Search

Goran Medic,1,2 Nikos Kotsopoulos,3 Mark P Connolly,2,3 Jennifer Lavelle,4 Vincent Norlock,4 Manish Wadhwa,4 Belinda A Mohr,5 Wayne M Derkac4 1Chief Medical Office, Philips Healthcare, Eindhoven, Netherlands; 2Department of Pharmacy, University of Groningen, Groningen, Netherlands; 3Global Market Access Solutions LLC, Charlotte, NC, USA; 4BioTelemetry, Inc., A Philips Company, Malvern, PA, USA; 5Chief Medical Office, Philips, Cambridge, MA, USACorrespondence: Goran MedicChief Medical Office, Philips Healthcare, High Tech Campus 37-3.009, Eindhoven, 5656 AG, NetherlandsTel +31-61-819-3782Email goran.medic@philips.comPurpose: The aim of this study was to compare costs and outcomes of mobile cardiac outpatient telemetry (MCOT) patch followed by implantable loop recorder (ILR) compared to ILR alone in cryptogenic stroke patients from the US health-care payors’ perspective.Patients and Methods: A quantitative decision tree cost-minimization simulation model was developed. Eligible patients were 18 years of age or older and were diagnosed with having a cryptogenic stroke, without previously documented atrial fibrillation (AF). All patients were assigned first to one then to the alternative monitoring strategies. Following AF detection, patients were initiated on oral anticoagulants (OAC). The model assessed direct costs for one year attributed to MCOT patch followed by ILR or ILR alone using a monitoring duration of 30 days post-cryptogenic stroke.Results: In the base case modeling, the MCOT patch arm detected 4.6 more patients with AFs compared to the ILR alone arm in a cohort of 1000 patients (209 vs 45 patients with detected AFs, respectively). Using MCOT patch followed by ILR in half of the patients initially undiagnosed with AF leads to significant cost savings of US$4,083,214 compared to ILR alone in a cohort of 1000 patients. Cost per patient with detected AF was significantly lower in the MCOT patch arm $29,598 vs $228,507 in the ILR only arm.Conclusion: An initial strategy of 30-day electrocardiogram (ECG) monitoring with MCOT patch in diagnosis of AF in cryptogenic stroke patients realizes significant cost-savings compared to proceeding directly to ILR only. Almost 8 times lower costs were achieved with improved detection rates and reduction of secondary stroke risk due to new anticoagulant use in subjects with MCOT patch detected AF. These results strengthen emerging recommendations for prolonged ECG monitoring in secondary stroke prevention.Keywords: ambulatory cardiac monitoring, Holter, atrial fibrillation, electrocardiography, economic evaluation, secondary prevention

Studying the flows of parent country nationals in multinational enterprises (MNEs) to subsidiary operations has a relatively long tradition. Studying flows of subsidiary employees to other subsidiaries, as third country nationals, and to the corporate headquarters, as inpatriates, however, has empirically much less pedigree. Drawing on a large-scale empirical study of MNEs in Ireland, this paper provides a benchmark of outward flows of international assignees from the Irish subsidiaries of foreign-owned MNEs to both corporate headquarters and other worldwide operations. Building on insights from the resource-based view and neo-institutional theory, we develop and test a theoretical model to explain outward staffing flows. The results show that almost half of all MNEs use some form of outward staffing flows from their Irish operations. Although the impact of specific variables in explaining inter-organization variation differs between the utilization of inpatriate and third country national assignments, overall we find that a number of headquarters, subsidiary, structural, and human resource systems factors emerge as strong predictors of outward staffing flows. © 2010 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

A numerical model of ocean flow, hydrography, and transport is used to extrapolate observations of currents and hydrography and infer patterns of material flux in the deep ocean around Axial Seamount, a destination node of NSF's Ocean Observatories Initiative's Cabled Array. Using an inverse method, the model is made to approximate measured deep ocean flow around this site during a 35 day time period in the year 2002. The model is then used to extract month-long mean patterns and examine smaller-scale spatial and temporal variability around Axial. Like prior observations, model month-long mean currents flow anticyclonically around the seamount's summit in toroidal form with maximum speeds at 1500 m depth of 10-11 cm/s. As a time mean, the temperature (salinity) anomaly distribution takes the form of a cold (briny) dome above the summit. Passive tracer material continually released at the location of the ASHES vent field exits the caldera primarily through its southern open end before filling the caldera. Once outside the caldera, the tracer circles the summit in clockwise fashion, fractionally reentering the caldera over lower walls at its north end, while gradually bleeding southwestward during the modeled time period into the ambient ocean. A second tracer release experiment using a source of only 2 day duration inside and near the CASM vent field at the northern end of the caldera suggests a residence time of the fluid at that locale of 8-9 days. [ABSTRACT FROM AUTHOR]

The article presents information on the use of botulinum toxin (BTX) as a treatment for overactive bladder syndrome that may affect the patient's quality of life. As stated, BTX spreads in bladder and reduces the release of adenosine triphosphate, acetylcholine, and norepinephrine. As further stated, BTX is becoming the effective treatment for overactive bladder but research is required in order to identify minimal dosage and reduced side effects.

Employee voice has been an enduring theme within the employment relations literature.This article profiles the incidence of a range of direct and indirect employee voice mechanisms within multinational companies (MNCs) and, using an analytical framework, identifies a number of different approaches to employee voice. Drawing from a highly representative sample of MNCs in Ireland, we point to quite a significant level of engagement with all types of employee voice, both direct and indirect. Using the analytical framework, we find that the most common approach to employee voice was an indirect voice approach (i.e. the use of trade unions and/or non-union structures of collective employee representation). The regression analysis identifies factors such as country of origin, sector, the European Union Directive on Information and Consultation and date of establishment as having varying impacts on the approaches adopted by MNCs to employee voice. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe the methods of a randomized clinical trial of intra-vesical botulinum toxin for refractory urge urinary incontinence. Methods: Clinical sites of the Pelvic Floor Disorders Network (www.pfdn.org) recruited patients with refractory urge urinary incontinence and urodynamic evidence of detrusor overactivity incontinence (DOI) to a 2:1 placebo controlled cystoscopic injection of botulinum toxin A. Results: The primary outcome is time to failure after first injection, with failure defined as a Patient Global Impression of Improvement (PGI-I) score 4 or greater at least 2 months after the first injection or the commencement of any new treatment at any time after the first injection, or an increased intensity of previously established treatment for DOI. Conclusions: This trial was designed to test the efficacy of intra-detrusor botulinum toxin A for the treatment of refractory urge incontinence. Progress of the trial can be monitored on www.clinicaltrials. gov [ABSTRACT FROM AUTHOR]

Astoria Canyon represents the westernmost portion of the Columbia River drainage system, with the head of the canyon beginning just 16 km west of the mouth of the Columbia River along the northern Oregon and southern Washington coasts. During the summer of 2001, physical, chemical, and biological measurements in the canyon were taken to better understand the hydrodynamic setting of, and the feeding relationships among, the pelagic and benthic communities. Results show that currents were strongly tidal, and transport, where measured, was primarily up and into the canyon below shelf depth as previous studies in the canyon have shown. Temperature time series suggests that the largest diurnal oscillations occurred at, or were trapped near, the bottom of the canyon. Within the upper canyon, subtidal temperature was correlated with upper-level shelf-edge currents, linking subtidal upwelling events in the canyon with near-surface subtidal along-shore flow. Invertebrates, such as shrimp, euphausiids, and squid, as well as mesopelagic fishes, dominated the Isaacs–Kidd midwater trawl catches along the canyon walls. Large trawl catches were comprised mainly of hake and rockfishes (shallow trawls) and macrourids, scorpaenids, stomiids, and zoarcids (bottom trawls). Gut-content analysis of rockfishes and lanternfishes revealed substantial use of midwater prey such as euphausiids and mesopelagic fishes. The δ13C values of fishes and invertebrates reflected local primary production, as indicated by particulate organic matter (POM) δ13C values from samples collected at various depths along the axis of the canyon, as well as across the canyon at several sites. The δ15N values of fishes and invertebrates indicated lanternfishes, along with euphausiids, amphipods, shrimp and squid, may be important dietary components of higher-trophic-level fishes in both the benthic and benthopelagic food webs. The δ13C and δ15N values of Sebastes species showed significant enrichment in the adults of species that are largely piscivorous relative to the values of adults of more omnivorous species. [Copyright &y& Elsevier]

BACKGROUND: It is now well documented that both black and white patients with severe mental illness are likely to use different types of treatment facilities, have different lengths of hospital stays, and receive different types and dosages of psychotropic medications. It is still uncertain, however, whether these differences exist at the early stages of treatment. METHOD: We examined treatment patterns for a countywide sample of patients with psychotic disorders recruited at their initial psychiatric hospitalization. Illness characteristics, prior treatment histories, admission conditions, and psychotropic medication use during this hospitalization were compared for both black and white patients. RESULTS: Black patients were less likely to have had out-patient treatment prior to their first hospitalization and were more likely to be hospitalized in public than in community psychiatric units than were white patients. Black patients were also more likely to be hospitalized primarily for a behavioral disturbance and escorted to the hospital by the emergency medical services or police, while white patients were more often hospitalized primarily for subjective suffering. These patterns were particularly significant for those with a non-schizophrenia diagnosis. However, there were few statistically significant differences between black and white patients on psychotropic medication use during the first hospitalization. CONCLUSIONS: Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Lachman test is the most reliable clinical test for diagnosing rupture of the anterior cruciate ligament (ACL). It is generally believed that the lateral side contributes more than the medial side to anterior tibial translation, but this has never been convincingly proven. The MRI study presented in this article addresses this issue. HYPOTHESIS: The lateral side of the ACL-deficient knee contributes more than the medial side to anterior tibial translation. STUDY DESIGN: Prospective cohort study. METHODS: The Lachman test and the radiologic Lachman test were performed on 10 patients with isolated rupture of the ACL while the knee was scanned dynamically using open-access magnetic resonance imaging. The amount of movement in the midmedial and midlateral compartments of both the contralateral normal knee and the ACL-deficient knee was measured. RESULTS: In both normal and ACL-deficient knees, the lateral compartment contributes more than the medial to anterior translation of the tibia. Rupture of the ACL leads to increased laxity in both medial and lateral compartments with a statistically significant greater contribution from the lateral side. CONCLUSION: Rupture of the ACL leads to increased anterior tibial translation coupled with tibial internal rotation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Since the introduction of multilumen central venous catheters two decades ago, there has been controversy whether the additional lumens place patients with these catheters at higher risk for infection. Our objective was to determine the risk of catheter-related bloodstream infection (CRBSI) and catheter colonization in multilumen catheters compared with single-lumen catheters. DATA SOURCE: Studies were identified by a computerized search of MEDLINE, EMBASE, CINAHL, Current Contents, and PREMEDLINE databases and by review of bibliographies and expert consultation. Studies comparing the prevalence of CRBSI or catheter colonization among single-, double-, and triple-lumen central venous catheters were included. We excluded studies if they included central venous catheters that were long-term, cuffed, tunneled, or coated with antibiotic or antiseptic agents. DATA ABSTRACTION: Two independent reviewers abstracted data on: 1) risk factors for CRBSI and colonization, 2) outcome definitions used, 3) the absolute prevalence of CRBSI and catheter colonization, and 4) study design and quality. DATA SYNTHESIS: A total of 15 studies met inclusion criteria. Summary odds ratios were calculated using a random-effects model. Although CRBSI was more common in multilumen catheters (summary odds ratios, 2.15; 95% confidence interval, 1.00-4.66), catheter colonization was not (summary odds ratios, 1.78; 95% confidence interval, 0.92-3.47). Tests for heterogeneity, however, suggested substantial variation by study. When only studies of higher quality were included, multilumen catheters were found not to be associated with a significant increase in CRBSI prevalence (summary odds ratios, 1.30; 95% confidence interval, 0.50-3.41). CONCLUSIONS: Multilumen central venous catheters may be associated with a slightly higher risk of infection when compared with single-lumen catheters; however, this relationship diminishes when only high-quality studies that control for patient differences are considered. The slight increase in infectious risk when using multilumen catheters is likely offset by their improved convenience, thereby justifying the continued use of multilumen vascular catheters. [ABSTRACT FROM AUTHOR]