bound on the size of the circulant permutation matrix (CPM) for a QC-LDPC code is derived, and the codes constructed by this method are optimal to the given bound. Further, most of the codes constructed using this method are of smaller CPM size. Specifically, for L > 25 , our constructed QC-LDPC codes have the shortest CPM size compared to the existing ones in the literature. [ABSTRACT FROM AUTHOR]

In the present study, the effect of irradiance on growth performance of Scenedesmus obliquus was investigated, and various non-linear growth models were evaluated to predict its temporal evolution. This microalga was cultured in a LED-illuminated flat-panel gas-lift photobioreactor operated in batch mode at varying irradiance ranging from 50 to 200 µmol/m2/s keeping all the other physico-chemical parameters constant. When growth data in terms of optical density were fitted in sigmoidal growth models, three non-linear models, namely, Richards model, Gompertz model, and logistic model, were found to be the best fit. Comparing these models based on statistical information, the logistic model could more appropriately and precisely describe algal growth under varying light intensity. Finally, the parameters of the logistic model were determined using regression analysis and were incorporated in the logistic equation to investigate the kinetic characteristics of S. obliquus. The optimum light intensity (Iopt) for growth was found to be 150 µmol/m2/s, at which a maximum specific growth rate (µopt) of 0.35/day was obtained. The model developed was validated experimentally and could successfully explain the photo-inhibition phenomenon occurring at light intensity above 150 µmol/m2/s. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that might facilitate or impede the implementation of a shared decision-making in lupus electronic tool (SMILE) in clinics by assessing perspectives of clinicians, clinic champions, and patient advocacy organization leaders. Methods: We conducted a series of semi-structured telephone interviews (25–45 minutes) about facilitators and barriers of implementing the SMILE decision-aid tool with 23 lupus care providers (18 physicians, 5 champions), and leaders of two patient advocacy organizations. Interviews were audio recorded, transcribed, coded, and analyzed. Results: Physicians and clinic champions were from 18 geographically diverse US clinics. The patient advocacy leaders were from the Lupus Foundation of America and the Arthritis Foundation. Most of the clinics were rheumatology specialty (94%), at university-based academic centers (72%), located in urban areas (72%), had a specialized lupus clinic (72%), were very interested (72%) in the SMILE tool and were ready to implement it (89%). Several specific factors, composed as four themes, were identified that could either facilitate or impede the implementation of the SMILE tool: (1) patient-related theme: patient recruitment and education, and the clinic visit time; (2) clinic-related theme: staff work-load and time, and physical space to view and use the SMILE tool; (3) technology-related theme: Wi-Fi connection and iPad navigation; and (4) management-related theme: influence on the clinics' daily workflow, the need of a study champion and coordination, and leadership support. Conclusion: Physicians, staff, and patient advocacy leaders perceived the SMILE as a promising tool to facilitate patient-provider communication and quality improvement in lupus. Identification of the patient-, clinic-, technology-, and management-related barriers to the SMILE implementation will allow its integration into busy clinical practice workflow. Key Points • Physicians, staff and patient advocacy leaders perceived computerized lupus decision aid to be a promising tool to facilitate shared decision-making for lupus treatment. • Stakeholder identified patient-related, clinic-resource-related, technology-related and clinic-management related themes as barriers or facilitators to viewing computerized lupus decision aid during regular clinic visits. [ABSTRACT FROM AUTHOR]

To assess if gout is associated with a higher risk of incident chronic pain. This study used the 2006–2012 Medicare claims data. We used multivariable-adjusted Cox regression analyses to examine the association of pre-existing diagnosis of gout with incident (new) diagnosis of chronic pain, adjusting for demographics, medical comorbidity, and use of common medications for cardiovascular disease and gout. Sensitivity analyses substituted Charlson-Romano score with a categorical variable or each Charlson-Romano comorbidity. There were 1,321,521 eligible people, of whom 424,518 developed incident chronic pain. Crude incidence rates of chronic pain were as follows: gout, 158.1 per 1000 person-years and no gout, 64.5 per 1000 person-years. In multivariable-adjusted Cox regression analyses, gout was associated with higher hazard ratio of chronic pain, 2.02 (95% CI, 1.98, 2.05), confirmed in sensitivity analyses 1.96 (95% CI, 1.93, 1.99) (model 2) and 1.77 (95% CI, 1.74, 1.80) (model 3). No meaningful differences were found by gender and race in subgroup analyses; slightly lower hazard of chronic pain with gout was seen in oldest people. Use of allopurinol or febuxostat was associated with lower risk of chronic pain, 0.79 (95% CI, 0.77, 0.82; model 1) and 0.72 (95% CI, 0.56, 0.92; model 1). Gout was associated with a doubling of the risk of chronic pain and gout treatments with reduction in the risk. Efforts must be made to optimize gout control, so that chronic pain can be avoided as a long-term sequalae of gout and when present, treated early and appropriately. Key points • Gout was associated with twofold higher risk of incident (or new) diagnosis of chronic pain. • Gout treatments were associated with a lower chronic pain risk. • Increased risk of chronic pain with gout was similar across age, race, and sex. • Studies should examine if optimal gout control with treat-to-target approach can reduce the risk of chronic pain in people with gout. [ABSTRACT FROM AUTHOR]

The prevalence of rheumatoid arthritis (RA), the most common autoimmune inflammatory arthritis, is increasing, partly due to the aging of the general population. RA is an independent risk factor for the development of cardiovascular disease (CVD). Older adults and elderly patients with RA develop CVD at a younger age compared with their general population peers. Both the traditional cardiovascular risk factors (age, sex, smoking, diabetes mellitus, hypertension), and systemic inflammation (i.e. high disease activity) are contributors to accelerated CVD in people with RA. Of the disease-modifying antirheumatic drugs (DMARDs) used for RA treatment, methotrexate, triple combination oral therapy (methotrexate, sulfasalazine, and hydroxychloroquine), tumor necrosis factor inhibitor biologicals, and abatacept have the strongest data in favor of the reduction of cardiovascular events in patients with RA. A treat-to-target strategy should be employed in older adults and elderly patients with RA to ensure appropriate reduction in cardiovascular risk, which can also prevent short- and long-term musculoskeletal disability. Our review findings are in line with the 2016 European League Against Rheumatism guideline recommendations, specifically: (1) RA disease activity should be controlled with an optimal DMARD regimen using a treat-to-target approach; (2) the lipid profile should be assessed and monitored in every older adult and elderly RA patient; (3) CVD risk factors, including smoking cessation, blood pressure, and blood glucose control, should be optimized; (4) RA treatment should be initiated as soon as possible; and (5) shared decision making regarding the treatment of patients with RA should include a discussion on the potential amelioration of increased cardiovascular risk. [ABSTRACT FROM AUTHOR]

Little is known about the effect of gout on in-hospital complications and healthcare utilization after total hip arthroplasty (THA). We used the 1998-2014 U.S. National Inpatient Sample (NIS) to examine this question using cohort study design. Multivariable-adjusted Cox regression analyses included age, race, gender, underlying diagnosis, Deyo-Romano comorbidity index, insurance payer, and income. In adjusted analyses, we found that gout was associated with 9-20% higher healthcare utilization and 6% higher hazard of transfusion after primary THA. These findings can inform surgeons and patients of gout-associated complications post-THA. [ABSTRACT FROM AUTHOR]

Cardiovascular disease affects more than 90 million Americans. Recent studies support an increased cardiovascular disease risk in inflammatory conditions, such as gout. Increased serum urate levels, or hyperuricemia, are a precursor to gout. Data from meta-analyses have shown hyperuricemia to be linked to hypertension and coronary heart disease. Similarly, gout has been associated with an increased risk of myocardial infarction, cerebrovascular accidents, and death from cardiovascular disease in randomized clinical trials. Urate-lowering therapy reduces serum urate and may decrease systemic inflammation, generation of oxidative species, and reverses endothelial dysfunction through hyperuricemia-dependent or hyperuricemia-independent pathways. Cardioprotective benefits of allopurinol, a first-line agent for the treatment of gout, have been demonstrated to potentially prevent myocardial infarction, stroke, atrial fibrillation, and other cardiovascular diseases in observational studies in select populations. Randomized controlled trials (RCTs) have also examined the role of newer urate-lowering therapies, such as febuxostat and lesinurad, and their risk of cardiovascular-specific mortality in comparison to allopurinol. A large post-marketing study of febuxostat vs. allopurinol showed higher all-cause and cardiovascular-specific mortality in the febuxostat group than in the allopurinol group; a major study limitation was that large numbers of patients were lost to follow-up or discontinued treatment. RCTs are required to assess the comparative effectiveness of urate-lowering therapies, validate findings of observational studies, and to determine which subgroup populations of gout are most likely to benefit from appropriate long-term urate-lowering therapy. This review examines the data for increased cardiovascular disease in gout and potential underlying mechanisms (including hyperuricemia, inflammation, endothelial dysfunction, oxidative stress) and the effect of urate-lowering therapy on cardiovascular disease. [ABSTRACT FROM AUTHOR]

To assess the goals of gout treatment from a patient perspective, a convenience sample of consecutive patients with doctor-diagnosed gout seen at a community-based outpatient clinic were invited. Sex-stratified nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed, and rank-ordered by each participant. Thirty-six patients with doctor-diagnosed gout participated in 12 nominal groups: 6 male only, 5 female only, and 1 group with both. Mean age was 61.9 years (SD, 12.3); mean gout duration was 13.3 years (SD, 12.5); 53% were men, 64% African-American, 42% retired, 47% currently married, 87% were using either allopurinol and/or febuxostat, and 40% had had no gout flares in the last 6 months. The top 5 treatment goals accounted for 91% of all votes and included the following: (1) prevent and better manage flare-ups and improve function (25%), (2) eliminate flare-ups/disease remission (30%), (3) diet and activity modification/lifestyle change (13%), (4) patient education and public awareness (12%), and (5) medication management and minimization of side effects (11%). When examining the top-rated concern for each nominal group, the first two goals were nominated by four groups each, diet/activity modification and medication management by 1 group each, and patient education by 3 groups. There were no differences evident by sex in top-ranked treatment goal. People with gout identified and rank-ordered treatment goals relevant to them. Providers of gout care need to be cognizant of these goals. Disease management concordant with these treatment goals might lead to a more satisfied, informed patient. [ABSTRACT FROM AUTHOR]

Our objective was to examine if Medicaid/Medicare health insurance and household income were associated with poorer outcomes after primary total hip arthroplasty (THA). We used multivariable-adjusted Cox regression analyses to assess whether insurance payer type and household income were independently associated with health care utilization outcomes or complications post-THA in a cohort of hospital discharges from the 1998-2014 US National Inpatient Sample, adjusting for demographics, underlying diagnosis for THA, medical comorbidity, and hospital characteristics. In a national cohort of 4,116,485 primary THAs, the mean age was 65.5 years, 57% were female, 87% White, and 83% had osteoarthritis. Compared to private insurance, patients with Medicaid had significantly higher hazard ratio (HR) (95% confidence interval (CI)) for hospital charges above the median, 1.18 (1.15, 1.21); discharge to a rehabilitation/inpatient facility, 1.67 (1.62, 1.72); length of hospital stay > 3 days, 1.62 (1.58, 1.67); and in-hospital post-operative complications including infection, 1.70 (1.47, 1.97); transfusion, 1.13 (1.09, 1.16); revision, 1.55 (1.32, 1.82); and mortality, 1.89 (1.35, 2.63). Results were similar for those with Medicare payer status. Compared to the highest quartile, the lowest income quartile was associated with significantly higher HR (95% CI) of hospital charges above median, 1.43 (1.41, 1.45), and a lower HR of discharge to a rehabilitation/inpatient facility, 0.78 (0.77, 0.79); hospital stay > 3 days, 0.82 (0.80, 0.83); infection, 0.57 (0.50, 0.65); and transfusion, 0.80 (0.79, 0.82). The association of Medicaid/Medicare insurance and income with post-THA health care utilization and complications implies that a better understanding of underlying reasons is needed to improve post-THA outcomes. [ABSTRACT FROM AUTHOR]

Background: Although well described for gastrointestinal and pelvic cancers, use of minimally invasive surgery (MIS) for the management of retroperitoneal soft tissue sarcoma (RPS) remains unknown. The current study aimed to describe patterns of MIS use and assess the association between MIS and clinical outcomes among patients undergoing surgery for RPS.Methods: Patients undergoing a primary resection for RPS between 2010 and 2014 were identified using the National Cancer Database. Multivariable logistic and Cox proportional hazards models were used to assess the association between use of MIS and clinical outcomes. Sensitivity analysis was performed using propensity score-matching (PSM).Results: This study identified 3844 patients who met the inclusion criteria. Of these patients, 89.3% (n = 3432) underwent an open surgery, whereas 10.7% (n = 412) underwent MIS. The patients undergoing MIS were more likely to present with smaller tumors (open vs MIS: median tumor size, 17 cm; interquartile range [IQR, 9.8-26.0] vs 10.5 cm [IQR, 6.5-18.0]) and to undergo surgery at community hospitals (26.8% vs 36.1%; both P < 0.001). Although MIS was associated with a shorter hospital length of stay [LOS] (median LOS, 6 days [IQR, 5-9 days] vs 4 days [IQR, 2-7]; P < 0.001), postoperative mortality and overall survival were comparable between the two treatment groups (all P > 0.05). These findings were confirmed using PSM.Conclusions: MIS was associated with a shorter LOS, however, postoperative mortality and overall survival were comparable by operative approach. Future research is required to evaluate the use of MIS for the management of RPS. Policies are required to ensure that patients receive care in accordance with best practices and recommended guidelines. [ABSTRACT FROM AUTHOR]

A new anisidine possessing benzothiaozle-based chemosensor ( 1) has been designed and synthesized. The chemosensor 1 was designed to provide hard base environment for ratiometric detection of comparatively less studied Al ions. In CHCN, the fluorescence spectra of chemosensor 1 red shifted from 368 to 430 nm with addition of Al and Hg ions; while Cu ions caused quenching of emission intensity of 1. These differential changes observed with Al and Cu ions addition enabled chemosensor 1 to construct 'NOR' and 'TRANSFER' logic gates. [ABSTRACT FROM AUTHOR]

Novel synthetic derivatives of sesquiterpene lactone isoxanthanol ( 1) have been prepared and bioevaluated against four human cancer cell lines viz. T98G (glioblastoma), A431 (epidermoid carcinoma), NCI-H322 (bronchioloalveolar carcinoma), and A549 (lung adeno carcinoma) for their cytotoxic potential using paclitaxel as the standard. This has resulted in the identification of potent molecules displaying IC 1.9 and 5.0 µM, respectively against the A549 cancer cell line. The study has resulted in the identification of potential cytotoxic activity of the analog (compound 10) bearing electron donating aryl alkenoic substituent. Furthermore, the induction of cell death has been assessed for the most active compound ( 10) using flow cytometric method and sub-G1 cell population determination by propidium iodide staining. The concentration dependent inhibitory effect of 10 on the A549 cells ability did not reproduce and form colonies at 20 µM concentration. Graphical Abstract: Synthesis of isoxanthanol derivatives and their cytotoxic study resulted in identification of potential cytotoxic agents. Compound 10, one of its aryl alkenoic substituent showed potency against NCI-H322 (bronchioloalveolar carcinoma), and A549 (lung adeno carcinoma) cell lines. [ABSTRACT FROM AUTHOR]

Low-dose SoluMatrix diclofenac was developed to provide effective pain relief for osteoarthritis pain. We evaluated the effects of SoluMatrix diclofenac on health-related quality of life (HRQoL) measures in patients with osteoarthritis, hypothesizing that SoluMatrix-treated patients would experience significant improvement compared with placebo. In this 12-week, phase 3 randomized controlled trial, 305 patients with osteoarthritis of the hip or knee received SoluMatrix diclofenac 35 mg three times (TID) or twice (BID) daily or placebo. Measures included HRQoL, assessed by Short Form 36 (SF-36, version 2), and pain, stiffness, and physical function, assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at week 12. Descriptive statistics were calculated for mean changes from baseline; inferential statistics compared treatment groups with placebo. SoluMatrix diclofenac 35 mg BID (6.2 [0.75]; P = 0.0048) or TID (6.6 [0.80]; P = 0.0014) produced large improvements in the SF-36 physical component summary (PCS) scores at week 12 (least squares mean change from baseline [SE]) compared with placebo (3.5 [0.78]). Minimum clinically important differences were observed in six out of eight SF-36 domains among patients in SoluMatrix diclofenac groups and five out of eight domains in the placebo group; treatment with SoluMatrix diclofenac 35 mg TID produced significant improvements ( P ≤ 0.03) in five out of eight domains versus placebo. SoluMatrix diclofenac 35 mg TID significantly improved responses to 23 out of 24 questions in the WOMAC versus placebo ( P ≤ 0.0334). Low-dose SoluMatrix diclofenac 35 mg TID and BID significantly improved HRQoL, pain, stiffness, and physical function in patients with osteoarthritis of the hip or knee. [ABSTRACT FROM AUTHOR]

Gout diagnostic criteria help focus attention on the accurate and early diagnosis of gout. New recommendations reinforce that joint aspiration and demonstration of monosodium urate crystals remains the gold standard for a diagnosis of gout and should be attempted in every patient with suspected gout. [ABSTRACT FROM AUTHOR]

The above article originally published with an error present in Table 1. The data "Home" on the first column of the Table 1 should be interchange with the previous data "Inpatient facility†". This is presented correctly in this article. [ABSTRACT FROM AUTHOR]

Biologic use is a major advance in the treatment of several autoimmune conditions, including rheumatoid arthritis. In this review, we summarize key studies of serious/hospitalized infections in rheumatoid arthritis (RA). RA is a risk factor for infections. High RA disease activity is associated with higher risk of serious infection. The risk of serious infections with tumor necrosis factor inhibitor (TNFi) biologics is increased in the first 6 months of initiating therapy, and this risk was higher compared to the use of traditional disease-modifying anti-rheumatic drugs (DMARDs). Emerging data also suggest that biologics may differ from each other regarding the risk of serious or hospitalized infections. Past history of serious infections, glucocorticoid dose, and older age were other important predictors of risk of serious infections in patients treated with biologics. [ABSTRACT FROM AUTHOR]

Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare patient characteristics, utilization rates, and outcomes after total elbow arthroplasty (TEA) by sex. We used the nationwide inpatient sample from 1998 to 2011 to study sex-related time trends in patient characteristics, comorbidity, and outcomes after TEA. We used chi-squared test, analysis of variance, and the Cochran-Armitage test to assess differences in utilization rates and characteristics over time by sex and logistic regression to compare mortality, discharge disposition, and the length of hospital stay by sex. Overall TEA utilization 0.45 in 1998 to 0.96 per 100,000 in 2011 ( p < 0.0001). The utilization rates were significantly higher in females compared to males throughout the study period: 0.62 vs. 0.29 in 1998 ( p < 0.0001) and 1.31 vs. 0.70 in 2011 ( p < 0.0001). Compared to males, females undergoing TEA were more likely to be white (79.7 vs. 71.4 %; p < 0.0001), have rheumatoid arthritis (16.7 vs. 8.1 %; p < 0.0001), and have Deyo-Charlson index of 2 or more (11.3 vs. 5.9 %; p < 0.0001) and were older (63.5 vs. 51.4 years; p < 0.0001). Compared to males undergoing TEA, females had significantly lower mortality, 0.1 vs. 0.4 % ( p = 0.03); lower proportion were discharged to home, 81.9 vs. 89.6 % ( p < 0.0001), and fewer had has index hospital stay above the median, 30.0 vs. 33.0 % ( p = 0.01); most differences were significant after multivariable adjustment. TEA utilization in the USA more than doubled in the last 14 years, with rates higher in females than males. Females had better outcomes after TEA than men. Preoperative risk communication should be sex-specific based on these data. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare total ankle arthroplasty (TAA) utilization and outcomes by patient residence. We used the Nationwide Inpatient Sample (NIS) from 2003 to 2011 to compare utilization and outcomes (post-arthroplasty discharge disposition, length of hospitalization, and mortality) by rural vs. urban residence. Ten thousand eight hundred thirty-three patients in urban and 3,324 patients in rural area underwent TAA. Compared to rural residents, urban residents had: lower mean age, 62.4 vs. 61.8 years ( p < 0.0001); higher percent of women, 49 vs. 56 % ( p = 0.0008); and lower proportion of Whites, 93 vs. 86 % ( p = 0.0005). There were rural-urban disparities in TAA utilization in 2003 (0.32 vs. 0.39/100,000; p = 0.021), but not in 2011 (1.19 vs. 1.17/100,00; p = 0.80). TAA outcomes did not differ by rural vs. urban residence: (1) 11.3 % rural vs. 14.2 % urban residents were discharged to an inpatient facility ( p = 0.098); (2) length of hospital stay above the median stay, was 44.8 vs. 42.2 % ( p = 0.30); and (3) mortality was 0.2 vs. 0.1 %, respectively ( p = 0.81). Multivariable-adjusted logistic regression models did not show any significant differences in discharge to home, length of stay, or mortality, by residence. Our study demonstrated an absence of any evidence of rural-urban differences in TAA outcomes. The rural-urban differences in TAA utilization noted in 2003 were no longer significant in 2011. [ABSTRACT FROM AUTHOR]

We hypothesized that serum urate-associated SNPs, individually or collectively, interact with BMI and renal disease to contribute to risk of incident gout. We measured the incidence of gout and associated comorbidities using the original and offspring cohorts of the Framingham Heart Study. We used direct and imputed genotypes for eight validated serum urate loci. We fit binomial regression models of gout incidence as a function of the covariates, age, type 2 diabetes, sex, and all main and interaction effects of the eight serum urate SNPs with BMI and renal disease. Models were also fit with a genetic risk score for serum urate levels which corresponds to the sum of risk alleles at the eight SNPs. Model covariates, age ( P = 5.95E−06), sex ( P = 2.46E−39), diabetes ( P = 2.34E−07), BMI ( P = 1.14E−11) and the SNPs, rs1967017 ( P = 9.54E−03), rs13129697 ( P = 4.34E−07), rs2199936 ( P = 7.28E−03) and rs675209 ( P = 4.84E−02) were all associated with incident gout. No BMI by SNP or BMI by serum urate genetic risk score interactions were statistically significant, but renal disease by rs1106766 was statistically significant ( P = 6.12E−03). We demonstrated that minor alleles of rs1106766 (intergenic, INHBC) were negatively associated with the risk of incident gout in subjects without renal disease, but not for individuals with renal disease. These analyses demonstrate that a significant component of the risk of gout may involve complex interplay between genes and environment. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the time trends in utilization, clinical characteristics, and outcomes of patients undergoing total ankle arthroplasty (TAA) in the USA. We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time trends across the years and the analysis of variance (ANOVA), Wilcoxon test, or chi-squared test (as appropriate) to compare the first (1998-2000) and the last time periods (2009-2010). TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females, and from 0.11 to 0.81 per 100,000 in males ( p < 0.0001 for each comparison for time trends). Compared to the 1998-2000 period, those undergoing TAA in 2009-2010 were older (41 % fewer patients <50 years, p < 0.0001), less likely to have rheumatoid arthritis as the underlying diagnosis (55 % fewer patients, p = 0.0001), more likely to have Deyo-Charlson index of 2 or more (197 % more, p = 0.0010), and had a shorter length of stay at 2.5 days (17 % reduction, p < 0.0001). Mortality was rare ranging from 0 to 0.6 % and discharge to inpatient facility ranged 12.6-14.1 %; we noted no significant time trends in either ( p > 0.05). The utilization rate of TAA increased rapidly in the USA from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time. [ABSTRACT FROM AUTHOR]

The article describes a study which examined whether gout was associated with an increase in the risk of incident hypothyroidism in adults 65 years or older. Topics include gout as the most common inflammatory arthritis in the elderly, the diagnosis of gout and hypothyroidism, and the demographic and clinical characteristics of episodes of incident hypothyroidism.

An introduction is presented which discusses articles published within the issue on topics including science and practice of medication adherence, cultural issues in medication adherence, and using social-behavioral models of medication adherence.

The aim of the study was to assess racial disparities in utilization rates and outcomes after primary total elbow arthroplasty (TEA). We used the National Inpatient Sample from 1998 to 2010, a US national database. Patient characteristics, comorbidity and outcomes after TEA were assessed over time and differences by race studied over the study period. Cochran-Armitage test was used for time trends and logistic regression for the comparison of outcomes by race. In 1998, TEA utilization rate was 0.38/100,000 in Whites and 0.24/100,000 in Blacks ( p = 0.002); in 2010, it was 0.91 and 0.59/100,000, respectively ( p < 0.0001). White-Black disparity in TEA utilization was significant across 13 years ( p = 0.03). Compared with White patients, Black patients undergoing TEA were younger (61.9 vs. 52 years; p < 0.0001), less likely to be female (70.6 vs. 61.4 %; p = 0.0007) and more likely to have rheumatoid arthritis as the underlying diagnosis (13.0 vs. 17.2 %; p = 0.036). Mortality was rare, 0.26 % in Blacks and 0.32 % in Whites ( p = 0.83). Discharge to an inpatient facility was higher in White versus Black patients in unadjusted analyses (16.8 vs. 10.4 %; p = 0.003), but in analyses adjusted for age, sex, Deyo-Charlson index and the underlying diagnosis, the differences were no longer significant ( p = 0.79). The length of hospital stay greater than the median stay was noted in 29.8 % Whites versus 31.2 % Blacks, respectively ( p = 0.61). There was no evidence of White-Black disparity in hospital length of stay in 1998-2000 ( p = 0.66) or 2009-2010 ( p = 0.59) periods. In this study, we found persisting racial disparities in TEA utilization rates. No White-Black disparities were noted in TEA outcomes, except slight differences in discharge disposition. [ABSTRACT FROM AUTHOR]

An efficient first total synthesis of a naturally occurring guanidine alkaloid, Nitensidine D isolated from ethanol extract of Pterogyne nitens has been described. Geraniol has been used as the starting material. N-alkylation of phthalimide has been achieved using immobilized ionic liquid and formamidinesulfinic acid acts as the guanylating reagent. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Background: There is compelling evidence of a genetic foundation of patient-reported quality of life (QOL). Given the rapid development of substantial scientific advances in this area of research, the current paper updates and extends reviews published in 2010. Objectives: The objective was to provide an updated overview of the biological pathways, candidate genes, and molecular markers involved in fatigue, pain, negative (depressed mood) and positive (well-being/happiness) emotional functioning, social functioning, and overall QOL. Methods: We followed a purposeful search algorithm of existing literature to capture empirical papers investigating the relationship between biological pathways and molecular markers and the identified QOL domains. Results: Multiple major pathways are involved in each QOL domain. The inflammatory pathway has the strongest evidence as a controlling mechanism underlying fatigue. Inflammation and neurotransmission are key processes involved in pain perception, and the catechol-O-methyltransferase (COMT) gene is associated with multiple sorts of pain. The neurotransmitter and neuroplasticity theories have the strongest evidence for their relationship with depression. Oxytocin-related genes and genes involved in the serotonergic and dopaminergic pathways play a role in social functioning. Inflammatory pathways, via cytokines, also play an important role in overall QOL. Conclusions: Whereas the current findings need future experiments and replication efforts, they will provide researchers supportive background information when embarking on studies relating candidate genes and/or molecular markers to QOL domains. The ultimate goal of this area of research is to enhance patients' QOL. [ABSTRACT FROM AUTHOR]