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Background: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as "cancer survivors" and those without a history of cancer as "no cancer history." We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. Results: There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. Conclusion: Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. Results: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P <.01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P <.01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. Conclusion: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity. [ABSTRACT FROM AUTHOR]

Background: The 6-minute walk (6 MW) is the most commonly applied measure of endurance walking capacity in persons with multiple sclerosis (MS); however, we are not aware of a quantitative synthesis of 6 MW performance in MS.Research Question: We undertook a meta-analysis quantifying the overall magnitude of difference in 6 MW performance between MS and healthy controls (HCs), and then within MS as a function of disability status. We further examined possible moderator variables of 6 MW performance.Methods: The systematic search was conducted for articles that included the 6 MW in persons with MS and involved comparison groups (i.e., HCs or MS disability subgroups (i.e., mild vs moderate-to-severe disability status)). The mean and standard deviation of the distance traveled during the 6 MW as well as sample sizes were entered into Comprehensive Meta-Analysis software and we estimated the overall effect size (Cohen's d) using a random effects model and examined categorical variables as possible moderators (e.g., instruction protocol, provision of encouragement, method of distance measurement, and course description).Results: Thirty-four studies met inclusion criteria with a total sample size of 3204 persons (MS: 2683; HC: 521) yielding 42 total comparisons. Persons with MS walked a shorter distance than HCs (mean difference = -177.2 ± 19.1 m) with a large effect size (d = - 1.87). Persons with mild disability walked further than those with moderate-to-severe disability (mean difference = 185.19 ± 9.2 m) with a large effect (d = 1.83). The categorical variables of provision of encouragement and course layout moderated the effect of MS and course layout moderated the effect of disability status on 6 MW performance.Significance: This meta-analysis of 6 MW performance defines mean difference in 6 MW performance in MS compared with HCs and provides an estimate of the disease-related effect of MS on endurance walking capacity for application within clinical research and practice. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by K. Nakao, L. J. Milazzo-Sayre, M. J. Rosenstein and R. W. Manderscheid on using variables to explain medical referral patterns to and from inpatient psychiatric services and another one by R. D. Drennan on the implementation of multidimensional scaling procedure on the chronological placement of proveniences at an excavation site.

OBJECTIVE To determine trends in male reproductive surgeries. MATERIALS AND METHODS A database analysis was performed using the Healthcare Cost and Utilization Project databases from 1988, 1992 and 1998-2002. SAS statistical software was used to estimate the total numbers of reproductive surgeries and their variances for each year. RESULTS The number of male reproductive surgeries has declined during the period of study, both in the inpatient and outpatient arenas. The number of procedures with a diagnosis of infertility has also declined. CONCLUSION The number of male reproductive surgeries has declined from 1988 to 2002. [ABSTRACT FROM AUTHOR]

Background: Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. Methods: Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. Results: There was no significant difference between interventions, although programs that used non–theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =−0.15, 95% CI =−0.29 to −0.02, p = .03). Conclusions: Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success. [ABSTRACT FROM AUTHOR]

To determine the prevalence of adrenal androgen (AA) excess in the polycystic ovary syndrome (PCOS) using age- and race-specific normative values.Cross-sectional observational study.One hundred and eight-two (88 Black and 94 White) age-matched healthy eumenorrhoeic nonhirsute women (controls) and 213 (27 Black and 186 White) women with PCOS were recruited.Total testosterone (T), free T, androstenedione (A4), dehydroepiandrosterone sulfate (DHEAS) and SHBG, as well as fasting insulin and glucose, were measured in plasma.The mean total T, free T, A4, DHEAS and body mass index (BMI) were higher in women with PCOS than in control women. DHEAS levels were significantly lower in Black controls than White controls, whereas fasting insulin and BMI were higher in Black controls. In control and Black PCOS women, DHEAS levels did not correlate with BMI, waist-to-hip ratio (WHR) or fasting insulin. Among White women with PCOS, DHEAS levels correlated negatively with BMI and fasting insulin. DHEAS levels decreased similarly with age in control and PCOS women of either race. For each race and age group the upper 95% normative values for log DHEAS was calculated, and the number of PCOS subjects with log DHEAS values above this level were assessed. The prevalence of supranormal DHEAS levels was 33·3% and 19·9%, respectively, among Black and White women with PCOS.The prevalence of DHEAS excess is approximately 20% among White and 30% among Black PCOS patients, when using age- and race-adjusted normative values. This study also indicates that the age-associated decline in DHEAS levels is observable and similar in both control and PCOS women, regardless of race. While BMI and fasting insulin had little impact on circulating DHEAS levels in healthy women, among White PCOS patients these parameters were negatively associated with circulating DHEAS levels. [ABSTRACT FROM AUTHOR]

Objective: We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder. Design: Prospective cohort analysis. Setting: University-based tertiary care. Patient(s): Three-hundred sixteen untreated consecutive women diagnosed as having PCOS. Intervention(s): None. Main Outcome Measure(s): Each subject underwent an evaluation of ovulatory function, body habitus, acne, and hirsutism; serum free and total testosterone (T), 17-hydroxyprogesterone (17-HP), and DHEAS; and fasting plasma glucose and insulin levels. Insulin resistance and β-cell function were assessed using the homeostatic assessment model equation (HOMA-IR and HOMA-β-cell, respectively). Result(s): The Oligo+HA+Hirsutism phenotype was present in 48% of subjects, Oligo+HA in 29%, and Oligo+Hirsutism in 23%. The three phenotypes did not differ in mean body mass index, waist-to-hip ratio, racial composition, degree of oligo-ovulation, prevalence of acne, or family history of hyperandrogenic symptomatology. However, subjects demonstrating the Oligo+HA+Hirsutism phenotype were the youngest and had the greatest degrees of hyperandrogenemia, hyperinsulinemia, and β-cell function; patients with the Oligo+Hirsutism phenotype where the oldest and had the mildest degrees of hyperandrogenemia, hyperinsulinemia, and β-cell function. Subjects with the Oligo+HA phenotype demonstrated intermediate degrees of hyperandrogenemia and metabolic dysfunction. Conclusion(s): We conclude that the three clinical phenotypes of PCOS do not represent forms of the same metabolic disorder and may be the result of varying degrees of metabolic dysfunction; greater degrees of β-cell function and circulating insulin levels favored the development of hirsutism and frank hyperandrogenemia. [Copyright &y& Elsevier]

Objective. To compare the marginal gap using different types of die stones and titanium dies with and without powders for imaging. Methods. A melamine tooth was prepared and scanned using a laboratory 3-shape scanner to mill a polyurethane die, which was duplicated into different stones (Jade, Lean, CEREC) and titanium. Each die was sprayed with imaging powders (NP, IPS, Optispray, Vita) to form 15 groups. Ten of each combination of stone/titanium and imaging powders were used to mill crowns. A light-bodied impression material was injected into the intaglio surface of each crown and placed on the corresponding die. Each crown was removed, and the monophase material was injected to form a monophase die, which was cut into 8 sections. Digital images were captured using a stereomicroscope to measure marginal gap. Scanning electron microscopy was used to determine the particle size and shape of imaging powders and stones. Results. Marginal gaps ranged from mean (standard deviation) 49.32 to 91.20 micrometers (3.97-42.41 mm). There was no statistical difference (P > .05) in the marginal gap by any combination of stone/titanium and imaging powders. All of the imaging powders had a similar size and rounded shape, whereas the surface of the stones showed different structures. Conclusions. When a laboratory 3-shape scanner is used, all imaging powders performed the same for scanning titanium abutments. However, there was no added value related to the use of imaging powder on die stone. It is recommended that the selection of stone for a master cast be based on the physical properties. Practical Implications. When a laboratory 3-shape scanner is used, the imaging powder is not required for scanning die stone. Whenever scanning titanium implant abutments, select the least expensive imaging powder. [ABSTRACT FROM AUTHOR]

Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. Therefore, the aim of this study was to review the clinicopathologic features of a contemporary series of primary HNMM, retrieved from archival material of 2 large medical centers, and to explore the association, if any, between these variables, the clinical features, and outcomes. The clinicopathologic, radiographic, and follow-up information as well as the dominant histologic pattern, mitotic rate, presence/absence of pigmentation, necrosis, ulceration, vascular invasion, and host-associated lymphocytic response were retrieved and recorded. Twenty cases were identified including 1 melanoma in situ. Eight-five percent of tumors arose in the sinonasal tract and 3 (15%) in the oral cavity. After a median follow-up of 25 months, all patients with invasive melanoma developed recurrence and/or metastasis. Local recurrences occurred in 82% of the patients after a median of 12 months, and distant metastasis occurred in 71% of the patients after a median of 13 months. Of those with adequate follow-up, 82% died with disease, and the remaining 3 had recurrent or metastatic disease. Fourth-seven percent of tumors were pigmented, 89% showed at least focal necrosis, and 93% demonstrated ulceration. Sixth-eight percent showed vascular invasion and 63% had a brisk host lymphocytic response. Mitotic rates ranged from 2 to 60/10 high-power fields. The absence of an invasive component might be associated with a better prognosis but other clinical and pathological features that predict outcome, and/or could influence therapy, remain to be determined in HNMM. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) using a clinician interview approach. DESIGN: Cross-sectional. SETTING: Tertiary care medical center. PARTICIPANTS: Healthy older adults (n=75) and patients with amnestic MCI (n=58), mild AD (n=97), and moderate AD (n=31). MEASUREMENTS: The investigators and five study physicians developed a conceptually based, semistructured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity. RESULTS: Study physicians made more than 11,000 capacity judgments across the study sample (N=261). Very good interrater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95% of physician judgments for older controls were rated as capable, compared with 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD. CONCLUSION: Physicians and other clinicians can reliably evaluate financial capacity in cognitively impaired older adults using a relatively brief, semistructured clinical interview. Patients with MCI have mild impairment in financial capacity, those with mild AD have emerging global impairment, and those with moderate AD have advanced global impairment. Patients with MCI and their families should proactively engage in financial and legal planning, given these patients' risk of developing AD and accelerated loss of financial abilities. [ABSTRACT FROM AUTHOR]

Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Objectives: We streamlined our care using an algorithm for the postoperative care of patients who undergo Ivor Lewis esophagogastrectomy to try to reduce hospital stay to 7 days and maintain safety and patient satisfaction. Methods: A consecutive series of 90 patients who underwent elective esophageal resection by one general thoracic surgeon were studied. An algorithm to guide postoperative care was used, featuring avoidance of the ICU, early ambulation, jejunal tube feeds starting on postoperative day (POD) 1, removal of nasogastric tube and epidural on POD 3, a gastrograffin swallow on PODs 4 or 5, and discharge on POD 7. Results: There were 90 patients (70 men). Fifty-two patients (58%) underwent preoperative radiation and chemotherapy. Esophagectomies were done for cancer or high-grade dysplasia. Forty-two of the last 55 patients (77%) went directly to the floor. Sixteen patients (17.7%) had major complications, which included pneumonia in 5 patients and aspiration pneumonia in 4 patients. There were no anastomotic leaks, and there were four operative deaths (4.4%). There was a greater incidence of failure to fast track, and to have a major complication in patients who underwent neoadjuvant treatment (p = 0.025 and p = 0.048, respectively). Median hospital stay was 7 days (range, 6 to 74 days). Complications or mortality could not be definitively attributed to fast tracking. Ninety-seven percent reported excellent satisfaction with their hospital stay, and four patients were readmitted within 1 month of discharge. Conclusions: Fast tracking patients using an algorithm after esophageal resection is safe and delivers minimal morbidity and mortality, and a high patient satisfaction rate. A median hospital stay of 7 days is possible, and the ICU can be avoided in most patients. [ABSTRACT FROM AUTHOR]

Background: Most general thoracic surgeons use double-lumen endotracheal tube (DLET) anesthesia for all video-assisted thoracoscopic surgery (VATS). We evaluated a single-lumen endotracheal tube (SLET) for VATS for drainage of pleural effusions and pleural biopsies. Methods: A consecutive series of patients with recurrent pleural effusions underwent VATS using an SLET and only one incision. Operations were accomplished via one 2-cm incision using a 5-mm rigid thoracoscope and mediastinoscopic biopsy forceps for directed pleural biopsies. A working area was accomplished with low tidal volumes. Results: There were 376 patients (191 women). The indications for VATS were a nondiagnosed or benign pleural effusion in 294 patients, and a malignant effusion in 82 patients. Two hundred eight patients underwent biopsy of the parietal pleura, and mean operative time was 17 mm. Adequate visibility was obtained in all. When compared to preoperative cytology, VATS was more sensitive (45% compared to 99%, p < 0.001), had a higher negative predictive value (56% compared to 99%, p < 0.001), and was more accurate (67% compared to 99%, p < 0.001). Forty-seven percent of patients with a history of cancer had false-negative preoperative cytology results. Complications occurred in seven patients (2%), and there were three operative deaths (none related to the operative procedure). Conclusion: VATS using SLET and only one incision is possible, and it affords excellent visualization of the pleural space, allowing pleural biopsies and talc insufflation. It avoids the risk, lime, and cost of a DLET. It is significantly more sensitive and accurate than preoperative cytology, and it should be considered as the diagnostic and therapeutic procedure of choice in patients with recurrent pleural effusions. [ABSTRACT FROM AUTHOR]

Objective: To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana.Design: Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes.Setting: NRCs at four polyclinics and participants' homes in Accra, Ghana.Subjects: One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000.Results: Most caregivers attended the NRC sporadically (effective length of stay was 1.4+/-0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although there were significant increases in children's weight-for-age (P=0.048) and weight-for-height (P=0.002) Z-scores between enrollment and discharge, most children discontinued programme participation before adequate recuperation.Conclusions: The NRC education did not address the use of street foods for child feeding and was unsuccessful in changing in-home feeding behaviour. The prominence of street foods in children's diets warrants re-evaluation of the NRC's educational approaches to enhance their responsiveness to caregivers' needs and effectiveness for the continued recuperation of malnourished children at home. NRC feeding strategies need improvement to ensure adequate provision of energy and nutrients to support catch-up growth in children. [ABSTRACT FROM AUTHOR]

Objective: To examine characteristics that best predict family caregivers of stroke survivors at risk for depression. Survivor and caregiver demographic variables and caregiver general health, problem-solving skills, social support, satisfaction with rehabilitation health care services, preparedness, and burden were examined. Design: A correlational design. Participants: Seventy-tour family caregivers of individuals receiving inpatient stroke rehabilitation were interviewed 1-2 days prior to their relative's discharge. Main Outcome Measure: The Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). Results: Caregivers at risk for depression had a negative orientation toward solving problems, a lack of caregiver preparedness, and impaired social functioning secondary to their own health. Conclusions: Rehabilitation psychologists should be aware that these variables are important in predicting family caregivers of stroke survivors at risk for depression. [ABSTRACT FROM AUTHOR]

Assesses the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor the healing of stage II-IV pressure ulcers. Details of pressure ulcers; Limitations of measures which allow for overall wound assessment; Benefits of using PUSH.

Background and Purpose: We investigated existing nonpharmacological programs for people with dementia (PWD) to explore critical factors related to the effectiveness of these types of programs., Methods: We conducted a qualitative systematic literature review to identify nonpharmacological intervention programs developed for PWD and reviewed 36 randomized controlled trials. Among several outcomes reported in each study, we focused on the most common outcomes including quality of life (QoL), neuropsychiatric symptoms, depression, agitation, and cognition for further review., Results: Several factors were identified that might affect the outcomes of nonpharmacological interventions for PWD including study design, characteristics of the intervention, maintaining research participants, heterogeneity issues, and implementation fidelity. About half of studies in this review reported positive program effects on their targeted outcomes such as Well-being and Health for PWD on improving quality of life, neuropsychiatric symptoms and agitation; cognitive stimulation therapy on QoL, neuropsychiatric symptoms and cognition; and a stepwise multicomponent intervention on neuropsychiatric symptoms, depression and agitation., Conclusions: We found some programs even with a rigorous study design did not produce expected outcomes while other programs with poor designs reported positive outcomes, which necessitates further investigation on the validity of the assessments. Factors such as individual tailored and customized interventions, promoting social interactions, ease of administration and compatibility of interventions, and developing program theory need to be considered when developing nonpharmacological intervention programs., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (© 2022 Korean Dementia Association.)

The aim of this study was to investigate the association between geographic regions and ovarian cancer disparities in the United States. Data from the Surveillance, Epidemiology, and End Results (SEER) Program was used to identify women diagnosed with ovarian cancer. 18 registries were divided into two groups: South region and US14 region. Chi-Square tests were used to compare proportions, the logistic regression model to evaluate the association between 5-year survival and other variables, and the Cox proportional hazards model to estimate hazard ratios. The South region had a lower incidence rate than the US14 region (12.0 vs. 13.4 per 100,000), and a lower 5-year observed survival rate (37.5% vs. 39.8%). White women living in the US14 region had the best overall survival, compared to white women living in the South region, and black women living in both regions. Women in the South region were less likely to have insurance (6.6% vs. 2.7%, p<0.0001) and surgery (73.4% vs. 76.2%, p<0.0001). Women living in the South were 1.4 times more likely to die after five years of diagnosis than women living in the US14 region. The data confirmed regional disparities in ovarian cancer in the United States, showing women living in the South region were disadvantaged in ovarian cancer survival regardless of race, black or white. Future research focusing on the identification of contributing factors to regional disparity in ovarian cancer is necessary to develop practical approaches to improve health outcomes related to this lethal disease., Competing Interests: Conflict of interest statement The author has declared that no competing or conflict of interests exist. The funders had no role in study design, writing of the manuscript and decision to publish.

Hypothesis tests of equivalence are typically known for their application in bioequivalence studies and acceptance sampling. Their application to gene expression data, in particular high-dimensional gene expression data, has only recently been studied. In this paper, we examine how two multigroup equivalence tests, the F-test and the range test, perform when applied to microarray expression data. We adapted these tests to a well-known equivalence criterion, the difference ratio. Our simulation results showed that both tests can achieve moderate power while controlling the type I error at nominal level for typical expression microarray studies with the benefit of easy-to-interpret equivalence limits. For the range of parameters simulated in this paper, the F-test is more powerful than the range test. However, for comparing three groups, their powers are similar. Finally, the two multigroup tests were applied to a prostate cancer microarray dataset to identify genes whose expression follows a prespecified trajectory across five prostate cancer stages.

Purpose: The effect of dental fabrication procedures of zirconia monolithic restorations and changes in properties during low-temperature exposure in the oral environment is not completely understood. The purpose of this study was to investigate the effect of procedures for fabrication of dental restorations by low-temperature simulation and relative changes of flexural strength, nanoindentation hardness, Young's modulus, surface roughness, and structural stability of yttria-stabilized zirconia., Materials and Methods: A total of 64 zirconia specimens were prepared to simulate dental practice. The specimens were divided into the control group and the accelerated aging group. The simulated group followed the same procedure as the control group except for the aging treatment. Atomic force microscopy was used to measure surface roughness. The degree of tetragonal-to-monoclinic transformation was determined using X-ray diffraction. Nanoindentation hardness and modulus measurements were carried out on the surface of the zirconia specimens using a nanoindenter XP/G200 system. The yttria levels for nonaged and aged specimens were measured using energy dispersive spectroscopy. Flexural strength was determined using the piston-on-three-ball test. The t-test was used to determine statistical significance., Results: Means and standard deviations were calculated using all observations for each condition and evaluated using a group t-test (p < 0.05). The LTD treatment resulted in increased surface roughness (from 12.23 nm to 21.56 nm for Ra and 15.06 nm to 27.45 nm for RMS) and monoclinic phase fractions (from 2% to 21%), with a concomitant decrease in hardness (from 16.56 GPa to 15.14 GPa) and modulus (from 275.68 GPa to 256.56 GPa). Yttria content (from 4.43% to 4.46%) and flexural strength (from 586 MPa to 578 MPa) were not significantly altered, supporting longer term in vivo function without biomechanical fracture., Conclusion: The LTD treatment induced the tetragonal-to-monoclinic transformation with surface roughening in zirconia prepared using dental procedures., (© 2012 by the American College of Prosthodontists.)

Background: C-reactive protein (CRP) is positively associated with risk for cardiovascular disease and all-cause mortality. Some but not all randomized and non-randomized clinical trials found significant associations between fenofibrate therapy and CRP but the direction and magnitude of the association varied across studies. The duration of treatment, patient populations and sample sizes varied greatly, and most short-term studies (i.e., ≤ 12 weeks) had fewer than 50 patients. In this study we meta-analyzed randomized clinical trials to determine the short-term effect of fenofibrate on CRP., Methods: Two reviewers independently searched PubMed and other online databases for short-term randomized clinical trials that reported CRP concentrations before and after fenofibrate treatment. Of the 81 studies examined, 14 studies with 540 patients were found eligible. Data for the change in CRP and corresponding measures of dispersion were extracted for use in the meta-analysis., Results: The weighted mean CRP concentrations before and after fenofibrate therapy were 2.15 mg/L and 1.53 mg/L (-28.8% change), respectively. Inverse-variance weighted random effects meta-analysis revealed that short-term fenofibrate treatment significantly lowers CRP by 0.58 mg/L (95% CI: 0.36-0.80). There was significant heterogeneity between studies (Q statistic = 64.5, P< 0.0001, I2 = 79.8%). There was no evidence of publication bias and sensitivity analysis revealed that omitting any of the 14 studies did not lead to a different conclusion from the overall meta-analysis result., Conclusion: Short-term treatment with fenofibrate significantly lowers CRP concentration. Randomized trials that will recruit patients based with high baseline CRP concentrations and with change in CRP as a primary outcome are needed.

Several meta-analyses have focused on determination of the effectiveness of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention continues to be investigated. Nine randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial (BMD), the Physicians' Health Study (PHS), the Thrombosis Prevention Trial (TPT), the Hypertension Optimal Treatment (HOT) study, the Primary Prevention Project (PPP), the Women's Health Study (WHS), the Aspirin for Asymptomatic Atherosclerosis Trial (AAAT), the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial, and the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial. The combined sample consists of about 90,000 subjects divided approximately evenly between those taking aspirin and subjects not taking aspirin or taking placebo. A meta-analysis of these 9 trials assessed 6 CV end points: total coronary heart disease, nonfatal myocardial infarction (MI), total CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed, and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. The meta-analysis suggested superiority of aspirin for total CV events and nonfatal MI, (p <0.05 for each), with nonsignificant results for decreased risk for stroke, CV mortality, and all-cause mortality. There was no evidence of a statistical bias (p >0.05). In conclusion, aspirin decreased the risk for CV events and nonfatal MI in this large sample. Thus, primary prevention with aspirin decreased the risk for total CV events and nonfatal MI, but there were no significant differences in the incidences of stroke, CV mortality, all-cause mortality and total coronary heart disease., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously., Objectives: Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2)., Methods: Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index)., Results: There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m(2)) and by 2D-Echo Doppler (2.06 l/min/m(2)) and bias and precision was 0.05 (2.4%) and +/-0.48 l/min/m(2) (+/-23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05)., Conclusions: MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease.

Bartolucci et al.(2003) extended the distribution assumption from the normal (Lyles et al., 2000) to the elliptical contoured distribution (ECD) for random regression models used in analysis of longitudinal data accounting for both undetectable values and informative drop-outs. In this paper, the random regression models are constructed on the multivariate skew ECD. A real data set is used to illustrate that the skew ECDs can fit some unimodal continuous data better than the Gaussian distributions or more general continuous symmetric distributions when the symmetric distribution assumption is violated. Also, a simulation study is done for illustrating the model fitness from a variety of skew ECDs. The software we used is SAS/STAT, V. 9.13.

Objectives: To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity., Methods: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model., Results: The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4-21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2-10.9)., Conclusions: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field.

Objectives: We sought to assess the ability of a new multi-channel electrical bioimpedance (MEB) methodology to accurately measure both cardiac blood flow and peripheral limb blood flow., Background: Cardiac output is the primary determinant of peripheral blood flow; however, optimal regional tissue perfusion is ultimately dependent on the patency of the arterial conduits that transport that flow. A complete understanding of regional tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations., Methods: Cardiac blood flow (cardiac output) was measured by MEB in 30 healthy volunteers and was compared to a 2D-Echo Doppler cardiac output. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in 15 healthy volunteers. The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index)., Results: There was good correlation between the mean cardiac index by MEB (3.08 l/min/m2) and by Echo Doppler (3.13 l/min/m2) and bias and precision was 0.051 (1.6%) and +/-0.52 l/min/m2 (+/-17%), respectively. The close correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (p < 0.05) with a sensitivity of 100% and specificity of 100%., Conclusions: MEB methodology can precisely measure cardiac output and peripheral limb flow in healthy volunteers.

Until recently, 5 major studies have formed the basis for the use of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention has not been established firmly. Six randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial, the Physicians' Health Study, the Thrombosis Prevention Trial, the Hypertension Optimal Treatment study, the Primary Prevention Project, and the Women's Health Study. The combined sample consists of 47,293 subjects on aspirin and 45,580 not on aspirin or placebo. A meta-analysis of these 6 trials assessed 6 CV end points: total coronary heart disease (CHD), nonfatal myocardial infarction (MI), total CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. Using odds ratios and confidence intervals, the meta-analysis suggested superiority of aspirin for total CHD, nonfatal MI, and total CV events (p < or =0.001 in each case), with a nonsignificant trend (0.07 < p <0.34) for decreased risk of stroke, CV mortality, and all-cause mortality. There was no evidence of statistical bias (p >0.05). Given the study size and cohort, aspirin decreased the risk of CV events in this large patient sample. In conclusion, primary prevention with aspirin decreased the risk of total CHD, nonfatal MI, and total CV events, but there were no significant differences in the incidences of stroke or CV mortality.

Context: Hirsutism (i.e. facial and body terminal hair growth in a male-like pattern in women) is the principal clinical sign of hyperandrogenism, although its definition remains unclear., Objective: The purposes of the present study were to define 1) the degree of facial and body terminal hair, as assessed by the modified Ferriman-Gallwey (mFG) score, in unselected women from the general population; 2) the effect of race (Black and White) on the same; and 3) the normative cutoff values., Design and Setting: We conducted a prospective observational study at a tertiary academic medical center., Patients/participants: Participants included 633 unselected White (n = 283) and Black (n = 350) women presenting for a preemployment physical exam., Interventions: Interventions included history and physical examination., Main Outcome Measures: Terminal body hair growth was assessed using the mFG scoring system; nine body areas were scored from 0-4 for terminal hair growth distribution., Results: The mFG scores were not normally distributed; although cluster analysis failed to identify a natural cutoff value or clustering of the population, principal component and univariate analyses denoted two nearly distinct clusters that occurred above and below an mFG value of 2, with the bulk of the scores below. Overall, an mFG score of at least 3 was observed in 22.1% of all subjects (i.e. the upper quartile); of these subjects, 69.3% complained of being hirsute, compared with 15.8% of women with an mFG score below this value, and similar to the proportion of women with an mFG score of at least 8 who considered themselves to be hirsute (70.0%). Overall, there were no significant differences between Black and White women., Conclusions: Our data indicate that the prevalence and degree of facial and body terminal hair growth, as assessed by the mFG score, is similar in Black and White women and that an mFG of at least 3 signals the population of women whose hair growth falls out of the norm.

Background: Thoracotomy is associated with significant pain and morbidity., Methods: We performed a prospective randomized trial over 4 months. Patients were randomized to a standard posterior-lateral thoracotomy or an identical procedure, except an intercostal muscle was harvested from the lower rib (to protect the intercostal nerve) before chest retraction. To ensure an equal distribution among both groups, patients were stratified by race, sex, and type of pulmonary resection. All patients received similar pain management. Pain was assessed by using multiple pain scores during hospitalization and after discharge. Outcomes assessed were pain scores, spirometric values, analgesic use, and activity level., Results: There were 114 patients. The median time for intercostal muscle harvesting was 3.7 minutes. The numeric pain scores were lower for the intercostal muscle group on postoperative days 1 and 2 and at weeks 1, 2, 3, 4, 8, and 12 (P < .05 for all). In addition, patients in the intercostal muscle group had a smaller decrease in spirometric values, were less likely to be using analgesics, and were more likely to have returned to normal activity., Conclusions: The harvesting of an intercostal muscle flap before chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry. In addition, patients have less pain at 1, 2, 3, 4, 8, and 12 weeks postoperatively and are less likely to be using narcotics. Finally, it offers a pedicled muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy.

Objective: We sought to assess whether the standard uptake value of a pulmonary nodule is an independent predictor of biologic aggressiveness., Methods: This is a retrospective review of a prospective database of patients with non-small cell lung cancer. Patients had dedicated positron emission tomography scanning with F-18 fluorodeoxyglucose, with the maximum standard uptake value measured. All suspicious nodal and systemic locations on computed tomographic and positron emission tomographic scanning underwent biopsy, and when indicated, resection with complete lymphadenectomy was performed., Results: There were 315 patients. Multivariate analysis showed patients with a high maximum standard uptake value (>/=10) were more likely to have poorly differentiated tumors (risk ratio, 1.5; P = .005) and advanced stage (risk ratio, 1.9; P = .010) and were less likely to have their disease completely resected (risk ratio, 3.7; P = .004). Maximum standard uptake value was the best predictor of disease-free survival (hazard ratio, 2.5; P = .039) and survival (hazard ratio, 2.8; P = .001). Stage-specific analysis showed that patients with stage IB and stage II disease with a maximum standard uptake value of greater than the median for their respective stages had a lower disease-free survival at 4 years ( P = .005 and .044). The actual 4-year survival for patients with stage Ib non-small cell lung cancer was 80% versus 66% ( P = .048), for stage II disease it was 64% versus 32% ( P = .028), and for stage IIIa disease it was 64% versus 16% ( P = .012) for the low and high maximum standard uptake value groups, respectively., Conclusions: The maximum standard uptake value of a non-small cell lung cancer nodule on dedicated positron emission tomography is an independent predictor of stage and tumor characteristics. It is a more powerful independent predictor than the TNM stage for recurrence and survival for patients with early-stage resected cancer. This information might help guide treatment strategies.

Background: Patients with esophageal cancer who receive neoadjuvant chemoradiotherapy are restaged with computed tomography (CT), endoscopic ultrasound with fine needle aspiration (EUS-FNA), and integrated positron emission computed tomography (FDG-PET/CT), and the results affect treatment., Methods: This is a prospective trial on a consecutive series of patients who had initial chest, abdomen, and pelvis CT scan; EUS-FNA; and fluoro-2-deoxy- d -glucose (FDG)-integrated PET/CT; neoadjuvant chemoradiotherapy; repeat staging tests; pathologic staging; and, if appropriate, resection with lymphadenectomy. The primary objective was to assess the accuracy of these 3 tests in restaging patients after neoadjuvant therapy., Results: There were 48 patients (41 men), and 41 underwent Ivor Lewis esophagogastrectomy with lymphadenectomy. The accuracy of each test for distinguishing pathologic T4 from T1 to T3 disease is 76%, 80%, and 80% for CT scan, EUS-FNA and FDG-PET/CT, respectively. The accuracy for nodal disease was 78%, 78%, and 93% for CT scan, EUS-FNA and FDG-PET/CT, respectively ( P = .04). FDG-PET/CT correctly identified M1b disease in 4 patients, falsely suggested it in 4 patients, and missed it in 2 patients, whereas for CT, it was 3, 3, and 3 patients. Fifteen (31%) patients were complete responders, and FDG-PET/CT accurately predicted complete response in 89% compared with 67% for EUS-FNA ( P = .045) and 71% for CT ( P = .05)., Conclusions: FDG-PET/CT is more accurate than EUS-FNA and CT scan for predicting nodal status and complete responders after neoadjuvant therapy in patients with esophageal cancer. FDG-PET/CT and CT alone provide targets for biopsy, but results are often falsely positive.

Objective: To determine the prevalence of insulin resistance (IR) in a large population of patients with the polycystic ovary syndrome (PCOS)., Design: Prospective, case-control., Setting: University medical center., Patient(s): Two hundred seventy-one PCOS patients and 260 eumenorrheic, non-hirsute, control women., Intervention(s): History and physical examination and blood sampling., Main Outcome Measure(s): Total T, free T, DHEAS, sex hormone-binding globulin, and fasting glucose and insulin levels; homeostatic model assessment values for IR (HOMA-IR) and percent beta-cell function (HOMA-%beta-cell)., Result(s): Patients with PCOS and controls differed significantly in all parameters studied, except fasting glucose. Because the HOMA-IR and HOMA-%beta-cell values were variably associated with race, age, and body mass index, the HOMA-IR and HOMA-%beta-cell values were then adjusted for these cofounders. After adjustment, 64.4% of PCOS patients were noted to be insulin resistant, and 2.6% had beta-cell dysfunction. Compared with PCOS patients without IR (n = 96), patients with IR (n = 174) were more obese and had higher beta-cell function., Conclusion(s): In patients with PCOS, the prevalence of IR was 64% according to the HOMA-IR measurement, after adjustment. Patients with IR were more clinically affected. Although IR is a common abnormality in PCOS, it does not seem to be a universal feature.

Individual genome scans tend to have low power and can produce markedly biased estimates of QTL effects. Further, the confidence interval for their location is often prohibitively large for subsequent fine mapping and positional cloning. Given that a large number of genome scans have been conducted, not to mention the large number of variables and subsets tested, it is difficult to confidently rule out type 1 error as an explanation for significant effects even when there is apparent replication in a separate data set. We adapted Empirical Bayes (EB) methods [1] to analyze data from multiple genome scans simultaneously and alleviate each of these problems while still allowing for different QTL population effects across studies. We investigated the effects of using the EB method to include data from background studies to update the results of a single study of interest via simulation and demonstrated that it has a stable confidence level over a wide range of parameters defining the background studies and increased the power to detect linkage, even when some of the background studies were null or had QTL effect at other markers. This EB method for incorporating data from multiple studies into genome scan analyses seems promising., (Copyright 2005 S. Karger AG, Basel.)

Objective: The prevalence of androgen excess (AE) and the value of preemptive endocrine evaluation in women with minimal unwanted hair growth are unclear., Subjects: A total of 228 patients presented with minimal unwanted hair growth and a mF-G score of 5 or less. Total and free testosterone, dehydroepiandrosterone sulfate, 17-hydroxy-progesterone, sex hormone-binding globulin, and basal insulin and glucose levels were measured., Results: Of the patients, 54% demonstrated an AE disorder (50%: polycystic ovary syndrome, 2%: hyperandrogenic insulin-resistant acanthosis nigricans syndrome, 2%: nonclassic adrenal hyperplasia), 29% isolated oligoovulation, 6% isolated hyperandrogenemia, and 10% had a normal evaluation. Of the patients with menstrual irregularities, 65% had an underlying AE disorder compared with 22% of those with normal menstrual function ( P < .001). Of eumenorrheic patients, 11% had oligo-ovulation and an AE disorder., Conclusion: Patients with minimal unwanted hair growth should be evaluated endocrinologically because approximately 50% of subjects demonstrate an AE disorder. Eumenorrhea does not preclude an underlying AE disorder, and ovulatory function should be assessed in these women.

Microarray technology allows one to measure gene expression levels simultaneously on the whole-genome scale. The rapid progress generates both a great wealth of information and challenges in making inferences from such massive data sets. Bayesian statistical modeling offers an alternative approach to frequentist methodologies, and has several features that make these methods advantageous for the analysis of microarray data. These include the incorporation of prior information, flexible exploration of arbitrarily complex hypotheses, easy inclusion of nuisance parameters, and relatively well developed methods to handle missing data. Recent developments in Bayesian methodology generated a variety of techniques for the identification of differentially expressed genes, finding genes with similar expression profiles, and uncovering underlying gene regulatory networks. Bayesian methods will undoubtedly become more common in the future because of their great utility in microarray analysis.

Background and Purpose: Social problem-solving therapy shows promise as an intervention to improve the well-being of family caregivers. There is some evidence that training in problem solving may be effectively delivered by telephone. The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility., Methods: Using a randomized 3-group repeated-measures experimental design, 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study. The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training. This initial session was followed by weekly (the first month) and biweekly (the second and third month) telephone contacts., Results: Compared with the sham intervention and control groups, family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills; greater caregiver preparedness; less depression; and significant improvement in measures of vitality, social functioning, mental health, and role limitations related to emotional problems. There were no significant differences among the groups in caregiver burden. Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups., Conclusion: These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities.