WorldWideScience

Sample records for prospective randomised long-term

  1. Long term prospects for world gas trade

    International Nuclear Information System (INIS)

    Linder, P.T.

    1991-01-01

    Results are presented from a world gas trade model used to forecast long term gas markets. Assumptions that went into the model are described, including the extent of current proven gas reserves, production ratios, total energy and gas demand, gas supply cost curves for each producing country, available gas liquefaction and transportation facilities, and liquefied natural gas (LNG) shipping costs. The results indicate that even with generally very low supply costs for most gas producing basins, gas trade will continue to be restricted by the relatively high cost of transportation, whether by pipeline or tanker. As a consequence, future gas trade will tend to be regionally oriented. United States gas imports will come mostly from Canada, Venezuela, and Mexico; Western Europe will largely be supplied by the Soviet Union and Africa, and Japan's requirements will generally be met by Pacific Rim producers. Although the Middle East has vast quantities of gas reserves, its export growth will continue to be hampered by its remote location from major markets. 16 figs

  2. Bias due to withdrawal in long-term randomised trials in COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Anderson, Julie Anne; Calverley, Peter Mark Anthony

    2011-01-01

    Randomised controlled trials (RCTs) are considered the least biased method for evaluating drug efficacy and several large long-term RCTs in chronic obstructive pulmonary disease have been published. These usually include drugs with symptomatic benefits and have significant withdrawal rates....

  3. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukaemia: long-term follow-up of a prospective, randomised, multicentre trial.

    Science.gov (United States)

    Lipshultz, Steven E; Scully, Rebecca E; Lipsitz, Stuart R; Sallan, Stephen E; Silverman, Lewis B; Miller, Tracie L; Barry, Elly V; Asselin, Barbara L; Athale, Uma; Clavell, Luis A; Larsen, Eric; Moghrabi, Albert; Samson, Yvan; Michon, Bruno; Schorin, Marshall A; Cohen, Harvey J; Neuberg, Donna S; Orav, E John; Colan, Steven D

    2010-10-01

    Doxorubicin chemotherapy is associated with cardiomyopathy. Dexrazoxane reduces cardiac damage during treatment with doxorubicin in children with acute lymphoblastic leukaemia (ALL). We aimed to establish the long-term effect of dexrazoxane on the subclinical state of cardiac health in survivors of childhood high-risk ALL 5 years after completion of doxorubicin treatment. Between January, 1996, and September, 2000, children with high-risk ALL were enrolled from nine centres in the USA, Canada, and Puerto Rico. Patients were assigned by block randomisation to receive ten doses of 30 mg/m² doxorubicin alone or the same dose of doxorubicin preceded by 300 mg/m² dexrazoxane. Treatment assignment was obtained through a telephone call to a centralised registrar to conceal allocation. Investigators were masked to treatment assignment but treating physicians and patients were not; however, investigators, physicians, and patients were masked to study serum cardiac troponin-T concentrations and echocardiographic measurements. The primary endpoints were late left ventricular structure and function abnormalities as assessed by echocardiography; analyses were done including all patients with data available after treatment completion. This trial has been completed and is registered with ClinicalTrials.gov, number NCT00165087. 100 children were assigned to doxorubicin (66 analysed) and 105 to doxorubicin plus dexrazoxane (68 analysed). 5 years after the completion of doxorubicin chemotherapy, mean left ventricular fractional shortening and end-systolic dimension Z scores were significantly worse than normal for children who received doxorubicin alone (left ventricular fractional shortening: -0·82, 95% CI -1·31 to -0·33; end-systolic dimension: 0·57, 0·21-0·93) but not for those who also received dexrazoxane (-0·41, -0·88 to 0·06; 0·15, -0·20 to 0·51). The protective effect of dexrazoxane, relative to doxorubicin alone, on left ventricular wall thickness (difference

  4. Global prospects for nuclear power development in the long term

    International Nuclear Information System (INIS)

    Semenov, Boris A.

    1994-01-01

    Population growth, economic development and improvement of quality of life will lead to significant increase of electricity consumption worldwide with more rapid growth in developing and newly industrialised countries. At the same time, concerns for environmental protection and security of supply will call for the development of alternatives to fossil fuels for electricity generation. Sustain ability will be a major driving factor for the choice of electricity generation options and strategies. Costs, and macro-economic and social impacts, will also influence future strategies in the electricity sector. Since renewable sources require significant development efforts to reach competitiveness, nuclear power is the most likely non-fossil source to be deployed on a large scale for base load electricity generation. Nuclear power is already a proven technology providing a significant share of electricity supply worldwide. In several countries, including the Republic of Korea, nuclear generated electricity is a major contributor to secure and competitive electricity supply. Technological progress aiming towards enhancing safety as well as technical and economic performance of nuclear power plants will enlarge the potential market share of nuclear generated electricity. The purpose of the paper is to give an overview of the prospects for nuclear power development in the world in the medium and long term. For the short term, up to 2005, projections of nuclear power installed capacities are rather straightforward to establish. The Agency publishes such projections every years, based upon a review of nuclear programmes in Member States. For the medium term, up to 2015, two illustrative cases have been developed by the IAEA reflecting contrasted, but not extreme, assumptions on the different parameters influencing nuclear power deployment worldwide. The paper gives estimations of the installed nuclear capacity, and of the share of nuclear power in total electricity and energy

  5. Long-term preservation of Leptospira spp.: challenges and prospects.

    Science.gov (United States)

    Philip, Noraini; Garba, Bashiru; Neela, Vasantha Kumari

    2018-05-08

    Preservation of leptospiral cultures is tantamount to success in leptospiral diagnostics, research, and development of preventive strategies. Each Leptospira isolate has imperative value not only in disease diagnosis but also in epidemiology, virulence, pathogenesis, and drug development studies. As the number of circulating leptospires is continuously increasing and congruent with the importance to retain their original characteristics and properties, an efficient long-term preservation is critically needed to be well-established. However, the preservation of Leptospira is currently characterized by difficulties and conflicting results mainly due to the biological nature of this organism. Hence, this review seeks to describe the efforts in developing efficient preservation methods, to discover the challenges in preserving this organism and to identify the factors that can contribute to an effective long-term preservation of Leptospira. Through the enlightenment of the previous studies, a potentially effective method has been suggested. The article also attempts to evaluate novel strategies used in other industrial and biotechnological preservation efforts and consider their potential application to the conservation of Leptospira spp.

  6. 42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

    Science.gov (United States)

    2010-10-01

    ... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

  7. 42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

    Science.gov (United States)

    2010-10-01

    ... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

  8. DupuytrEn Treatment EffeCtiveness Trial (DETECT): a protocol for prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of collagenase clostridium histolyticum, percutaneous needle fasciotomy and limited fasciectomy as short-term and long-term treatment strategies in Dupuytren's contracture.

    Science.gov (United States)

    Räisänen, Mikko P; Karjalainen, Teemu; Göransson, Harry; Reito, Aleksi; Kautiainen, Hannu; Malmivaara, Antti; Leppänen, Olli V

    2018-03-28

    Dupuytren's contracture (DC) is a chronic fibroproliferative disorder of the palmar fascia which leads to flexion contracture in one or more fingers. There is no definitive cure for DC, and treatment aims at relieving symptoms by releasing the contracture using percutaneous or operative techniques. We planned a prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of (1) collagenase clostridium histolyticum injection followed by limited fasciectomy in non-responsive cases, (2) percutaneous needle fasciotomy followed by limited fasciectomy in non-responsive cases and (3) primary limited fasciectomy during short-term and long-term follow-up for Tubiana I-III stages DC. We will recruit participants from seven national centres in Finland. Primary outcome is the rate of success in the treatment arm at 5 years after recruitment. Success is a composite outcome comprising (1) at least 50% contracture release from the date of recruitment and (2) participants in a patient-accepted symptom state (PASS). Secondary outcomes are (1) angle of contracture, (2) quick disabilities of the arm, a shoulder and hand outcome measure (QuickDASH), (3) perceived hand function, (4) EQ-5D-3L, (5) rate of major adverse events, (6) patient's trust of the treatment, (7) global rating, (8) rate of PASS, (9) rate of minimal clinically important improvement, (10) expenses, (11) progression of disease, (12) progression-free survival, (13) favoured treatment modality, (14) patients achieving full contracture release and >50% improvement and (15) patient satisfaction with the treatment effect. Predictive factors for achieving the PASS will also be analysed. The protocol was approved by the Tampere University Hospital Institutional Review Board and Finnish Medicine Agency. The study will be performed according to the principles of good clinical practice. The results of the trial will be disseminated as

  9. Long-term consequences of and prospects for recovery from nuclear war: Two views. View II

    International Nuclear Information System (INIS)

    Anspaugh, L.R.

    1986-01-01

    The author comments on the information presented in this volume and speculates on the long-term consequences of nuclear war and the prospects for recovery. In order to do that, it might be useful to define long term. To him this means time frames of years to perhaps even hundreds of years in terms of the ultimate response and recovery of large-scale ecosystems. Such long time frames may seem excessive, but if some of the speculated efforts of nuclear war are actually realized, it may indeed take centuries before native ecosystems restabilize. Also, when referring to long-term effects of the magnitude required to have a major impact on entire ecosystems, it is clear that the driving force would not be the direct effects of nuclear war. Of potentially greater significance would be the secondary effects mediated by the intermediate-term impacts on global climate. Specifically, he refers to the speculative impacts of major decreases in the heat and light fluxes reaching the Earth's surface. Such changes are commonly referred to as ''nuclear winter.''

  10. Occurrence of gastric cancer and carcinoids in atrophic gastritis during prospective long-term follow up.

    Science.gov (United States)

    Lahner, Edith; Esposito, Gianluca; Pilozzi, Emanuela; Purchiaroni, Flaminia; Corleto, Vito D; Di Giulio, Emilio; Annibale, Bruno

    2015-07-01

    Atrophic gastritis (AG) is a risk condition for gastric cancer and type I gastric carcinoids. Recent studies assessing the overall risk of gastric cancer and carcinoids in AG at long-term follow up are lacking. This study aimed to investigate in a prospective cohort of AG patients the occurrence of gastric cancer and carcinoids at long-term follow up. A total of 200 AG patients from a prospective cohort (67% female, median age 55 years) with a follow up of 7.5 (range: 4-23.4) years were included. Inclusion criteria were presence of AG and at least one follow-up gastroscopy with biopsies at ≥4 years after AG diagnosis. Follow-up gastroscopies at 4-year intervals were performed. Overall, 22 gastric neoplastic lesions were detected (crude incidence 11%). Gastric cancer was diagnosed in four patients at a median follow up of 7.2 years (crude incidence 2%). Eleven type I gastric carcinoids were detected at a median follow up of 5.1 years (crude incidence of 5.5%). In seven patients, six low-grade and one high-grade dysplasia were found. The annual incidence rate person-year were 0.25% (95% confidence interval [CI]: 0.067-0.63%), 0.43% (95% CI: 0.17-0.89%), and 0.68% (95% CI: 0.34-1.21%) for gastric cancer, dysplasia, and type I-gastric carcinoids, respectively. The incidence rates of gastric cancer and carcinoids were not different (p = 0.07). This study shows an annual incidence rate of 1.36% person-year for gastric neoplastic lesions in AG patients at long-term follow up. AG patients are similarly exposed to gastric cancer and type I gastric carcinoids.

  11. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

    NARCIS (Netherlands)

    Bonati, L.H.; Dobson, J.; Featherstone, R.L.; Ederle, J.; Worp, H.B. van der; Borst, G.J. de; Mali, W.P.; Beard, J.D.; Cleveland, T.; Engelter, S.T.; Lyrer, P.A.; Ford, G.A.; Dorman, P.J.; Brown, M.M.; Leeuw, F.E. de; et al.,

    2015-01-01

    BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid

  12. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

    NARCIS (Netherlands)

    Bonati, Leo H.; Dobson, Joanna; Featherstone, Roland L.; Ederle, Jörg; van der Worp, H. Bart; de Borst, Gert J.; Mali, Willem P. Th M.; Beard, Jonathan D.; Cleveland, Trevor; Engelter, Stefan T.; Lyrer, Philippe A.; Ford, Gary A.; Dorman, Paul J.; Brown, Martin M.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Coward, L.; Dobson, J.; Doig, D.; Ederle, J.; Featherstone, R. F.; Kennedy, F.; Tindall, H.; Turner, E.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.

    2015-01-01

    Background Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. Methods Patients with symptomatic carotid stenosis

  13. Long-term child follow-up after large obstetric randomised controlled trials for the evaluation of perinatal interventions: a systematic review of the literature

    NARCIS (Netherlands)

    Teune, M. J.; van Wassenaer, A. G.; Malin, G. L.; Asztalos, E.; Alfirevic, Z.; Mol, B. W. J.; Opmeer, B. C.

    2013-01-01

    Although the hope is that many perinatal interventions are performed with an ultimate aim to improve the long-term health and development of the child, long-term outcome is rarely used as a primary end-point in perinatal randomised controlled trials (RCTs). To evaluate how often and with which tools

  14. Evans syndrome in children. Long-term outcome in a prospective French national observational cohort.

    Directory of Open Access Journals (Sweden)

    Nathalie eAladjidi

    2015-09-01

    Full Text Available Evans syndrome (ES is a rare autoimmune disorder whose long-term follow-up characteristics are unknown. Patients under 18 at the time of diagnosis of a first autoimmune cytopenia have been included since 2004 in a national prospective observational cohort. In 2014, 156 children diagnosed between 1981 and 2014 with ES, were analyzed. The median age at initial cytopenia was 5.4 (0.2-17.2 years old. For 85 sequential cases, the median delay between the episodes of AIHA and ITP was 2.4 years (0.1–16.3. The median follow-up since ES diagnosis was 6.5 years (0.1-28.8. ES revealed underlying diseases in 10% of children; in 60% of patients, various associated immune manifestations were observed, and ES remained primary in 30%. Five-year ITP and AIHA relapse-free survival were respectively 25% and 61%. In all, 69% of children required one or more than one second-line immune treatment and 15 patients (10% died at a median age of 14.3 years (1.7-28.1.This national work provides the first consistent clinical description for ES and underscores the high percentage of associated immune manifestations, the long-term complications, and treatment toxicities. Current challenges include the identification of underlying genetic immune dysregulations and better characterization of subgroups of patients and of second-line therapy strategies.

  15. Long term natural gas supply in North America: prospects for mexican exports

    International Nuclear Information System (INIS)

    Elizalde Baltierra, A.

    1999-01-01

    The aim of this work is to discuss the most important factors and uncertainties likely to affect future Mexican natural gas exports to the United States. Firstly, we study the long term natural gas supply/demand balance in North America over the period from 2000 to 2020. Secondly, we analyze the main driving forces determining future natural gas supply and demand in Mexico, which also allows us to discuss the prospects for Mexican gas exports. Finally, our analysis suggests that: in the short and medium term (2000-2010), Mexico will probably continue to increase imports of USA gas in order to satisfy increasing demand and will probably not export large volumes of gas to the USA; in the long term (2020-2020), Mexico could resume exports to the USA in sizeable quantities. Two main conditions appear necessary to resume exports: Premex's budgetary constraints should be relaxed and/or new foreign investment should be able to participate in the Mexican upstream oil and gas sector. (author)

  16. Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

    Science.gov (United States)

    Girard, Timothy D; Self, Wesley H; Edwards, Kathryn M; Grijalva, Carlos G; Zhu, Yuwei; Williams, Derek J; Jain, Seema; Jackson, James C

    2018-06-01

    Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated. To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia. Prospective cohort study. Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia. At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were ≥ 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions. We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults ≥ 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those cognitive domains affected one-third of patients ≥ 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.

  17. Natural history of diminutive colorectal polyps: long-term prospective observation by colonoscopy.

    Science.gov (United States)

    Mizuno, Ken-Ichi; Suzuki, Yutaka; Takeuchi, Manabu; Kobayashi, Masaaki; Aoyagi, Yutaka

    2014-04-01

    Endoscopic removal of colorectal adenomatous polyps effectively prevents cancer. However, the treatment strategy for diminutive polyps (diameter ≤ 5 mm) remains controversial. Understanding the natural history of diminutive polyps is a prerequisite to their effective management. We prospectively examined the natural history of diminutive polyps by long-term surveillance colonoscopy. A total of 207 polyps detected in 112 patients from December 1991 through March 2002 were studied. To avoid potential effects on size and morphological characteristics, all polyps were selected randomly and were followed without biopsy. Polyp size was estimated by comparing the lesion with the diameter of a biopsy forceps. Mean follow up was 7.8 years (SD, 4.8; range, 1.0-18.6; median, 7.5; interquartile range 3.4-11.2). Twenty-four polyps were resected endoscopically, and the histopathological diagnosis was mucosal high-grade neoplasia (Category 4) for one polyp, and mucosal low-grade neoplasia (Category 3) for 23 polyps. Mean linear size of the polyps was 3.2 mm (SD, 1.0; range, 1.3-5.0) at initial colonoscopy and 3.8 mm (SD 1.6; range 1.3-10.0) at final colonoscopy (Ppit pattern was associated with a lower growth rate than a type IIIL1 pattern. We clarified the natural history of diminutive polyps by long-term follow-up colonoscopy. The benign course of diminutive polyps should be considered in the design of treatment strategies. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  18. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Sørensen, T; Lange, Peter

    1999-01-01

    BACKGROUND: Little is known about the long-term efficacy of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD). We investigated the efficacy of inhaled budesonide on decline in lung function and respiratory symptoms in a 3-year placebo-controlled study of patients with COPD....... METHODS: We used a parallel-group, randomised, double-blind, placebo-controlled design in a singlecentre study, nested in a continuing epidemiological survey (the Copenhagen City Heart Study). Inclusion criteria were as follows: no asthma; a ratio of forced expiratory volume in 1 s (FEV1) and vital...... capacity of 0.7 or less; FEV1 which showed no response (budesonide, 800 microg plus 400 microg daily for 6 months followed by 400 microg twice daily for 30 months, or placebo...

  19. Cognitive functioning in long-term survivors of childhood leukemia: A prospective analysis

    International Nuclear Information System (INIS)

    Rubenstein, C.L.; Varni, J.W.; Katz, E.R.

    1990-01-01

    Treatment-related cognitive impairments have been reported for survivors of childhood leukemia following prophylactic central nervous system (CNS) treatment with 2400 cGy craniospinal irradiation and intrathecal chemotherapy. The present study was designed to prospectively evaluate cognitive functioning of 24 children prior to CNS prophylaxis of 1800 cGy of craniospinal irradiation and intrathecal drugs, and at intervals of 1 and 4-5 years. At diagnosis, prior to CNS treatment, all 24 subjects performed in the average range of intelligence, as measured by the Wechsler Intelligence Scales. Subjects continued to perform in the average range with no significant declines at the 1-year follow-up. Significant declines in cognitive functioning, however, were found at the 4- to 5-year follow-up period, with five subjects (21%) performing in the low average or borderline levels of intelligence. Of the 19 subjects performing in the average range, five showed significant discrepancies between Verbal and Performance IQ scores. Nine subjects exhibited poor performance on a subtest cluster assessing perceptual and attentional processes. With regard to school experiences, 50% of the subjects had received some type of special education services. The findings indicate the need for annual evaluations of cognitive functioning in long-term survivors of childhood leukemia who received 1800 cGy craniospinal irradiation, to identify potential cognitive late effects of treatment requiring appropriate special education services

  20. Specimen banking of marine organisms in the United States: Current status and long-term prospective

    Science.gov (United States)

    Becker, P.R.; Wise, S.A.; Thorsteinson, L.; Koster, B.J.; Rowles, T.

    1997-01-01

    A major part of the activities conducted over the last decade by the National Biomonitoring Specimen Bank (NBSB) has involved the archival of marine specimens collected by ongoing environmental monitoring programs. These archived specimens include bivalves, marine sediments, and fish tissues collected by the National Status and Trends and the Exxon Valdez Oil Spill Damage Assessment programs, and marine mammal tissues collected by the Marine Mammal Health and Stranding Response Program and the Alaska Marine Mammal Tissue Archival Project. In addition to supporting these programs, the specimens have been used to investigate circumpolar patterns of chlorinated hydrocarbon concentrations, genetic separation of marine animal stocks, baseline levels of essential and nonessential elements in marine mammals, and the potential risk to human consumers in the Arctic from anthropogenic contaminants found in local subsistence foods. The NBSB specimens represent a resource that has the potential for addressing future issues of marine environmental quality and ecosystem changes through retrospective analysis; however, an ecosystem-based food web approach would maximize this potential. The current status of the NBSB activities related to the banking of marine organisms is presented and discussed, the long-term prospective of these activities is presented, and the importance of an ecosystem-based food web monitoring approach to the value of specimen banking is discussed.

  1. Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark

    DEFF Research Database (Denmark)

    Lund, Thomas; Labriola, Merete; Christensen, Karl Bang

    2006-01-01

    employees interviewed in 2000 about their physical work environment, and various covariates were followed for 18 months in a national sickness absence register. Outcome measurements Cox regression analysis was performed to assess risk estimates for physical risk factors in the work environment and onset......OBJECTIVES: To examine the effects of physical work environment on long term sickness absence and to investigate interaction between physical and psychosocial risk factors. DESIGN AND SETTING: Prospective cohort study of long term sickness absence among employees in Denmark. PARTICIPANTS: 5357...... of long term sickness absence, defined as receiving sickness absence compensation for eight consecutive weeks or more. RESULTS: 348 participants (6.9%) developed long term sickness absence during follow-up. Of these, 194 (55.7%) were women and 154 (44.3%) were men. For both female and male employees, risk...

  2. Long-term results after external radiotherapy in age-related macular degeneration. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Prettenhofer, U.; Mayer, R.; Stranzl, H.; Oechs, A.; Hackl, A. [Dept. of Radiotherapy, Univ. Medical School, Graz (Austria); Haas, A. [Dept. of Opthalmology, Univ. Medical School, Graz (Austria)

    2004-02-01

    Purpose: to prospectively evaluate the short- and long-term efficacy of external radiotherapy (RT) in patients with age-related macular degeneration (AMD) by comparing two different dose schedules. Patients and methods: in this prospective, nonrandomized, comparative study including 80 patients, the efficacy of external RT with a total dose of 14.4 Gy (group A, n = 40) and 25.2 Gy (group B, n = 40) was compared. Patients of group a were irradiated between September 1995 and July 1996, patients of group b between August 1996 and November 1997. 67 patients presented with occult choroidal neovascularization (CNV), 13 with classic subfoveal lesions. Complete ophthalmologic investigation was performed before RT, at intervals of 3 months during the 1st year after RT, and of 6 months thereafter. Results: 12 months after RT, vision deteriorated in 85% (14.4 Gy) and 65% (25.2 Gy) of patients. Central visual field decreased with both dose schedules. There was no morphological benefit in neovascular changes. After 48 months, complete follow-up was possible in 46 patients who showed a significant loss of vision similar to the natural course of AMD. Conclusion: external RT of AMD with 14.4 Gy as well as with the escalated dose of 25.2 Gy showed a poor beneficial outcome after 6 and 12 months, respectively. After a follow-up of 4 years, visual outcome in irradiated patients was similar to the natural course of the disease. A conspicuous efficacy of RT in prevention of blindness could not be demonstrated. (orig.)

  3. A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries.

    Science.gov (United States)

    Wolinsky, Fredric D; Bentler, Suzanne E; Hockenberry, Jason; Jones, Michael P; Weigel, Paula A; Kaskie, Brian; Wallace, Robert B

    2011-09-20

    Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline

  4. Occipital Nerve Stimulation for Refractory Chronic Migraine: Results of a Long-Term Prospective Study.

    Science.gov (United States)

    Rodrigo, Dolores; Acin, Pilar; Bermejo, Pedro

    2017-01-01

    Refractory chronic migraine affects approximately 4% of the population worldwide and results in severe pain, lifestyle limitations, and decreased quality of life. Occipital nerve stimulation (ONS) refers to the electric stimulation of the distal branches of greater and lesser occipital nerves; the surgical technique has previously been described and has demonstrated efficacy in the treatment of a wide variety of headache disorders. The aim of this study is to evaluate the long-term efficacy and tolerability of ONS for medically intractable chronic migraine. Prospective, long-term, open-label, uncontrolled observational study. Single public university hospital. Patients who met the International Headache Society criteria for chronic migraine, all of them having been previously treated with other therapeutic alternatives, and who met all inclusion and exclusion criteria for neurostimulation, received the implantation of an ONS system after a positive psychological evaluation and a positive response to a preliminary occipital nerve blockage. The implantation was performed in 2 phases: a 10 day trial with implanted occipital leads connected to an external stimulator and, if more than 50% pain relief was obtained, permanent pulse generator implantation and connection to the previously implanted leads. After the surgery, the patients were thoroughly evaluated annually using different scales: pain Visual Analogue Scale (VAS), number of migraine attacks per month, sleep quality, functionality in social and labor activities, reduction in pain medication, patient satisfaction, tolerability, and reasons for termination. The average follow-up time was 9.4 ± 6.1 years, and 31 patients completed a 7-year follow-up period. Thirty-seven patients were enrolled and classified according to the location and quality of their pain, accompanying symptoms, work status, and psychological effects. Substantial pain reduction was obtained in most patients, and the VAS decreased by 4.9 ± 2

  5. Dengue virus infection among long-term travelers from the Netherlands: A prospective study, 2008-2011

    NARCIS (Netherlands)

    Overbosch, Femke W.; Schinkel, Janke; Stolte, Ineke G.; Prins, Maria; Sonder, Gerard J. B.

    2018-01-01

    Dengue is increasing rapidly in endemic regions. Data on incidence among travelers to these areas are limited. Five prospective studies have been performed thus far, mainly among short-term travelers. To obtain the attack and incidence rate (AR, IR) of dengue virus (DENV) infection among long-term

  6. Depressive symptoms and the risk of long-term sickness absence: a prospective study among 4747 employees in Denmark

    DEFF Research Database (Denmark)

    Bültmann, Ute; Rugulies, Reiner; Lund, Thomas

    2006-01-01

    BACKGROUND: The aim of this paper is to examine the impact of depressive symptoms on long-term sickness absence in a representative sample of the Danish workforce. METHODS: This prospective study is based on 4,747 male and female employees, participating in the Danish Work Environment Cohort Study...

  7. Long-term proton pump inhibitor therapy and falls and fractures in elderly women: a prospective cohort study.

    Science.gov (United States)

    Lewis, Joshua R; Barre, Deka; Zhu, Kun; Ivey, Kerry L; Lim, Ee Mun; Hughes, Jeff; Prince, Richard L

    2014-11-01

    Proton pump inhibitors (PPIs) are widely used in the elderly. Recent studies have suggested that long-term PPI therapy is associated with fractures in the elderly, however the mechanism remains unknown. We investigated the association between long-term PPI therapy ≥1 year and fracture risk factors including bone structure, falls, and balance-related function in a post hoc analysis of a longitudinal population-based prospective cohort of elderly postmenopausal women and replicated the findings in a second prospective study of falling in elderly postmenopausal women. Long-term PPI therapy was associated with increased risk of falls and fracture-related hospitalizations; adjusted odds ratio (AOR) 2.17; 95% CI, 1.25-3.77; p = 0.006 and 1.95; 95% CI, 1.20-3.16; p = 0.007, respectively. In the replication study, long-term PPI use was associated with an increased risk of self-reported falling; AOR, 1.51; 95% CI, 1.00-2.27; p = 0.049. No association of long-term PPI therapy with bone structure was observed; however, questionnaire-assessed falls-associated metrics such as limiting outdoor activity (p = 0.002) and indoor activity (p = 0.001) due to fear of falling, dizziness (p risk in subjects on long-term PPI therapy. This increase in fracture risk in elderly women, already at high risk of fracture, appears to be mediated via increased falls risk and falling rather than impaired bone structure and should be carefully considered when prescribing long-term PPI therapy. © 2014 American Society for Bone and Mineral Research.

  8. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities

    NARCIS (Netherlands)

    Chin A Paw, M.J.M.; M.N. Poppel, van; Twisk, J.W.; van Mechelen, W.

    2006-01-01

    Objective: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations. Methods: Subjects (N = 224) were randomised to 6 months of twice weekly (1) resistance

  9. A randomised trial of enteral glutamine supplementation for very preterm children showed no beneficial or adverse long-term neurodevelopmental outcomes

    NARCIS (Netherlands)

    Twilhaar, E.S.; de Kieviet, J.F.; Oosterlaan, J.; van Elburg, R.M.

    2017-01-01

    Aim This study evaluated the long-term effects of enteral glutamine supplementation on neurodevelopmental outcomes of a Dutch cohort of very preterm children at 13 years of age. Methods The cohort was enrolled in a randomised placebo-controlled trial between 2001 and 2003 in which infants received

  10. A randomised trial of enteral glutamine supplementation for very preterm children showed no beneficial or adverse long-term neurodevelopmental outcomes

    NARCIS (Netherlands)

    Twilhaar, E. Sabrina; de Kieviet, Jorrit F.; Oosterlaan, Jaap; van Elburg, Ruurd M.

    2017-01-01

    This study evaluated the long-term effects of enteral glutamine supplementation on neurodevelopmental outcomes of a Dutch cohort of very preterm children at 13 years of age. The cohort was enrolled in a randomised placebo-controlled trial between 2001-2003 in which infants received glutamine- or

  11. Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care.

    Science.gov (United States)

    Lachance, Chantelle C; Feldman, Fabio; Laing, Andrew C; Leung, Pet Ming; Robinovitch, Stephen N; Mackey, Dawn C

    2016-12-01

    A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap. The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013. Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults. NCT01618786. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Decayed, missing and filled teeth and dental anomalies in long term survived leukemic children: a prospective controlled study

    OpenAIRE

    Lauritano, D; Petruzzi, M; Baldoni, M

    2012-01-01

    Objective: The aim of this prospective controlled study is the comparison between long-term children survived leukaemia and a control group in terms of the decayed, missing or filled permanent teeth (DMFT) and dental anomalies. Study design: Fifty-two long term children survived leukaemia, aged from 8 to 15 years (27 females, 25 males; mean age 11.5 years) were evaluated for the possible effects of the anti-leukaemic therapy on dental development and compared to a control group of 52 healthy ...

  13. Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial.

    Science.gov (United States)

    Cullington, Helen; Kitterick, Padraig; Weal, Mark; Margol-Gromada, Magdalena

    2018-04-20

    Substantial resources are required to provide lifelong postoperative care to people with cochlear implants. Most patients visit the clinic annually. We introduced a person-centred remote follow-up pathway, giving patients telemedicine tools to use at home so they would only visit the centre when intervention was required. To assess the feasibility of comparing a remote care pathway with the standard pathway in adults using cochlear implants. Two-arm randomised controlled trial. Randomisation used a minimisation approach, controlling for potential confounding factors. Participant blinding was not possible, but baseline measures occurred before allocation. University of Southampton Auditory Implant Service: provider of National Health Service care. 60 adults who had used cochlear implants for at least 6 months. Control group (n=30) followed usual care pathway.Remote care group (n=30) received care remotely for 6 months incorporating: home hearing in noise test, online support tool and self-adjustment of device (only 10 had compatible equipment). Primary: change in patient activation; measured using the Patient Activation Measure.Secondary: change in hearing and quality of life; qualitative feedback from patients and clinicians. One participant in the remote care group dropped out. The remote care group showed a greater increase in patient activation than the control group. Changes in hearing differed between the groups. The remote care group improved on the Triple Digit Test hearing test; the control group perceived their hearing was worse on the Speech, Spatial and Qualities of Hearing Scale questionnaire. Quality of life remained unchanged in both groups. Patients and clinicians were generally positive about remote care tools and wanted to continue. Adults with cochlear implants were willing to be randomised and complied with the protocol. Personalised remote care for long-term follow-up is feasible and acceptable, leading to more empowered patients. ISRCTN14644286

  14. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study.

    Science.gov (United States)

    Dobbie, Fiona; Hiscock, Rosemary; Leonardi-Bee, Jo; Murray, Susan; Shahab, Lion; Aveyard, Paul; Coleman, Tim; McEwen, Andy; McRobbie, Hayden; Purves, Richard; Bauld, Linda

    2015-11-01

    NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. There were 202,804 cases included in secondary analysis and 3075 in the prospective study. A combination of behavioural support and stop smoking medication delivered by SSS practitioners. Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have

  15. Relationship of Prior Antidepressant Exposure to Long-Term Prospective Outcome in Bipolar I Disorder Outpatients

    NARCIS (Netherlands)

    Post, Robert M.; Leverich, Gabriele S.; Altshuler, Lori L.; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Rowe, Mike; Kupka, Ralph W.; Grunze, Heinz; Goodwin, Frederick K.

    Objective:The long-term impact of prior antidepressant exposure on the subsequent course of bipolar illness remains controversial. Method: 139 outpatients (mean age, 42 years) with bipolar I disorder diagnosed by DSM-IV criteria had a detailed retrospective examination of their prior course of

  16. Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice.

    Science.gov (United States)

    Dupont, B; Dao, T; Joubert, C; Dupont-Lucas, C; Gloro, R; Nguyen-Khac, E; Beaujard, E; Mathurin, P; Vastel, E; Musikas, M; Ollivier, I; Piquet, M-A

    2012-05-01

    Malnutrition and jaundice are independent prognostic factors in cirrhosis. To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis. The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin ≥51 µmol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan-Meier method and Logrank test. Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P = 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P = 0.99]. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P = 0.59). Enteral nutrition does not improve the survival and hepatic or nutritional parameters of cirrhotic patients with jaundice. © 2012 Blackwell Publishing Ltd.

  17. Sustained favorable long-term outcome in the treatment of schizophrenia: a 3-year prospective observational study

    Directory of Open Access Journals (Sweden)

    Ascher-Svanum Haya

    2011-08-01

    Full Text Available Abstract Background This study of chronically ill patients with schizophrenia aimed to identify patients who achieve sustained favorable long-term outcome - when the outcome incorporates severity of symptoms, level of functioning, and use of acute care services - and to identify the best baseline predictors of achieving this sustained favorable long-term outcome. Methods Using data from the United States Schizophrenia Care and Assessment Program (US-SCAP (N = 2327, a large 3-year prospective, multisite, observational study of individuals treated for schizophrenia in the US, a hierarchical cluster analysis was performed to group patients based upon baseline symptom severity. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS scores, level of functioning, and use of acute care services. Level of functioning reflected patient-reported productivity and clinician-rated occupational role functioning. Use of acute care services reflected self-reported psychiatric hospitalization and emergency service use. Change of health state was determined over the 3-year period. A patient was classified as having a sustained favorable long-term outcome if their health state values had the closest distance to the defined "best baseline cluster" at each point over the length of the study. Stepwise logistic regression was used to determine baseline predictors of sustained favorable long-term outcome. Results At baseline, 5 distinct health state clusters were identified, ranging from "best" to "worst." Of 1635 patients with sufficient data, only 157 (10% experienced sustained favorable long-term outcome during the 2-years postbaseline. The baseline predictors associated with sustained favorable long-term outcome included better quality of life, more daily activities, patient-reported clearer thinking from medication, better global functioning, being employed, not being a victim of a crime, not having received individual therapy, and not

  18. Decayed, missing and filled teeth index and dental anomalies in long-term survivors leukaemic children: a prospective controlled study.

    Science.gov (United States)

    Lauritano, Dorina; Petruzzi, Massimo

    2012-11-01

    The aim of this prospective controlled study is the comparison between long-term children survived leukaemia and a control group in terms of the decayed, missing or filled permanent teeth (DMFT) and dental anomalies. Fifty-two long term children survived leukaemia, aged from 8 to 15 years (27 females, 25 males; mean age 11.5 years) were evaluated for the possible effects of the anti-leukaemic therapy on dental development and compared to a control group of 52 healthy children (27 females, 25 males, mean age 11 years). All long-term children who survived were at least 24 months in continuous complete remission. The study of the dental status with a routine oral examination and panoramic radiographs was performed. The DMFT (recorded according to the WHO criteria) and dental anomalies were registered and evaluated. The results of this study evidence that long-term children survived leukaemia, in comparison with the control group, have an higher risk to develop dental caries and show a greater severity of dental anomalies including V-shaped roots, dental agenesis, microdontia, enamel dysplasias. Paediatric patients with haemathological diseases require a special attentions in dental care in addition to the antineoplastic treatment. Therefore, oral hygiene and oral health can be maintained thanks to a close cooperation between the paediatric oncohaematologists, pediatrics dental surgeons and dental hygienists.

  19. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localised prostate cancer

    International Nuclear Information System (INIS)

    Ash, Dan; Bottomley, David; Al-Qaisieh, Bashar; Carey, Brendan; Gould, Kath; Henry, Ann

    2007-01-01

    Background and purpose: To prospectively evaluate long-term urinary, bowel and sexual function after I-125 brachytherapy for localised prostate cancer using patient administered validated Quality of Life (QoL) instruments. Materials and methods: Between March 1995 and March 2004, 673 men underwent brachytherapy and recorded urinary symptoms prospectively using the International Prostate Symptom Score (IPSS). In addition, in a subgroup of 116 patients, the Expanded Prostate Cancer Index Composite (EPIC) was used to record QoL information on urinary, bowel and sexual function before treatment and at regular time intervals for at least two years. Results: Initially, there was a sharp rise in urinary symptoms which was most marked within the first three months. Scores then resolved slowly and returned to within one or two units of pre-treatment level at one year. Subsequently, there was no significant deterioration in urinary symptoms up to nine years following brachytherapy. Few had significant bowel symptoms. Sexual function deteriorated initially and then improved but failed to return to pre-treatment levels by two years. Patients requiring neo-adjuvant hormones experienced significantly more dysfunction. Conclusions: After an initial period of mild to moderate urinary symptoms prostate brachytherapy is well tolerated with relatively little deterioration in long-term quality of life. Long-term reduction in sexual function may be seen particularly in those requiring hormones

  20. A Japanese Stress Check Program screening tool predicts employee long-term sickness absence: a prospective study.

    Science.gov (United States)

    Tsutsumi, Akizumi; Shimazu, Akihito; Eguchi, Hisashi; Inoue, Akiomi; Kawakami, Norito

    2018-01-25

    On December 1, 2015, the Japanese government launched the Stress Check Program, a new occupational health policy to screen employees for high psychosocial stress in the workplace. As only weak evidence exists for the effectiveness of the program, we sought to estimate the risk of stress-associated long-term sickness absence as defined in the program manual. Participants were 7356 male and 7362 female employees in a financial service company who completed the Brief Job Stress Questionnaire (BJSQ). We followed them for 1 year and used company records to identify employees with sickness absence of 1 month or longer. We defined high-risk employees using the BJSQ and criteria recommended by the program manual. We used the Cox proportional regression model to evaluate the prospective association between stress and long-term sickness absence. During the follow-up period, we identified 34 male and 35 female employees who took long-term sickness absence. After adjustment for age, length of service, job type, position, and post-examination interview, hazard ratios (95% confidence intervals) for incident long-term sickness absence in high-stress employees were 6.59 (3.04-14.25) for men and 2.77 (1.32-5.83) for women. The corresponding population attributable risks for high stress were 23.8% (10.3-42.6) for men and 21.0% (4.6-42.1) for women. During the 1-year follow-up, employees identified as high stress (as defined by the Stress Check Program manual) had significantly elevated risks for long-term sickness absence.

  1. Physical capacity and risk for long-term sickness absence: a prospective cohort study among 8664 female health care workers.

    Science.gov (United States)

    Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas

    2015-05-01

    To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. Low physical capacity increases the risk of long-term sickness absence among female health care workers.

  2. Henoch-Schönlein purpura: a long-term prospective study in Greek children.

    Science.gov (United States)

    Fretzayas, Andrew; Sionti, Irini; Moustaki, Maria; Papadimitriou, Anastasios; Nicolaidou, Polyxeni

    2008-12-01

    Henoch-Schönlein purpura is a common vasculitis of childhood. The present study, comprising 74 children enrolled during a 9-year period, aimed to delineate the clinical spectrum and the long term follow-up of the disease. Patients were diagnosed strictly on the criteria established by the American College of Rheumatology. The diagnosis was further strengthened by a skin biopsy performed in more than half of cases (42/74), which revealed leukocytoclastic vasculitis in all patients, whereas IgA deposits were found in 37/42 children. There was a predominance of boys (41 males), and the mean age of study population was 5.2 +/- 2.54 years. Palpable purpura was identified in 73/74 children, whereas transient arthritis manifested in 68/74 children. Gastrointestinal blood loss was elicited in 30 children, 11 of whom had also renal involvement. The latter was seen in 19/74 (25.7%) children, and in the long term follow-up (extended to 2004, from 4-12 years, mean duration 7.3 years), 2 children remained with persistent occult hematuria. Relapses occurred in 49 children (66%), and half of them experienced more than 1 recurrence. Arthritis was less common in the relapsed episodes, and this difference was statistically significant (P period. Recurrences often differ to some extent from the initial episode with arthritis being less common with relapses.

  3. A prospective study of severe hypoglycemia and long-term spatial memory in children with type 1 diabetes.

    Science.gov (United States)

    Hershey, Tamara; Lillie, Rema; Sadler, Michelle; White, Neil H

    2004-06-01

    In a previous retrospective study, severe hypoglycemia (SH) was associated with decreased long-term spatial memory in children with type 1 diabetes mellitus (T1DM). In this study, we tested the hypothesis that prospectively ascertained SH would also be associated with decreased spatial long-term memory over time. Children with T1DM (n = 42) and sibling controls (n = 25) performed a spatial delayed response (SDR) task with short and long delays and other neuropsychological tests at baseline and after 15 months of monitoring. Extreme glycemic events and other medical complications were recorded prospectively during follow-up. Fourteen T1DM children experienced at least one episode of SH during the follow-up period (range = 1-5). After controlling for long-delay SDR performance at baseline, age, gender, and age of onset, the presence of SH during the prospective period was statistically associated with decreased long-delay SDR performance at follow-up (semipartial r = -0.38, p = 0.017). This relationship was not seen with short-delay SDR or with verbal or object memory, attention, or motor speed. These results, together with previously reported data, support the hypothesis that SH has specific, negative effects on spatial memory skills in T1DM children.

  4. A Prospective Observational Survey on the Long-Term Effect of LDL Apheresis on Drug-Resistant Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Eri Muso

    2015-08-01

    Full Text Available Background/Aims: LDL apheresis (LDL-A is used for drug-resistant nephrotic syndrome (NS as an alternative therapy to induce remission by improvement of hyperlipidemia. Several clinical studies have suggested the efficacy of LDL-A for refractory NS, but the level of evidence remains insufficient. A multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome, was conducted to evaluate its clinical efficacy with high-level evidence. Methods: Patients with NS who showed resistance to primary medication for at least 4 weeks were prospectively recruited to the study and treated with LDL-A. The long-term outcome was evaluated based on the rate of remission of NS 2 years after treatment. Factors affecting the outcome were also examined. Results: A total of 58 refractory NS patients from 40 facilities were recruited and enrolled as subjects of the POLARIS study. Of the 44 subjects followed for 2 years, 21 (47.7% showed remission of NS based on a urinary protein (UP level Conclusions: Almost half of the cases of drug-resistant NS showed remission 2 years after LDL-A. Improvement of nephrotic parameters at termination of the LDL-A treatment was a predictor of a favorable outcome.

  5. Work-unit social capital and long-term sickness absence: a prospective cohort study of 32 053 hospital employees.

    Science.gov (United States)

    Török, Eszter; Clark, Alice Jessie; Jensen, Johan Høy; Lange, Theis; Bonde, Jens Peter; Bjorner, Jakob Bue; Rugulies, Reiner; Hvidtfeldt, Ulla Arthur; Hansen, Åse Marie; Ersbøll, Annette Kjær; Rod, Naja Hulvej

    2018-06-06

    There is a lack of studies investigating social capital at the workplace level in small and relatively homogeneous work-units. The aim of the study was to investigate whether work-unit social capital predicts a lower risk of individual long-term sickness absence among Danish hospital employees followed prospectively for 1 year. This study is based on the Well-being in HospitAL Employees cohort. The study sample consisted of 32 053 individuals nested within 2182 work-units in the Capital Region of Denmark. Work-unit social capital was measured with an eight-item scale covering elements of trust, justice and collaboration between employees and leaders. Social capital at the work-unit level was computed as the aggregated mean of individual-level social capital within each work-unit. Data on long-term sickness absence were retrieved from the employers' payroll system and were operationalised as ≥29 consecutive days of sickness absence. We used a 12-point difference in social capital as the metric in our analyses and conducted two-level hierarchical logistic regression analysis. Adjustments were made for sex, age, seniority, occupational group and part-time work at the individual level, and work-unit size, the proportion of female employees and the proportion of part-time work at the work-unit level. The OR for long-term sickness absence associated with a 12-point higher work-unit social capital was 0.73 (95% CI 0.68 to 0.78). Further, we found an association between higher work-unit social capital and lower long-term sickness absence across quartiles of social capital: compared with the lowest quartile, the OR for long-term sickness absence in the highest quartile was 0.51 (95% CI 0.44 to 0.60). Our study provides support for work-unit social capital being a protective factor for individual long-term sickness absence among hospital employees in the Capital Region of Denmark. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  6. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials.

    Science.gov (United States)

    Ahmed, Haroon; Davies, Freya; Francis, Nick; Farewell, Daniel; Butler, Christoper; Paranjothy, Shantini

    2017-05-29

    To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. Systematic review andmeta-analysis of randomised trials. We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature( CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs. We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim-sulfamethoxazole after 1 month of prophylaxis. Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial.

    Science.gov (United States)

    Jennings, Paul A; Cameron, Peter; Bernard, Stephen; Walker, Tony; Jolley, Damien; Fitzgerald, Mark; Masci, Kevin

    2014-10-01

    Improved early pain control may affect the longer-term prevalence of persistent pain. In a previous randomised, controlled trial, we found that the administration of ketamine on hospital arrival decreased pain scores to a greater extent than morphine alone in patients with prehospital traumatic pain. In this follow-up study, we sought to determine the prevalence of persistent pain and whether there were differences in patients who received ketamine or morphine. This study was a long-term follow-up study of the prehospital, prospective, randomised, controlled, open-label study comparing ketamine with morphine in patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine. Patients were followed-up by telephone 6-12 months after enrollment, and a questionnaire including the SF-36 (V.2) health-related quality of life survey and the Verbal Numerical Rating Scale for pain was administered. A total of 97/135 (72%) patients were able to be followed-up 6-12 months after enrollment between July 2008 and July 2010. Overall, 44/97 (45%) participants reported persistent pain related to their injury, with 3/97 (3%) reporting persistent severe pain. The prevalence of persistent pain was the same between study groups (22/50 (44%) for the ketamine group vs 22/47 (46%) for the morphine group). There was no difference in the SF-36 scores between study arms. There is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. Although decreased pain scores at hospital arrival are achieved with ketamine compared with morphine, this difference does not affect the prevalence of persistent pain or health-related quality of life 6 months after injury. Further larger studies are required to confirm this finding. Australian and New Zealand Clinical Trials Registry (ACTRN12607000441415). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  8. The influence of coping styles on long-term employment in multiple sclerosis: A prospective study.

    Science.gov (United States)

    Grytten, Nina; Skår, Anne Br; Aarseth, Jan Harald; Assmus, Jorg; Farbu, Elisabeth; Lode, Kirsten; Nyland, Harald I; Smedal, Tori; Myhr, Kjell Morten

    2017-06-01

    The aim was to investigate predictive values of coping styles, clinical and demographic factors on time to unemployment in patients diagnosed with multiple sclerosis (MS) during 1998-2002 in Norway. All patients ( N = 108) diagnosed with MS 1998-2002 in Hordaland and Rogaland counties, Western Norway, were invited to participate in the long-term follow-up study in 2002. Baseline recordings included disability scoring (Expanded Disability Status Scale (EDSS)), fatigue (Fatigue Severity Scale (FSS)), depression (Beck Depression Inventory (BDI)), and questionnaire assessing coping (the Dispositional Coping Styles Scale (COPE)). Logistic regression analysis was used to identify factors associated with unemployed at baseline, and Cox regression analysis to identify factors at baseline associated with time to unemployment during follow-up. In all, 41 (44%) were employed at baseline. After 13 years follow-up in 2015, mean disease duration of 22 years, 16 (17%) were still employed. Median time from baseline to unemployment was 6 years (±5). Older age at diagnosis, female gender, and depression were associated with patients being unemployed at baseline. Female gender, long disease duration, and denial as avoidant coping strategy at baseline predicted shorter time to unemployment. Avoidant coping style, female gender, and longer disease duration were associated with shorter time to unemployment. These factors should be considered when advising patients on MS and future employment.

  9. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy

    NARCIS (Netherlands)

    Moonen, An; Annese, Vito; Belmans, Ann; Bredenoord, Albert J.; Bruley des Varannes, Stanislas; Costantini, Mario; Dousset, Bertrand; Elizalde, J. I.; Fumagalli, Uberto; Gaudric, Marianne; Merla, Antonio; Smout, Andre J.; Tack, Jan; Zaninotto, Giovanni; Busch, Olivier R.; Boeckxstaens, Guy E.

    2016-01-01

    Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking. 201 newly diagnosed patients with achalasia were

  10. Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

    Energy Technology Data Exchange (ETDEWEB)

    Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R. [University Hospital Zurich, Cardiac Imaging, Department of Nuclear Medicine, Zurich (Switzerland)

    2017-11-15

    To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

  11. Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

    International Nuclear Information System (INIS)

    Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R.

    2017-01-01

    To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

  12. Long-term consequences of and prospects for recovery from nuclear war: Two views. View I

    International Nuclear Information System (INIS)

    Sagan, C.

    1986-01-01

    There is a kind of deadly embrace between the United States and the Soviet Union - their military establishments depend on each other - that goes back at least to 1945 and that has led to the construction of a kind of global doomsday machine, which has been almost entirely ignored until lately. The population of the plant has, by and large, been sleepwalking through the last 40 years. The consequences of nuclear war, even as they were known 20 or 30 years ago, did not permeate the public consciousness. And this is still the case, although less so, as a kind of race transpires between how fast and disquieting discoveries are made about the nature of nuclear war and and how fast these discoveries are absorbed, often with great reluctance, into the consciousness of the public and the government. In this summary, the author proceeds in rough serial order through some of the topics presented in this volume and gives a few impressions. On the nuclear winter issue itself, there now seems to be a fairly broad consensus after the original TTAPS study that is something worth worrying about, something probably very grave. Even the most conservative and carefully phrased reports on this subject make that apparent. The National Research Council's report states that nuclear winter is a ''clear possibility'' and that the probability that the severity winter would be worse than in the ''baseline case'' is roughly the same as the probability that it would be better. Despite uncertainties, ''the committee believes that long-term climatic effects with severe implications for the biosphere could occur.''

  13. Long-term outcome of phenobarbital treatment for epilepsy in rural China: a prospective cohort study.

    Science.gov (United States)

    Kwan, Patrick; Wang, Wenzhi; Wu, Jianzhong; Li, Shichuo; Yang, Hongchao; Ding, Ding; Hong, Zhen; Dai, Xiuying; Yang, Bing; Wang, Taiping; Yuan, Chenglin; Ma, Guangyu; de Boer, Hanneke M; Sander, Josemir W

    2013-03-01

    To evaluate the long-term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. We carried out follow-up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face-to-face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow-up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3-84; mean duration of follow-up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty-three individuals (25%) became seizure-free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  14. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery : A randomised trial

    NARCIS (Netherlands)

    Dieleman, J. M.; de Wit, G. A.; Nierich, A. P.; Rosseel, P. M.; van der Maaten, J. M.; Hofland, J.; Diephuis, J. C.; de Lange, F.; Boer, C.; Neslo, R. E.; Moons, K. G.; van Herwerden, L. A.; Tijssen, J. G.; Kalkman, C. J.; van Dijk, D.

    Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre,

  15. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery: a randomised trial

    NARCIS (Netherlands)

    Dieleman, J. M.; de Wit, G. A.; Nierich, A. P.; Rosseel, P. M.; van der Maaten, J. M.; Hofland, J.; Diephuis, J. C.; de Lange, F.; Boer, C.; Neslo, R. E.; Moons, K. G.; van Herwerden, L. A.; Tijssen, J. G.; Kalkman, C. J.; van Dijk, D.

    2017-01-01

    Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre,

  16. The Long-Term Prospects of Biofuels in the EU-15 Countries

    Directory of Open Access Journals (Sweden)

    Reinhard Haas

    2012-08-01

    Full Text Available The core objective of this paper is to analyze the energy and CO2 reduction potentials as well as the market prospects of biofuels in EU-15 in a dynamic framework till 2050. The most important result of this analysis is that 2nd generation biofuels might become economically competitive between 2020 and 2030, yet this can only be achieved if the following preconditions are fulfilled: (1 achievement of significant learning effects leading to considerably lower plant costs; (2 significant improvement of conversion efficiency from feedstock to fuel leading to lower feedstock costs and better ecological performance; (3 increases in conventional diesel and gasoline prices, e.g., due to CO2 based taxes.

  17. Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs.

    Science.gov (United States)

    Benlloch-Gonzalez, Manuel; Gomes, Eymeric; Bouvy, Bernard; Poncet, Cyrill

    2015-07-01

    This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material.

  18. Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

    Science.gov (United States)

    Caljouw, Monique A A; Cools, Herman J M; Gussekloo, Jacobijn

    2014-05-22

    Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months. At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P dependency status, predicted an increase in care dependency over time. The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

  19. Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

    International Nuclear Information System (INIS)

    Anselmetti, Giovanni Carlo; Manca, Antonio; Montemurro, Filippo; Hirsch, Joshua; Chiara, Gabriele; Grignani, Giovanni; Carnevale Schianca, Fabrizio; Capaldi, Antonio; Rota Scalabrini, Delia; Sardo, Elena; Debernardi, Felicino; Iussich, Gabriella; Regge, Daniele

    2012-01-01

    Purpose: Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM. Materials and Methods: PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 ± 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded. Results: The median pretreatment VAS score of 9 (range 4–10) significantly (P < 0.001) decreased to 1 (range 0–9) after PV. Median pre-ODI values of 82% (range 36–89%) significantly improved to 7% (range 0–82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001). Conclusion: PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

  20. Long-term weight regain after gastric bypass: a 5-year prospective study.

    Science.gov (United States)

    Magro, Daniéla Oliveira; Geloneze, Bruno; Delfini, Regis; Pareja, Bruna Contini; Callejas, Francisco; Pareja, José Carlos

    2008-06-01

    A certain weight gain occurs after obesity surgery compared to the lower weight usually observed between 18 and 24 months postsurgery. The objective of this study was to evaluate weight regain in patients submitted to gastric bypass over a 5-year follow-up period. A longitudinal prospective study was conducted on 782 obese patients of both genders. Only patients with at least 2 years of surgery were included. The percentage of excess body mass index (BMI) loss at 24, 36, 48, and 60 months postsurgery was compared to the measurements obtained at 18 months after surgery. Surgical therapeutic failure was also evaluated. Percent excess BMI loss was significant up to 18 months postsurgery (p < 0.001), with a mean difference in BMI of 1.06 kg/m2 compared to 12 months postsurgery. Percent BMI loss was no longer significant after 24 months, and weight regain became significant within 48 months after surgery (p < 0.01). Among the patients who presented weight regain, a mean 8% increase was observed within 60 months compared to the lowest weight obtained at 18 months after surgery. The percentage of surgical failure was higher in the superobese group at all times studied, reaching 18.8% at 48 months after surgery. Weight regain was observed within 24 months after surgery in approximately 50% of patients. Both weight regain and surgical failure were higher in the superobese group. Studies in regard to metabolic and hormonal mechanisms underlying weight regain might elucidate the causes of this finding.

  1. Cardiorespiratory fitness and future risk of pneumonia: a long-term prospective cohort study.

    Science.gov (United States)

    Kunutsor, Setor K; Laukkanen, Tanjaniina; Laukkanen, Jari A

    2017-09-01

    We aimed to assess the prospective association of cardiorespiratory fitness (CRF) with the risk of pneumonia. Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed using a respiratory gas exchange analyzer in 2244 middle-aged men in the Kuopio Ischemic Heart Disease cohort. We corrected for within-person variability in CRF levels using data from repeat measurements taken several years apart. During a median follow-up of 25.8 years, 369 men received a hospital diagnosis of pneumonia. The age-adjusted regression dilution ratio of CRF was 0.58 (95% confidence interval: 0.53-0.63). Cardiorespiratory fitness was linearly associated with pneumonia risk. The hazard ratio (95% confidence interval) for pneumonia per 1 standard deviation increase in CRF in analysis adjusted for several risk factors for pneumonia was 0.77 (0.68-0.87). The association remained consistent on additional adjustment for total energy intake, socioeconomic status, physical activity, and C-reactive protein 0.82 (0.72-0.94). The corresponding adjusted hazard ratios (95% confidence intervals) were 0.58 (0.41-0.80) and 0.67 (0.48-0.95) respectively, when comparing the extreme quartiles of CRF levels. Our findings indicate a graded inverse and independent association between CRF and the future risk of pneumonia in a general male population. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study

    DEFF Research Database (Denmark)

    Kasch, H; Qerama, E; Kongsted, Alice

    2008-01-01

    BACKGROUND AND PURPOSE: Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful...... of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median...... complaints after a whiplash injury as predictors for subsequent handicap. METHODS: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number...

  3. Long-term prospective cohort study on dental implants: clinical and microbiological parameters.

    Science.gov (United States)

    Tenenbaum, Henri; Bogen, Omer; Séverac, François; Elkaim, René; Davideau, Jean-Luc; Huck, Olivier

    2017-01-01

    The aim of the present prospective cohort study is to evaluate clinical and microbiological data of dental implants after at least 8 years of follow-up. A total of 110 patients and 232 implants were included at baseline and followed during 1 year. Fifty-two patients and 108 implants could be evaluated at the final examination. Clinical and microbiological data were taken at baseline, 1 year and at least 8 years. The mean follow-up time was 10.8 ± 1.7 years. Plaque index was, respectively, 0.50 ± 0.50 at baseline, 0.50 ± 0.50 at 1 year and 0.33 ± 0.67 at ≥8 years. Gingival index was, respectively, 1.08 ± 0.19 at baseline, 1.01 ± 0.39 at 1 year and 0.22 ± 0.47 at ≥8 years. Sulcular bleeding index was, respectively, 0.17 ± 0.22 at baseline, 0.11 ± 0.33 at 1 year and 0.17 ± 0.22 at ≥8 years. Probing depth was, respectively, 2.67 ± 0.75 at baseline, 3.00 ± 0.83 at 1 year and 2.74 ± 1.00 at ≥8 years. Clinical attachment level was, respectively, 3.75 ± 1.17 at baseline, 4.00 ± 1.06 at 1 year and 4.00 ± 1.17 at ≥8 years. Peri-implant mucositis was detected around 60.2% of implants in 73.1% of patients, while peri-implantitis was affecting 12% of implants in 15.4% of patients. Some bacteria species were associated with worsened clinical parameters. About 69.4% of implants (75/108) and 67.3% of the patients (35/52) were considered as success in the present prospective cohort study after a mean follow-up of 10.8 years. Microbial follow-up may help to identify patients at risk for peri-implant disease. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Long-term prospects of CDM and JI; Langfristige Perspektiven von CDM und JI

    Energy Technology Data Exchange (ETDEWEB)

    Cames, Martin; Anger, Niels; Boehringer, Christoph; Harthan, Ralph O.; Schneider, Lambert [Oeko-Institut, Berlin (Germany)

    2007-07-15

    This study analyses whether Germany should use the flexible mechanisms under the Kyoto protocol or whether it should continue to achieve its greenhouse gas reduction targets by dint of domestic policies and measures. It estimates the future potential of the project-based Kyoto mechanisms (CDM and JI) and the impacts of its use on the German and the global economy, using an integrated-assessment model. In a Delphi survey, the expectations of international experts on the future prospects of the project-based Kyoto mechanisms are assessed. The study finishes with an analysis of options for promoting the use of the flexible mechanisms in Germany and concludes that the Federal Government of Germany should establish a project-based mechanisms fund of 25 to 50 million Kyoto units to cover the compliance uncertainties due to unexpected temperature or business cycle variations. (orig.) [German] Diese Studie untersucht, ob Deutschland die flexiblen Mechanismen unter dem Kyoto-Protokoll nutzen sollte oder weiterhin seine Treibhausgasreduktionsziele durch inlaendische Politiken und Massnahmen erreichen sollte. Das kuenftige Potenzial der projektbezogenen Kyoto-Mechanismen (CDM und JI) wird untersucht und die Auswirkungen von deren Nutzung auf die deutsche und globale Wirtschaft werden mit einem Integrated-Assessment-Modell abgeschaetzt. In einer Delphi-Befragung werden die Erwartungen internationaler Experten in Hinblick auf die kuenftigen Perspektiven der projektbezogenen Kyoto- Mechanismen ermittelt. Abschliessend werden Moeglichkeiten zur Foerderung der Nutzung der flexiblen Mechanismen in Deutschland analysiert, mit der Schlussfolgerung, dass die Bundesregierung einen 25 bis 50 Millionen Kyoto-Einheiten umfassenden Fonds fuer projektbezogene Mechanismen einrichten sollte, um die Unsicherheiten bei der Erfuellung des Kyoto-Ziels infolge unerwarteter Temperaturschwankungen oder einer Aenderung der Konjunkturentwicklung abzudecken. (orig.)

  5. Long term functioning in early onset psychosis: Two years prospective follow-up study

    Directory of Open Access Journals (Sweden)

    Taha Ghada RA

    2011-07-01

    Full Text Available Abstract Background There were few studies on the outcome of schizophrenia in developing countries. Whether the outcome is similar to or different from developed world is still a point for research. The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not. Other aims included investigation of possible predictors and associated factors with remission and outcome. Method The study prospectively investigated a group of 56 patients with onset of psychosis during childhood or adolescence. Diagnosis made according to DSM-IV criteria and included; schizophrenia, psychotic disorder not otherwise specified and acute psychosis. Severity of psychosis was measured by PANSS. Measures of the outcome included; remission criteria of Andreasen et al 2005, the children's global assessment scale and educational level. Results Analysis of data was done for only 37 patients. Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified. Mean duration of follow up was 38.4 +/- 16.9 months. At the end of the study, 6 patients (16.2% had one episode, 23(62.1% had multiple episodes and 8 (21.6% continuous course. Nineteen patients (51.4% achieved full remission, and only 11(29.7% achieved their average educational level for their age. Twenty seven percent of the sample had good outcome and 24.3% had poor outcome. Factors associated with non remission and poor outcome included gradual onset, low IQ, poor premorbid adjustment, negative symptoms at onset of the illness and poor adherence to drugs. Moreover, there was tendency of negative symptoms at illness start to predict poor outcome. Conclusion Some patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness. Although remission is a difficult target in childhood psychosis, it is still achievable.

  6. Dengue virus infection among long-term travelers from the Netherlands: A prospective study, 2008-2011.

    Directory of Open Access Journals (Sweden)

    Femke W Overbosch

    Full Text Available Dengue is increasing rapidly in endemic regions. Data on incidence among travelers to these areas are limited. Five prospective studies have been performed thus far, mainly among short-term travelers.To obtain the attack and incidence rate (AR, IR of dengue virus (DENV infection among long-term travelers and identify associated risk factors.A prospective study was performed among long-term travelers (12-52 weeks attending the Public Health Service in Amsterdam. Clients planning to travel to (subtropical countries were invited to participate. Participants kept a travel diary, recording itinerary, symptoms, and physician visits. Pre- and post-travel blood samples were serologically tested for the presence of Anti-DENV IgG antibodies. Seroconversion was considered suggestive of a primary DENV infection. Anti-DENV IgG present in both corresponding samples in combination with a post-/pre-travel ratio of ≥4:1 was suggestive of a secondary infection. Risk factors for a DENV infection were studied using poisson regression.In total, 600 participants were included; median age was 25 years (IQR: 23-29, 35.5% were male, and median travel duration was 20 weeks (IQR: 15-25. In 39 of 600 participants (AR: 6.5%; 95% CI 4.5-8.5% anti-DENV IgG test results were suggestive of a recent infection, yielding an IR of 13.9 per 1,000 person-months traveling (95%CI: 9.9-19.1. No secondary infections were found. IR for Asia, Africa, and America were comparable and 13.5, 15.8, and 13.6 per 1,000 person-months respectively. Of participants with a recent DENV infection, 51% did not report dengue-like illness (DLI or fever, but 10% were hospitalized. In multivariable analysis, travelers who seroconverted were significantly more likely to be vaccinated with ≥2 flavivirus vaccines for the current trip or to have reported DLI in >1 consecutive weeks.Long-term travelers are at substantial risk of DENV infection. Half of those with a DENV infection reported no symptoms, but 10

  7. The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study.

    Directory of Open Access Journals (Sweden)

    Alexander Marschall

    Full Text Available To investigate the prognostic value of B-mode and Power Doppler (PD ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS.Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months and long-term (15-36 months follow-up. At baseline, the cross-sectional area (CSA of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0-3. Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ and the DASH Questionnaire, as well as visual analogue scales for the patient's assessment of pain (painVAS and physician's global assessment (physVAS. The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.Short-term and long-term follow-up data were available for 111 (82.2% and 105 (77.8% patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists. Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05, but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.

  8. Long-term health consequences of violence exposure in adolescence: a 26–year prospective study

    Directory of Open Access Journals (Sweden)

    Olofsson Niclas

    2012-06-01

    Full Text Available Abstract Background Violence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years. Methods The primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU. We analyzed three cohorts, individuals aged 15–19 in 1974 and 1981, and individuals aged 18–19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts. Results Multivariate models of violence exposures in adolescence in the 1974–91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men. Conclusions This study’s findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

  9. Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study.

    Science.gov (United States)

    Hsu, Chung-Yuan; Lin, Yu-Sheng; Su, Yu-Jih; Lin, Hsing-Fen; Lin, Ming-Shyan; Syu, Ya-Jhu; Cheng, Tien-Tsai; Yu, Shan-Fu; Chen, Jia-Feng; Chen, Tien-Hsing

    2017-12-01

    The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE. We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year. A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups. Long-term HCQ appears to have no vascular protective effect in patients with SLE. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  10. Clinical Risk Factors for Head Impact During Falls in Older Adults: A Prospective Cohort Study in Long-Term Care.

    Science.gov (United States)

    Yang, Yijian; Mackey, Dawn C; Liu-Ambrose, Teresa; Leung, Pet-Ming; Feldman, Fabio; Robinovitch, Stephen N

    To examine risk factors associated with head impact during falls in older adults in long-term care (LTC). Two LTC facilities in British Columbia, Canada. 160 LTC residents. Prospective cohort study. Between 2007 and 2014, we video captured 520 falls experienced by participants. Each fall video was analyzed to determine whether impact occurred to the head. Using generalized estimating equation models, we examined how head impact was associated with other fall characteristics and health status prior to the fall. Head impact occurred in 33% of falls. Individuals with mild cognitive impairment were at higher risk for head impact (odds ratio = 2.8; 95% confidence interval, 1.5-5.0) than those with more severe cognitive impairment. Impaired vision was associated with 2.0-fold (1.3-3.0) higher odds of head impact. Women were 2.2 times (1.4-3.3) more likely than men to impact their head during a fall. Head impact is common during falls in LTC, with less cognitively impaired, female residents who suffered from visual impairment, being most likely to impact their head. Future research should focus on improving our ability to detect neural consequences of head impact and evaluating the effect of interventions for reducing the risk for fall-related head injuries in LTC.

  11. Long-Term Functional and Anatomical Outcome after Descemet Stripping Automated Endothelial Keratoplasty: A Prospective Single-Center Study

    Directory of Open Access Journals (Sweden)

    Jeroen van Rooij

    2018-01-01

    Full Text Available Purpose. To investigate the long-term anatomical and functional outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK. Methods. Prospective follow-up of 114 eyes (95 subjects after DSAEK for endothelial dysfunction. Measurements included best spectacle-corrected visual acuity (BSCVA, straylight, endothelial cell density (ECD, and graft thickness. Results. The mean follow-up time was 5.1 ± 1.5 years. Four grafts ultimately failed (after 5 to 7 years. From baseline up to 1 year after DSAEK, mean BSCVA improved by 0.30 logMAR. This beneficial effect remained until the last follow-up (LFU. After DSAEK, straylight was reduced. ECD sharply dropped by 900 cells/mm2 (33% immediately after surgery and, thereafter, steadily decreased at a rate of 11 cells/mm2 per month. No significant correlation was observed between graft thickness at 3 years and BSCVA. Conclusions. We observed a low graft failure rate and a normalization of graft thickness. Postoperative straylight remained elevated relative to the normal population. The sharp initial and the subsequent more gradual ECD decline are consistent with other studies. A significant and prolonged functional gain can be achieved by posterior lamellar grafting for endothelial dysfunction.

  12. The role of long-term doxycycline in patients of idiopathic pulmonaryfibrosis: The results of an open prospective trial

    Directory of Open Access Journals (Sweden)

    Bhattacharyya Parthasarathi

    2009-01-01

    Full Text Available Objective: To evaluate the effect of long term use of doxycycline in IPF patients. Materials and Methods: Patients of IPF, selected randomly from out patient services and diagnosed on the basis of HRCT chest, were put on doxycycline in an open prospective trial. They were followed up with monitoring of subjective well being along with measurement of pulse rate and arterial oxygen saturation at rest and after a fixed and certain exercise, forced vital capacity, six minutes walk test, St Georges Respiratory questionnaire, and serial chest X-rays. Results: Out of seven patients put on doxycycline, six of them continued the drug for a mean period of 531.43 (± 328.88 days. All the patients tolerated the drug well and had shown uniform subjective and overall objective improvement in all the parameters concerned; the change in the radiological parameter being statistically significant. Conclusion: Doxycycline merits an appropriate clinical trial in the management of idiopathic pulmonary fibrosis. This widely used and relatively safe drug can add a new dimension to the therapeutic regimen. However, further in-depth studies will be required to evaluate its role in the management of IPF.

  13. Cognitive function in patients with cerebral arteriovenous malformations after radiosurgery: prospective long-term follow-up

    International Nuclear Information System (INIS)

    Steinvorth, Sarah; Wenz, Frederik; Wildermuth, Susanne; Essig, Marco; Fuss, Martin; Lohr, Frank; Debus, Juergen; Wannenmacher, Michael; Hacke, Werner

    2002-01-01

    Purpose: To evaluate the long-term cognitive function of patients with cerebral arteriovenous malformations (AVMs) after radiosurgery. Methods and Materials: The data of 95 AVM patients were prospectively assessed up to 3 years after radiosurgery. Of these patients, 39 had a follow-up of at least 2 years. Radiosurgery was performed using a modified linear accelerator (minimal doses to the target volume 15-22 Gy, median dose 20). The neuropsychological evaluation included testing of intelligence, attention, and memory. The effect of a preexisting intracranial hemorrhage, as well as AVM occlusion, on cognitive functions was analyzed after 1 and 2 years. Results: No cognitive declines were observed during follow-up. Instead significant improvements occurred in intelligence (1 year, +6.1 IQ points; 2 years, +5.1 IQ points), memory (1 year, +18.3 percentile score; 2 years, +12.2 percentile score), and attention (1 year, +19 percentile score; 2 years, +18 percentile score). Patients without previous intracranial hemorrhage improved more than patients with intracranial hemorrhage, although this difference was not statistically significant. The role of AVM occlusion on cognitive function is not clear at present. Conclusion: Radiosurgery does not induce measurable deterioration of cognitive function in patients with cerebral AVMs

  14. The long-term effect of minimalist shoes on running performance and injury: design of a randomised controlled trial

    Science.gov (United States)

    Fuller, Joel T; Thewlis, Dominic; Tsiros, Margarita D; Brown, Nicholas A T; Buckley, Jonathan D

    2015-01-01

    Introduction The outcome of the effects of transitioning to minimalist running shoes is a topic of interest for runners and scientists. However, few studies have investigated the longer term effects of running in minimalist shoes. The purpose of this randomised controlled trial (RCT) is to investigate the effects of a 26 week transition to minimalist shoes on running performance and injury risk in trained runners unaccustomed to minimalist footwear. Methods and analysis A randomised parallel intervention design will be used. Seventy-six trained male runners will be recruited. To be eligible, runners must be aged 18–40 years, run with a habitual rearfoot footfall pattern, train with conventional shoes and have no prior experience with minimalist shoes. Runners will complete a standardised transition to either minimalist or control shoes and undergo assessments at baseline, 6 and 26 weeks. 5 km time-trial performance (5TT), running economy, running biomechanics, triceps surae muscle strength and lower limb bone mineral density will be assessed at each time point. Pain and injury will be recorded weekly. Training will be standardised during the first 6 weeks. Primary statistical analysis will compare 5TT between shoe groups at the 6-week time point and injury incidence across the entire 26-week study period. Ethics and dissemination This RCT has been approved by the Human Research Ethics Committee of the University of South Australia. Participants will be required to provide their written informed consent prior to participation in the study. Study findings will be disseminated in the form of journal publications and conference presentations after completion of planned data analysis. Trial registration number This RCT has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000642785). PMID:26297368

  15. Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET): Long-term results of a controlled randomised trial.

    Science.gov (United States)

    Stahl, Michael; Walz, Martin K; Riera-Knorrenschild, Jorge; Stuschke, Martin; Sandermann, Andreas; Bitzer, Michael; Wilke, Hansjochen; Budach, Wilfried

    2017-08-01

    Results of the PreOperative therapy in Esophagogastric adenocarcinoma Trial (POET) showed some benefits when including radiotherapy into the preoperative treatment. This article is reporting long-term results of this phase III study. Patients with locally advanced adenocarcinomas of the oesophagogastric junction (Siewert types I-III) were eligible. Randomisation was done to chemotherapy (group A) or induction chemotherapy and chemoradiotherapy (CRT; group B) followed by surgery. The primary end-point of the study was overall survival at 3 years. The study was closed early after 119 patients having been randomised and were eligible. Local progression-free survival after tumour resection was significantly improved by CRT (hazard ratio [HR] 0.37; 0.16-0.85, p = value 0.01) and 20 versus 12 patients were free of local tumour progression at 5 years (p = 0.03). Although the rate of postoperative in-hospital mortality was somewhat higher with CRT (10.2% versus 3.8%, p = 0.26), more patients were alive at 3 and 5 years after CRT (46.7% and 39.5%) compared with chemotherapy (26.1% and 24.4%). Thus, overall survival showed a trend in favour of preoperative CRT (HR 0.65, 95% confidence interval [CI] 0.42-1.01, p = 0.055). Although the primary end-point overall survival of the study was not met, our long-term follow-up data suggest a benefit in local progression-free survival when radiotherapy was added to preoperative chemotherapy in patients with locally advanced adenocarcinoma of the oesophagogastric junction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Insomnia predicts long-term all-cause mortality after acute myocardial infarction: A prospective cohort study.

    Science.gov (United States)

    Condén, Emelie; Rosenblad, Andreas

    2016-07-15

    Sleep impairment such as insomnia is an established risk factor for the development of cardiovascular disease and acute myocardial infarction (AMI). The aim of the current study was to examine the association between insomnia and all-cause mortality among AMI patients. This prospective cohort study used data on n=732 patients recruited from September 2006 to May 2011 as part of the Västmanland Myocardial Infarction Study (VaMIS), a prospective cohort study of AMI patients living in Västmanland County, Sweden. Participants were followed up for all-cause mortality until December 9, 2015. The outcome of interest was time-to-death (TTD), with the presence of insomnia being the risk factor of main interest. Data were analyzed using a piecewise Cox regression model with change point for insomnia at two years of follow-up, adjusted for socioeconomic, lifestyle and clinical risk factors. In total, n=175 (23.9%) of the participants suffered from insomnia. During a mean (SD) follow-up time of 6.0 (2.5) years (4392person-years), a total of n=231 (31.6%) participants died, n=77 (44.0%) in the insomnia group and n=154 (27.6%) in the non-insomnia group (log-rank test pinsomnia did not imply a higher risk of death during the first two years after AMI (HR 0.849; 95% CI 0.508-1.421; p=0.534). During the period after the first two years, however, insomnia implied a 1.6 times higher risk of death (HR 1.597; 95% CI 1.090-2.341; p=0.016). Insomnia implies a higher risk of death among AMI patients in the long term. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. A long-term evaluation of the stage of change approach and compensable injury outcomes - a cluster-randomised trial.

    Science.gov (United States)

    Rothmore, Paul; Aylward, Paul; Gray, Jodi; Karnon, Jonathan

    2017-05-01

    This study investigated the long-term injury outcomes for workers in companies from a range of industries which had been randomly allocated to receive ergonomics interventions tailored according to the stage of change (SOC) approach or standard ergonomics advice. Differences in compensable injury outcomes between the groups were analysed using logistic regression models. Questionnaire results from face-to-face interviews to assess musculoskeletal pain and discomfort (MSPD), job satisfaction and other factors were also analysed. Although not significant at the 0.05 level, after adjusting for workgroup clustering, workers in receipt of tailored advice were 55% (OR = 0.45, 95% CI = 0.19-1.08) less likely to report a compensable injury than those in receipt of standard ergonomics advice. Workload, job satisfaction and MSPD were significantly correlated with injury outcomes. The observed outcomes support the potential value of the SOC approach, as well as highlighting the need to consider workload, job satisfaction and MSPD when planning injury prevention programmes. Practitioner Summary: This study investigated compensable injury outcomes for workers who had received ergonomics advice tailored according to the stage of change (SOC) approach compared with standard ergonomics advice. The results support the potential value of the SOC approach and highlight the need to consider workload, job satisfaction and musculoskeletal pain and discomfort when planning injury prevention interventions.

  18. Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomised controlled trial.

    Science.gov (United States)

    Wagner, Gudrun; Penelo, Eva; Wanner, Christian; Gwinner, Paulina; Trofaier, Marie-Louise; Imgart, Hartmut; Waldherr, Karin; Wöber-Bingöl, Ciçek; Karwautz, Andreas F K

    2013-02-01

    Cognitive-behavioural therapy (CBT)-based guided self-help is recommended as a first step in the treatment of bulimia nervosa. To evaluate in a randomised controlled trial (Clinicaltrials.gov registration number: NCT00461071) the long-term effectiveness of internet-based guided self-help (INT-GSH) compared with conventional guided bibliotherapy (BIB-GSH) in females with bulimia nervosa. A total of 155 participants were randomly assigned to INT-GSH or BIB-GSH for 7 months. Outcomes were assessed at baseline, month 4, month 7 and month 18. The greatest improvement was reported after 4 months with a continued reduction in eating disorder symptomatology reported at month 7 and 18. After 18 months, 14.6% (n = 7/48) of the participants in the INT-GSH group and 25% (n = 7/28) in the BIB-GSH group were abstinent from binge eating and compensatory measures, 43.8% (n = 21/48) and 39.2% (n = 11/28) respectively were in remission. No differences regarding outcome between the two groups were found. Internet-based guided self-help for bulimia nervosa was not superior compared with bibliotherapy, the gold standard of self-help. Improvements remain stable in the long term.

  19. A randomised trial of enteral glutamine supplementation for very preterm children showed no beneficial or adverse long-term neurodevelopmental outcomes.

    Science.gov (United States)

    Twilhaar, E Sabrina; de Kieviet, Jorrit F; Oosterlaan, Jaap; van Elburg, Ruurd M

    2018-04-01

    This study evaluated the long-term effects of enteral glutamine supplementation on neurodevelopmental outcomes of a Dutch cohort of very preterm children at 13 years of age. The cohort was enrolled in a randomised placebo-controlled trial between 2001 and 2003 in which infants received glutamine- or alanine-supplemented enteral nutrition during the first month of life. Participants were invited for follow-up at a mean age of 13.30 years. Motor, neurocognitive, academic and behavioural outcomes were assessed in 61 children. No differences were found between the groups regarding motor, intellectual, academic and behavioural functioning. Forward span visuospatial working memory performance was better in the controls (crude/adjusted model: d = 0.67/0.64, p = 0.02/0.02), but no difference was found for backward span. After the data were adjusted for confounders, the groups differed regarding parent-rated attention (crude/adjusted model: d = 0.47/0.73, p = 0.07/0.003), but both groups scored within the normal range. This was the first study on the long-term effects of enteral glutamine supplementation on the neurodevelopmental outcomes of very preterm children. Our study provided no evidence that enteral glutamine supplementation had any beneficial or adverse effects on the children's motor, neurocognitive, academic and behavioural outcomes at 13 years of age. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Bonati, Leo H

    2009-10-01

    In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS.

  1. Randomized controlled trial evaluating the temporal effects of high-intensity exercise on learning, short-term and long-term memory, and prospective memory.

    Science.gov (United States)

    Frith, Emily; Sng, Eveleen; Loprinzi, Paul D

    2017-11-01

    The broader purpose of this study was to examine the temporal effects of high-intensity exercise on learning, short-term and long-term retrospective memory and prospective memory. Among a sample of 88 young adult participants, 22 were randomized into one of four different groups: exercise before learning, control group, exercise during learning, and exercise after learning. The retrospective assessments (learning, short-term and long-term memory) were assessed using the Rey Auditory Verbal Learning Test. Long-term memory including a 20-min and 24-hr follow-up assessment. Prospective memory was assessed using a time-based procedure by having participants contact (via phone) the researchers at a follow-up time period. The exercise stimulus included a 15-min bout of progressive maximal exertion treadmill exercise. High-intensity exercise prior to memory encoding (vs. exercise during memory encoding or consolidation) was effective in enhancing long-term memory (for both 20-min and 24-h follow-up assessments). We did not observe a differential temporal effect of high-intensity exercise on short-term memory (immediate post-memory encoding), learning or prospective memory. The timing of high-intensity exercise may play an important role in facilitating long-term memory. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  2. Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants.

    Science.gov (United States)

    Darr, Emily; Meyer, S Craig; Whang, Peter G; Kovalsky, Don; Frank, Clay; Lockstadt, Harry; Limoni, Robert; Redmond, Andy; Ploska, Philip; Oh, Michael Y; Cher, Daniel; Chowdhary, Abhineet

    2018-01-01

    Minimally invasive sacroiliac joint fusion (SIJF) has become an increasingly accepted surgical option for chronic sacroiliac (SI) joint dysfunction, a prevalent cause of unremitting low back/buttock pain. The objective of this study was to report clinical and functional outcomes of SIJF using triangular titanium implants (TTI) in the treatment of chronic SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint (SIJ) disruption at 3 years postoperatively. A total of 103 subjects with SIJ dysfunction at 12 centers were treated with TTI in two prospective clinical trials (NCT01640353 and NCT01681004) and enrolled in this long-term follow-up study (NCT02270203). Subjects were evaluated in study clinics at study start and again at 3, 4, and 5 years. Mean (SD) preoperative SIJ pain score was 81.5, and mean preoperative Oswestry Disability Index (ODI) was 56.3. At 3 years, mean pain SIJ pain score decreased to 26.2 (a 55-point improvement from baseline, p <0.0001). At 3 years, mean ODI was 28.2 (a 28-point improvement from baseline, p <0.0001). In all, 82% of subjects were very satisfied with the procedure at 3 years. EuroQol-5D (EQ-5D) time trade-off index improved by 0.30 points ( p <0.0001). No adverse events definitely related to the study device or procedure were reported; one subject underwent revision surgery at year 3.7. SIJ pain contralateral to the originally treated side occurred in 15 subjects of whom four underwent contralateral SIJF. The proportion of subjects who were employed outside the home full- or part-time at 3 years decreased somewhat from baseline ( p =0.1814), and the proportion of subjects who would have the procedure again was lower at 3 years compared to earlier time points. In long-term (3-year) follow-up, minimally invasive trans-iliac SIJF with TTI was associated with improved pain, disability, and quality of life with relatively high satisfaction rates. Level II. SIJF with TTI.

  3. Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies.

    Science.gov (United States)

    Pan, A; Malik, V S; Hao, T; Willett, W C; Mozaffarian, D; Hu, F B

    2013-10-01

    To examine the long-term relationship between changes in water and beverage intake and weight change. Prospective cohort studies of 50013 women aged 40-64 years in the Nurses' Health Study (NHS, 1986-2006), 52987 women aged 27-44 years in the NHS II (1991-2007) and 21988 men aged 40-64 years in the Health Professionals Follow-up Study (1986-2006) without obesity and chronic diseases at baseline. We assessed the association of weight change within each 4-year interval, with changes in beverage intakes and other lifestyle behaviors during the same period. Multivariate linear regression with robust variance and accounting for within-person repeated measures were used to evaluate the association. Results across the three cohorts were pooled by an inverse-variance-weighted meta-analysis. Participants gained an average of 1.45 kg (5th to 95th percentile: -1.87 to 5.46) within each 4-year period. After controlling for age, baseline body mass index and changes in other lifestyle behaviors (diet, smoking habits, exercise, alcohol, sleep duration, TV watching), each 1 cup per day increment of water intake was inversely associated with weight gain within each 4-year period (-0.13 kg; 95% confidence interval (CI): -0.17 to -0.08). The associations for other beverages were: sugar-sweetened beverages (SSBs) (0.36 kg; 95% CI: 0.24-0.48), fruit juice (0.22 kg; 95% CI: 0.15-0.28), coffee (-0.14 kg; 95% CI: -0.19 to -0.09), tea (-0.03 kg; 95% CI: -0.05 to -0.01), diet beverages (-0.10 kg; 95% CI: -0.14 to -0.06), low-fat milk (0.02 kg; 95% CI: -0.04 to 0.09) and whole milk (0.02 kg; 95% CI: -0.06 to 0.10). We estimated that replacement of 1 serving per day of SSBs by 1 cup per day of water was associated with 0.49 kg (95% CI: 0.32-0.65) less weight gain over each 4-year period, and the replacement estimate of fruit juices by water was 0.35 kg (95% CI: 0.23-0.46). Substitution of SSBs or fruit juices by other beverages (coffee, tea, diet beverages, low-fat and whole milk) were all

  4. Long-term Efficacy, Safety, and Immunogenicity of Biosimilar Infliximab After One Year in a Prospective Nationwide Cohort.

    Science.gov (United States)

    Gonczi, Lorant; Gecse, Krisztina B; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Rutka, Mariann; Farkas, Klaudia; Golovics, Petra A; Lovasz, Barbara D; Banai, Janos; Bene, Laszlo; Gasztonyi, Bea; Kristof, Tunde; Lakatos, Laszlo; Miheller, Pal; Nagy, Ferenc; Palatka, Karoly; Papp, Maria; Patai, Arpad; Salamon, Agnes; Szamosi, Tamas; Szepes, Zoltan; Toth, Gabor T; Vincze, Aron; Szalay, Balazs; Molnar, Tamas; Lakatos, Peter L

    2017-11-01

    It has been previously shown that biosimilar infliximab CT-P13 is effective and safe in inducing remission in inflammatory bowel diseases. We report here the 1-year outcomes from a prospective nationwide inflammatory bowel disease cohort. A prospective, nationwide, multicenter, observational cohort was designed to examine the efficacy and safety of CT-P13 in the induction and maintenance treatment of Crohn's disease (CD) and ulcerative colitis (UC). Demographic data were collected and a harmonized monitoring strategy was applied. Clinical remission, response, and biochemical response were evaluated at weeks 14, 30, and 54, respectively. Safety data were registered. Three hundred fifty-three consecutive inflammatory bowel disease (209 CD and 144 UC) patients were included, of which 229 patients reached the week 54 endpoint at final evaluation. Age at disease onset: 24/28 years (median, interquartile range: 19-34/22-39) in patients with CD/UC. Forty-nine, 53, 48% and 86, 81 and 65% of patients with CD reached clinical remission and response by weeks 14, 30, and 54, respectively. Clinical remission and response rates were 56, 41, 43% and 74, 66, 50% in patients with UC. Clinical efficacy was influenced by previous anti-tumor necrosis factor (TNF) exposure in patients with a drug holiday beyond 1 year. The mean C-reactive protein level decreased significantly in both CD and UC by week 14 and was maintained throughout the 1-year follow-up (both UC/CD: P < 0.001). Thirty-one (8.8%) patients had infusion reactions and 32 (9%) patients had infections. Antidrug antibody positivity rates were significantly higher throughout patients with previous anti-TNF exposure; concomitant azathioprine prevented antidrug antibody formation in anti-TNF-naive patients with CD. Results from this prospective nationwide cohort confirm that CT-P13 is effective and safe in inducing and maintaining long-term remission in both CD and UC. Efficacy was influenced by previous anti-TNF exposure; no

  5. Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Benth Jūratė

    2009-05-01

    Full Text Available Abstract Background The increasing attention on functional assessments in medical and vocational rehabilitation requires a focus change for the general practitioners (GP into paying attention to patient resources, possibilities and coping instead of symptoms, problems and limitations. The GPs report difficulties in performing the requested explicit functional assessments. The purpose of this study was to implement a structured method in general practice for assessing functional ability in persons with long-term sick leave. The study aim was to evaluate intervention effects on important GP parameters; knowledge, attitudes, self-efficacy towards functional assessments and knowledge about patient work factors. Methods Fifty-seven GPs were randomly assigned to an intervention or a control group. The intervention group GPs attended an introductory one-day work-shop and implemented structured functional assessments during an eight months intervention period. GP knowledge, GP attitudes, and GP self-efficacy towards functional assessments, as well as GP knowledge of patient work factors, were collected before, after and six months after the intervention period started. Evaluation score-sheets were filled in by both the intervention GPs and their patients immediately after the consultation to evaluate the GPs' knowledge of patient work factors. Results The intervention GPs reported increased knowledge (B: 0.56, 95% CI (0.19, 0.91 and self-efficacy (B: 0.90, 95% CI (0.53, 1.26 towards functional assessments, and increased knowledge about their patients' workplace (B: 0.75, 95% CI (0.35, 1.15 and perceived stressors (B: 0.55, 95% CI (0.23, 0.88 with lasting effects at the second follow-up. No intervention effect was seen in relation to GP attitudes. Both before and after the intervention, the GPs were most informed about physical stressors, and less about mental and work organisational stressors (Guttman's reproducibility coefficient: 0.95 and 1.00. After

  6. Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial.

    Science.gov (United States)

    Østerås, Nina; Gulbrandsen, Pål; Benth, Jūrate Saltyte; Hofoss, Dag; Brage, Søren

    2009-05-06

    The increasing attention on functional assessments in medical and vocational rehabilitation requires a focus change for the general practitioners (GP) into paying attention to patient resources, possibilities and coping instead of symptoms, problems and limitations. The GPs report difficulties in performing the requested explicit functional assessments. The purpose of this study was to implement a structured method in general practice for assessing functional ability in persons with long-term sick leave. The study aim was to evaluate intervention effects on important GP parameters; knowledge, attitudes, self-efficacy towards functional assessments and knowledge about patient work factors. Fifty-seven GPs were randomly assigned to an intervention or a control group. The intervention group GPs attended an introductory one-day work-shop and implemented structured functional assessments during an eight months intervention period. GP knowledge, GP attitudes, and GP self-efficacy towards functional assessments, as well as GP knowledge of patient work factors, were collected before, after and six months after the intervention period started. Evaluation score-sheets were filled in by both the intervention GPs and their patients immediately after the consultation to evaluate the GPs' knowledge of patient work factors. The intervention GPs reported increased knowledge (B: 0.56, 95% CI (0.19, 0.91)) and self-efficacy (B: 0.90, 95% CI (0.53, 1.26)) towards functional assessments, and increased knowledge about their patients' workplace (B: 0.75, 95% CI (0.35, 1.15)) and perceived stressors (B: 0.55, 95% CI (0.23, 0.88)) with lasting effects at the second follow-up. No intervention effect was seen in relation to GP attitudes. Both before and after the intervention, the GPs were most informed about physical stressors, and less about mental and work organisational stressors (Guttman's reproducibility coefficient: 0.95 and 1.00). After the consultation, both the intervention GPs

  7. Impact of Burnout and Psychosocial Work Characteristics on Future Long-Term Sickness Absence. Prospective Results of the Danish PUMA Study Among Human Service Workers

    NARCIS (Netherlands)

    Borritz, Marianne; Christensen, Karl Bang; Bultmann, Ute; Rugulies, Reiner; Lund, Thomas; Andersen, Ingelise; Villadsen, Ebbe; Diderichsen, Finn; Kristensen, Tage S.

    2010-01-01

    Objectives: The objective of this study was to examine if burnout and psychosocial factors predicted long-term sickness absence (>2 weeks) at work unit level. Methods: Data were collected prospectively at 82-work units in human services (PUMA cohort, PUMA: Danish acronym for Burnout, Motivation and

  8. School neighborhood disadvantage as a predictor of long-term sick leave among teachers: prospective cohort study.

    Science.gov (United States)

    Virtanen, Marianna; Kivimäki, Mika; Pentti, Jaana; Oksanen, Tuula; Ahola, Kirsi; Linna, Anne; Kouvonen, Anne; Salo, Paula; Vahtera, Jussi

    2010-04-01

    This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.

  9. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    King, Christopher R.; Brooks, James D.; Gill, Harcharan; Presti, Joseph C.

    2012-01-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 ± 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%–102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  10. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    King, Christopher R., E-mail: crking@mednet.ucla.edu [Departments of Radiation Oncology and Urology, University of California Los Angeles School of Medicine, Los Angeles, CA (United States); Brooks, James D.; Gill, Harcharan; Presti, Joseph C. [Department of Urology, Stanford University School of Medicine, Stanford, CA (United States)

    2012-02-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 {+-} 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%-102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  11. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study.

    Science.gov (United States)

    Zielske, Joerg; Bohne, Silvia; Brunkhorst, Frank M; Axer, Hubertus; Guntinas-Lichius, Orlando

    2014-11-01

    Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration-Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.

  12. Efficacy of Long-Term Oral Vitamin B12 Supplementation after Total Gastrectomy: Results from a Prospective Study

    Directory of Open Access Journals (Sweden)

    Joana Moleiro

    2017-11-01

    Full Text Available Background/Objectives: Vitamin B12 (VB12 deficiency is a common complication after total gastrectomy which may be associated with megaloblastic anemia and potentially irreversible neurologic symptoms. Intramuscular supplementation of VB12 has been considered the standard treatment, although it is associated with high costs and patient discomfort. Patients/Methods: We performed a prospective uncontrolled study (ACTRN12614000107628 in order to evaluate the clinical and laboratory efficacy of long-term oral VB12 supplementation in patients submitted to total gastrectomy. All patients received daily oral VB12 (1 mg/day and were evaluated every 3 months (clinical and laboratory evaluation: hemoglobin, VB12, total iron, ferritin, and folate. Results: A total of 26 patients were included with a mean age of 64 years (29-79. Patients were included with a mean period of 65 months (3-309 after total gastrectomy. At inclusion time, 17/26 patients were under intramuscular VB12, and 9 had not started supplementation yet. There were normal serum VB12 levels in 25/26 patients (mean VB12 serum levels: 657 pg/mL. The mean follow-up period was 20 (8.5-28 months. During follow-up, all patients had normal VB12 levels and there was no need for intramuscular supplementation. The patient with low VB12 levels had an increase to adequate levels, which remained stable. There were no differences with statistical significance among VB12 levels at 6 (867 pg/mL, 12 (1,008 pg/mL, 18 (1,018 pg/mL, and 24 (1,061 pg/mL months. Iron and folate supplementation was necessary in 21 and 7 patients, respectively. Conclusions: Oral VB12 supplementation is effective and safe in patients who underwent total gastrectomy and should be considered the preferential form of supplementation.

  13. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial.

    LENUS (Irish Health Repository)

    Smith, Myles J F

    2014-01-07

    Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.

  14. Long-term Efficacy of Trabeculectomy on Chinese Patients with Pigmentary Glaucoma: A Prospective Case Series Observational Study

    Directory of Open Access Journals (Sweden)

    Guo-Ping Qing

    2016-01-01

    Conclusions: All surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.

  15. Impact of burnout and psychosocial work characteristics on future long-term sickness absence. Prospective results of the Danish PUMA-study among human service workers

    DEFF Research Database (Denmark)

    Borritz, Marianne; Christensen, KB; Bültmann, Ute

    2010-01-01

    and Job satisfaction) followed up during the proceeding 18 months regarding onset of long-term sickness absence. Questionnaire data regarding burnout and psychosocial factors were aggregated at work unit level. We used Poisson regression models with psychosocial factors and burnout as predictors of long...... work environment, and equally important, the organizations should be attentive to employees with symptoms of burnout......Objectives: The objective of this study was to examine if burnout and psychosocial factors predicted long-term sickness absence (>2 weeks) at work unit level. Methods: Data were collected prospectively at 82-work units in human services (PUMA cohort, PUMA: Danish acronym for Burnout, Motivation...

  16. Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

    Directory of Open Access Journals (Sweden)

    Darr E

    2018-04-01

    Full Text Available Emily Darr,1 S Craig Meyer,2 Peter G Whang,3 Don Kovalsky,4 Clay Frank,5 Harry Lockstadt,6 Robert Limoni,7 Andy Redmond,8 Philip Ploska,9 Michael Y Oh,10 Daniel Cher,11 Abhineet Chowdhary12 1Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA; 2Columbia Orthopaedic Medical Group, Columbia, MO, USA; 3Department of Orthopedics, Yale University, New Haven, CT, USA; 4Orthopaedic Center of Southern Illinois, Mt. Vernon, IL, USA; 5Integrated Spine Care, Wauwatosa, WI, USA; 6Bluegrass Orthopedics, Lexington, KY, USA; 7Orthopedics & Sports Medicine, BayCare Clinic, Green Bay, WI, USA; 8Precision Spine Care, Tyler, TX, USA; 9OrthoSpine Solutions, Stockbridge, GA, USA; 10Allegheny General Hospital, Pittsburgh, PA, USA; 11SI-BONE, Inc., San Jose, CA, USA; 12Overlake Medical Center, Bellevue, WA, USA Background: Minimally invasive sacroiliac joint fusion (SIJF has become an increasingly accepted surgical option for chronic sacroiliac (SI joint dysfunction, a prevalent cause of unremitting low back/buttock pain. Objective: The objective of this study was to report clinical and functional outcomes of SIJF using triangular titanium implants (TTI in the treatment of chronic SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint (SIJ disruption at 3 years postoperatively. Methods: A total of 103 subjects with SIJ dysfunction at 12 centers were treated with TTI in two prospective clinical trials (NCT01640353 and NCT01681004 and enrolled in this long-term follow-up study (NCT02270203. Subjects were evaluated in study clinics at study start and again at 3, 4, and 5 years. Results: Mean (SD preoperative SIJ pain score was 81.5, and mean preoperative Oswestry Disability Index (ODI was 56.3. At 3 years, mean pain SIJ pain score decreased to 26.2 (a 55-point improvement from baseline, p<0.0001. At 3 years, mean ODI was 28.2 (a 28-point improvement from baseline, p<0.0001. In all, 82% of subjects were very

  17. Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial.

    Science.gov (United States)

    Andersén, Åsa; Larsson, Kjerstin; Lytsy, Per; Berglund, Erik; Kristiansson, Per; Anderzén, Ingrid

    2018-01-09

    Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group's self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10-0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI - 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54-0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

  18. Nutrition-related risk indexes and long-term mortality in noncritically ill inpatients who receive total parenteral nutrition (prospective multicenter study).

    Science.gov (United States)

    Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, Ma Carmen; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P; Cabrerizo, Lucio; Rubio, Miguel A; Chicharro, Luisa; Burgos, Rosa; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, Estrella; Manjón, Laura; Diéguez, Marta; Carrera, Ma José; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; del Olmo, Dolores; Pereira, José Luis; Tous, María C; Olveira, Gabriel

    2015-10-01

    Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (Nutrition and Metabolism. All rights reserved.

  19. Golimumab in patients with active rheumatoid arthritis who have previous experience with tumour necrosis factor inhibitors: results of a long-term extension of the randomised, double-blind, placebo-controlled GO-AFTER study through week 160

    NARCIS (Netherlands)

    Smolen, Josef S.; Kay, Jonathan; Landewé, Robert B. M.; Matteson, Eric L.; Gaylis, Norman; Wollenhaupt, Jurgen; Murphy, Frederick T.; Zhou, Yiying; Hsia, Elizabeth C.; Doyle, Mittie K.

    2012-01-01

    The aim of this study was to assess long-term golimumab therapy in patients with rheumatoid arthritis (RA) who discontinued previous tumour necrosis factor alpha (TNFα) inhibitor(s) for any reason. Results through week 24 of this multicentre, randomised, double-blind, placebo-controlled study of

  20. Objectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Terence Dwyer

    Full Text Available Self-reported physical activity has been inversely associated with mortality but the effect of objectively measured step activity on mortality has never been evaluated. The objective is to determine the prospective association of daily step activity on mortality among free-living adults.Cohort study of free-living adults residing in Tasmania, Australia between 2000 and 2005 who participated in one of three cohort studies (n = 2 576 total participants. Daily step activity by pedometer at baseline at a mean of 58.8 years of age, and for a subset, repeated monitoring was available 3.7 (SD 1.3 years later (n = 1 679. All-cause mortality (n = 219 deaths was ascertained by record-linkage to the Australian National Death Index; 90% of participants were followed-up over ten years, until June 2011. Higher daily step count at baseline was linearly associated with lower all-cause mortality (adjusted hazard ratio AHR, 0.94; 95% CI, 0.90 to 0.98 per 1 000 steps; P = 0.004. Risk was altered little by removing deaths occurring in the first two years. Increasing baseline daily steps from sedentary to 10 000 steps a day was associated with a 46% (95% CI, 18% to 65%; P = 0.004 lower risk of mortality in the decade of follow-up. In addition, those who increased their daily steps over the monitoring period had a substantial reduction in mortality risk, after adjusting for baseline daily step count (AHR, 0.39; 95% CI, 0.22 to 0.72; P = 0.002, or other factors (AHR, 0.38; 95% CI, 0.21-0.70; P = 0.002.Higher daily step count was linearly associated with subsequent long term mortality among free living adults. These data are the first to quantify mortality reductions using an objective measure of physical activity in a free living population. They strongly underscore the importance of physical inactivity as a major public health problem.

  1. [Serum total cholesterol levels and eligibility for long-term care insurance: a prospective cohort study of the Tsurugaya project].

    Science.gov (United States)

    Hoshi, Rena; Tomata, Yasutake; Kakizaki, Masako; Tsuboya, Toru; Nagai, Masato; Watanabe, Ikue; Hozawa, Atsushi; Tsuji, Ichiro

    2013-08-01

    The purpose of this study was to examine the relationship between serum total cholesterol levels and certification eligibility for long-term care insurance in elderly Japanese individuals. The Tsurugaya Project was a comprehensive geriatric assessment conducted for community-dwelling elderly individuals aged ≥70 years in the Tsurugaya area, Sendai, Japan. Of the 2,925 inhabitants, 958 subjects participated in the Tsurugaya Project. For this analysis, we used 827 subjects who gave informed consent and were not qualified for long-term care insurance at the time of the baseline survey. Subjects were followed up for 6 years. We classified the subjects into 4 quintiles and used the fourth quintile (212-230 mg/dL) as a reference for statistical analysis. We used Cox proportional hazards model to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of certification eligibility for long-term care insurance according to total cholesterol levels in serum. During 6 years of follow-up, a total of 214 subjects were qualified for long-term care insurance certification. The lowest serum total cholesterol level (care insurance certification. Compared with the fourth quintile, multivariate HRs (95%CIs) of long-term care insurance certification were 1.91 (1.23-2.98), 1.36 (0.85-2.18), 0.99 (0.62-1.56), 1.38 (0.88-2.17), for total cholesterol levels were significantly associated with increased eligibility for long-term care insurance certification even after adjusting for a variety of confounding factors.

  2. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial.

    Science.gov (United States)

    Pickles, Andrew; Le Couteur, Ann; Leadbitter, Kathy; Salomone, Erica; Cole-Fletcher, Rachel; Tobin, Hannah; Gammer, Isobel; Lowry, Jessica; Vamvakas, George; Byford, Sarah; Aldred, Catherine; Slonims, Vicky; McConachie, Helen; Howlin, Patricia; Parr, Jeremy R; Charman, Tony; Green, Jonathan

    2016-11-19

    It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction. PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2-4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42-5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827. 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI -0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI -0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI -0

  3. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Bueno, Nassib Bezerra; de Melo, Ingrid Sofia Vieira; de Oliveira, Suzana Lima; da Rocha Ataide, Terezinha

    2013-10-01

    The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (LFD; i.e. a restricted-energy diet with less than 30% of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect,Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was bodyweight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure,glucose, insulin, HbA1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis,five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference 20·91 (95% CI 21·65, 20·17) kg, 1415 patients), TAG (weighted mean difference 20·18 (95% CI 20·27, 20·08) mmol/l, 1258 patients)and diastolic blood pressure (weighted mean difference 21·43 (95% CI 22·49, 20·37) mmHg, 1298 patients) while increased HDL-C(weighted mean difference 0·09 (95% CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95% CI 0·04,0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the longterm; hence, a VLCKD may be an alternative tool against obesity.

  4. Activities and sources of income after a period of long-term sick leave - a population-based prospective cohort study

    Directory of Open Access Journals (Sweden)

    Wikman Anders

    2012-09-01

    Full Text Available Abstract Background There is limited knowledge about what happens to people after long-term sick leave. The aim of this report was to conduct a prospective study of individuals who were on prolonged sick leave during a particular year, considering their activities and sources of income during subsequent years. To enable comparison of different time periods, we used three cohorts of individuals with different starting years. Methods Using data from national registers, three separate cohorts were constructed that included all people living in Sweden who were 20-64 years of age (>5 million in the years 1995, 2000 and 2005, respectively. The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995-2008: on long-term sick leave, employed, old-age pensioner, long-term unemployed, disability pensioner, on parental leave, social assistance recipient, student allowance recipient, deceased, or emigrated. Results Most individuals on long-term (> 6 months sick leave in 1995 were not employed 13 years later. Only 11% of the women and 13% of the men were primarily in employment after 13 years. Instead, a wide range of alternatives existed, for example, many had been granted disability pension, and about 10% of the women and 17% of the men had died during the follow-up period. A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up. Conclusions The low future employment rates for people on long-term sick leave may seem surprising. There are several possible explanations for the finding: The disorders these people may have, might have entailed longstanding difficulties on the labor market. Besides, long-term absence from work, no matter what its causes were, might have worsen the chances of further employment. The economic cycles may also have been of importance. The improving labor market during later years seems

  5. Activities and sources of income after a period of long-term sick leave--a population-based prospective cohort study.

    Science.gov (United States)

    Wikman, Anders; Wiberg, Michael; Marklund, Staffan; Alexanderson, Kristina

    2012-09-06

    There is limited knowledge about what happens to people after long-term sick leave. The aim of this report was to conduct a prospective study of individuals who were on prolonged sick leave during a particular year, considering their activities and sources of income during subsequent years. To enable comparison of different time periods, we used three cohorts of individuals with different starting years. Using data from national registers, three separate cohorts were constructed that included all people living in Sweden who were 20-64 years of age (>5 million) in the years 1995, 2000 and 2005, respectively. The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995-2008: on long-term sick leave, employed, old-age pensioner, long-term unemployed, disability pensioner, on parental leave, social assistance recipient, student allowance recipient, deceased, or emigrated. Most individuals on long-term (> 6 months) sick leave in 1995 were not employed 13 years later. Only 11% of the women and 13% of the men were primarily in employment after 13 years. Instead, a wide range of alternatives existed, for example, many had been granted disability pension, and about 10% of the women and 17% of the men had died during the follow-up period. A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up. The low future employment rates for people on long-term sick leave may seem surprising. There are several possible explanations for the finding: The disorders these people may have, might have entailed longstanding difficulties on the labor market. Besides, long-term absence from work, no matter what its causes were, might have worsen the chances of further employment. The economic cycles may also have been of importance. The improving labor market during later years seems to have improved the chances for employment among those earlier

  6. Prospective memory deficits in illicit polydrug users are associated with the average long-term typical dose of ecstasy typically consumed in a single session.

    Science.gov (United States)

    Gallagher, Denis T; Hadjiefthyvoulou, Florentia; Fisk, John E; Montgomery, Catharine; Robinson, Sarita J; Judge, Jeannie

    2014-01-01

    Neuroimaging evidence suggests that ecstasy-related reductions in SERT densities relate more closely to the number of tablets typically consumed per session rather than estimated total lifetime use. To better understand the basis of drug related deficits in prospective memory (p.m.) we explored the association between p.m. and average long-term typical dose and long-term frequency of use. Study 1: Sixty-five ecstasy/polydrug users and 85 nonecstasy users completed an event-based, a short-term and a long-term time-based p.m. task. Study 2: Study 1 data were merged with outcomes on the same p.m. measures from a previous study creating a combined sample of 103 ecstasy/polydrug users, 38 cannabis-only users, and 65 nonusers of illicit drugs. Study 1: Ecstasy/polydrug users had significant impairments on all p.m. outcomes compared with nonecstasy users. Study 2: Ecstasy/polydrug users were impaired in event-based p.m. compared with both other groups and in long-term time-based p.m. compared with nonillicit drug users. Both drug using groups did worse on the short-term time-based p.m. task compared with nonusers. Higher long-term average typical dose of ecstasy was associated with poorer performance on the event and short-term time-based p.m. tasks and accounted for unique variance in the two p.m. measures over and above the variance associated with cannabis and cocaine use. The typical ecstasy dose consumed in a single session is an important predictor of p.m. impairments with higher doses reflecting increasing tolerance giving rise to greater p.m. impairment.

  7. The long-term effects of a peer-led sex education programme (RIPPLE: a cluster randomised trial in schools in England.

    Directory of Open Access Journals (Sweden)

    Judith Stephenson

    2008-11-01

    Full Text Available Peer-led sex education is widely believed to be an effective approach to reducing unsafe sex among young people, but reliable evidence from long-term studies is lacking. To assess the effectiveness of one form of school-based peer-led sex education in reducing unintended teenage pregnancy, we did a cluster (school randomised trial with 7 y of follow-up.Twenty-seven representative schools in England, with over 9,000 pupils aged 13-14 y at baseline, took part in the trial. Schools were randomised to either peer-led sex education (intervention or to continue their usual teacher-led sex education (control. Peer educators, aged 16-17 y, were trained to deliver three 1-h classroom sessions of sex education to 13- to 14-y-old pupils from the same schools. The sessions used participatory learning methods designed to improve the younger pupils' skills in sexual communication and condom use and their knowledge about pregnancy, sexually transmitted infections (STIs, contraception, and local sexual health services. Main outcome measures were abortion and live births by age 20 y, determined by anonymised linkage of girls to routine (statutory data. Assessment of these outcomes was blind to sex education allocation. The proportion of girls who had one or more abortions before age 20 y was the same in each arm (intervention, 5.0% [95% confidence interval (CI 4.0%-6.3%]; control, 5.0% [95% CI 4.0%-6.4%]. The odds ratio (OR adjusted for randomisation strata was 1.07 (95% CI 0.80-1.42, p = 0.64, intervention versus control. The proportion of girls with one or more live births by 20.5 y was 7.5% (95% CI 5.9%-9.6% in the intervention arm and 10.6% (95% CI 6.8%-16.1% in the control arm, adjusted OR 0.77 (0.51-1.15. Fewer girls in the peer-led arm self-reported a pregnancy by age 18 y (7.2% intervention versus 11.2% control, adjusted OR 0.62 [95% CI 0.42-0.91], weighted for non-response; response rate 61% intervention, 45% control. There were no significant

  8. The long-term effects of a peer-led sex education programme (RIPPLE): a cluster randomised trial in schools in England.

    Science.gov (United States)

    Stephenson, Judith; Strange, Vicki; Allen, Elizabeth; Copas, Andrew; Johnson, Anne; Bonell, Chris; Babiker, Abdel; Oakley, Ann

    2008-11-25

    Peer-led sex education is widely believed to be an effective approach to reducing unsafe sex among young people, but reliable evidence from long-term studies is lacking. To assess the effectiveness of one form of school-based peer-led sex education in reducing unintended teenage pregnancy, we did a cluster (school) randomised trial with 7 y of follow-up. Twenty-seven representative schools in England, with over 9,000 pupils aged 13-14 y at baseline, took part in the trial. Schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). Peer educators, aged 16-17 y, were trained to deliver three 1-h classroom sessions of sex education to 13- to 14-y-old pupils from the same schools. The sessions used participatory learning methods designed to improve the younger pupils' skills in sexual communication and condom use and their knowledge about pregnancy, sexually transmitted infections (STIs), contraception, and local sexual health services. Main outcome measures were abortion and live births by age 20 y, determined by anonymised linkage of girls to routine (statutory) data. Assessment of these outcomes was blind to sex education allocation. The proportion of girls who had one or more abortions before age 20 y was the same in each arm (intervention, 5.0% [95% confidence interval (CI) 4.0%-6.3%]; control, 5.0% [95% CI 4.0%-6.4%]). The odds ratio (OR) adjusted for randomisation strata was 1.07 (95% CI 0.80-1.42, p = 0.64, intervention versus control). The proportion of girls with one or more live births by 20.5 y was 7.5% (95% CI 5.9%-9.6%) in the intervention arm and 10.6% (95% CI 6.8%-16.1%) in the control arm, adjusted OR 0.77 (0.51-1.15). Fewer girls in the peer-led arm self-reported a pregnancy by age 18 y (7.2% intervention versus 11.2% control, adjusted OR 0.62 [95% CI 0.42-0.91], weighted for non-response; response rate 61% intervention, 45% control). There were no significant differences for

  9. Long-term outcome of a cohort of adults with autism and intellectual disability: A pilot prospective study.

    Science.gov (United States)

    Fusar-Poli, Laura; Brondino, Natascia; Orsi, Paolo; Provenzani, Umberto; De Micheli, Andrea; Ucelli di Nemi, Stefania; Barale, Francesco; Politi, Pierluigi

    2017-01-01

    Autism spectrum disorders (ASD) are a long-life condition frequently associated with intellectual disability. To date, long-term outcome has been investigated mostly in ASD people with average or above-average intelligence and there is a paucity of data about autistic adults with comorbid intellectual disability. The aim of the present study is to assess long-term variations of adaptive abilities in a sample of autistic adults with intellectual disability and severe language impairment. 22 adults (17 males and 5 females) affected by autism and intellectual disability were recruited and evaluated after their admission in an Italian farm-community. Vineland Adaptive Behavior Scales (VABS) were used as outcome measure for adaptive abilities. After ten years the measurement was repeated in order to study the evolution of patients' skills along time. Additionally, sociodemographic variables, changes in medication and comorbidities were recorded. No statistically significant improvement neither deterioration was found according to VABS raw scores in the entire sample. On the contrary, a significant improvement was evident in standard scores for the Adaptive Behavior Composite Scale and for each domain. In general, our patients remained stable in adaptive abilities. However, our results are not generalisable to the entire autistic population, but only to inpatients with autism and comorbid intellectual disability. New measures should be developed in order to better assess changes in this particular population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries

    Directory of Open Access Journals (Sweden)

    Gudmundsson G

    2012-09-01

    Full Text Available Gunnar Gudmundsson,1,2 Charlotte Suppli Ulrik,3 Thorarinn Gislason,1,2 Eva Lindberg,4 Eva Brøndum,3 Per Bakke,5 Christer Janson31Department of Respiratory Medicine, Allergy and Sleep, National University Hospital, Reykjavik, Iceland; 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 3Department of Respiratory Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; 4Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden; 5Haukeland University Hospital, Bergen, NorwayBackground and aim: Mortality rate is high in patients with chronic obstructive pulmonary disease (COPD. Our aim was to investigate long-term mortality and associated risk factors in COPD patients previously hospitalized for a COPD exacerbation.Methods: A total of 256 patients from the Nordic countries were followed for 8.7 ± 0.4 years after the index hospitalization in 2000–2001. Prior to discharge, the St George’s Respiratory Questionnaire was administered and data on therapy and comorbidities were obtained. Information on long-term mortality was obtained from national registries in each of the Nordic countries.Results: In total, 202 patients (79% died during the follow up period, whereas 54 (21% were still alive. Primary cause of death was respiratory (n = 116, cardiovascular (n = 43, malignancy (n = 28, other (n = 10, or unknown (n = 5. Mortality was related to older age, with a hazard risk ratio (HRR of 1.75 per 10 years, lower forced expiratory volume in 1 second (FEV1 (HRR 0.80, body mass index (BMI <20 kg/m2 (HRR 3.21, and diabetes (HRR 3.02. Older age, lower BMI, and diabetes were related to both respiratory and cardiovascular mortality. An association was also found between lower FEV1 and respiratory mortality, whereas mortality was not significantly associated with therapy, anxiety, or depression.Conclusion: Almost four out of five patients died within 9 years following an admission

  11. Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study.

    Science.gov (United States)

    Hansell, Anna; Ghosh, Rebecca E; Blangiardo, Marta; Perkins, Chloe; Vienneau, Danielle; Goffe, Kayoung; Briggs, David; Gulliver, John

    2016-04-01

    Long-term air pollution exposure contributes to mortality but there are few studies examining effects of very long-term (>25 years) exposures. This study investigated modelled air pollution concentrations at residence for 1971, 1981, 1991 (black smoke (BS) and SO2) and 2001 (PM10) in relation to mortality up to 2009 in 367,658 members of the longitudinal survey, a 1% sample of the English Census. Outcomes were all-cause (excluding accidents), cardiovascular (CV) and respiratory mortality. BS and SO2 exposures remained associated with mortality decades after exposure-BS exposure in 1971 was significantly associated with all-cause (OR 1.02 (95% CI 1.01 to 1.04)) and respiratory (OR 1.05 (95% CI 1.01 to 1.09)) mortality in 2002-2009 (ORs expressed per 10 μg/m(3)). Largest effect sizes were seen for more recent exposures and for respiratory disease. PM10 exposure in 2001 was associated with all outcomes in 2002-2009 with stronger associations for respiratory (OR 1.22 (95% CI 1.04 to 1.44)) than CV mortality (OR 1.12 (95% CI 1.01 to 1.25)). Adjusting PM10 for past BS and SO2 exposures in 1971, 1981 and 1991 reduced the all-cause OR to 1.16 (95% CI 1.07 to 1.26) while CV and respiratory associations lost significance, suggesting confounding by past air pollution exposure, but there was no evidence for effect modification. Limitations include limited information on confounding by smoking and exposure misclassification of historic exposures. This large national study suggests that air pollution exposure has long-term effects on mortality that persist decades after exposure, and that historic air pollution exposures influence current estimates of associations between air pollution and mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Prospective opportunities for using the innovative nuclear reactors in Armenian energy sector long-term programme development

    International Nuclear Information System (INIS)

    Gevorgyan, A.

    2003-01-01

    Full text: In the base of the long-term planning for the Armenian energy sector development there have been laid the principles of energy independence and energy security, and not only those of least-cost criteria. The concept of energy security for Armenia under the existing conditions can be formulated in the following way - the country should have guaranteed ability for the reliable energy supply for all requirements of society both under the sustainable development and in extreme conditions. Ensuring the energy security is the main task and responsibility of all the state institutions without exceptions. In order to ensure the country's energy security, it is necessary to guarantee its energy independence. It means that the country's energy sector should be minimum dependent on the imported fuels, that is, it should be achieved the maximum utilization of the domestic energy sources. Taking the above-mentioned principles as a basis, we have modeled the Armenian electric-energy sector long-term development taking into account the future needs to cover the electricity demand forecasted. Two options were considered: the energy sector development including the nuclear energy scenario, and the option without the nuclear way of electricity generation, called combined cycle scenario. Summarizing the experience of energy crisis, lasted in Armenia during 1992-1996, we can assert that, upon having 40% energy independence, the normal functioning of practically all the life-support systems of Armenia in wide range of emergency situations can be assured. And only restarting Unit 2 of the ANPP made it possible to stop that crisis evolution and enable the country to move toward the further economic development. Besides, the environmental aspects are also among the most important components of the energy security. The ecological factors were included into the study when modeling scenarios of long-term energy development. As it is known, while nuclear power plants do not produce

  13. Treatment failure after uterine artery embolization: Prospective cohort study with multifactorial analysis of possible predictors of long-term outcome

    International Nuclear Information System (INIS)

    Scheurig-Muenkler, Christian; Koesters, Clemens; Grieser, Christian; Hamm, Bernd; Kroencke, Thomas J.

    2012-01-01

    Purpose: To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome. Materials and methods: One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48–72 h after UAE (I: 100%, n = 60; II: 90–99%, n = 32; and III: 0–89%, n = 23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms. Results: Long-term follow-up was completed after a median of 7.2 years (range 5.1–9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (p < 0.001) of treatment failure than patients in group I, whereas groups I and II did not differ significantly (p = 0.578). For patients with bleeding-related symptoms only, CRA showed a 5.1-fold higher risk (p = 0.025) of treatment failure than for patients with equally dominant bleeding- and bulk-related symptoms. A 40.5-fold higher likelihood (p < 0.001) of treatment failure was observed for patients in group III with bleeding-related symptoms only compared to those in group I with combined bleeding- and bulk-related symptoms. Conclusion: Incomplete fibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization.

  14. CATCH: a randomised clinical trial comparing long-term tinzaparin versus warfarin for treatment of acute venous thromboembolism in cancer patients

    International Nuclear Information System (INIS)

    Lee, Agnes YY; Bauersachs, Rupert; Janas, Mette S; Jarner, Mikala F; Kamphuisen, Pieter W; Meyer, Guy; Khorana, Alok A

    2013-01-01

    Low-molecular-weight heparin (LMWH) is recommended and commonly used for extended treatment of cancer-associated thrombosis (CAT), but its superiority over warfarin has been demonstrated in only one randomised study. We report here the rationale, design and a priori analysis plans of Comparison of Acute Treatments in Cancer Haemostasis (CATCH; NCT01130025), a multinational, Phase III, open-label, randomised controlled trial comparing tinzaparin with warfarin for extended treatment of CAT. The primary objective is to assess the efficacy of tinzaparin in preventing recurrent venous thromboembolism (VTE) in patients with active cancer and acute, symptomatic proximal deep vein thrombosis and/or pulmonary embolism. The secondary objectives are to determine: safety of tinzaparin given over 6 months; clinical and laboratory markers for recurrent VTE and/or major bleeding; 6-month overall mortality; incidence and severity of post-thrombotic syndrome; patient-reported quality of life; and healthcare resource utilisation. Nine hundred patients are randomised to receive tinzaparin 175 IU/kg once daily for 6 months or initial tinzaparin 175 IU/kg once daily for 5–10 days and dose-adjusted warfarin (target INR 2.0–3.0) for 6 months. The primary composite outcome is time to recurrent VTE, including incidental VTE and fatal pulmonary embolism. All patients are followed up to 6 months or death, whichever comes sooner. Blinded adjudication will be performed for all reported VTE, bleeding events and causes of death. Efficacy will be analysed using centrally adjudicated results of all patients according to intention-to-treat analysis. An independent Data Safety Monitoring Board is reviewing data at regular intervals and an interim analysis is planned after 450 patients have completed the study. The results will add significantly to the knowledge of the efficacy, safety and cost effectiveness of tinzaparin in the prevention of recurrent VTE in patients with cancer and thrombosis

  15. ASSOCIATION OF OPERATING RISK OF LONG-TERM OBLIGATIONS OF MUNICIPALITIY OF SOPOT WITH EUROPEAN UNION BUDGET PROSPECTS FOR 2007-2013

    Directory of Open Access Journals (Sweden)

    Tomasz Jastrzębski

    2015-06-01

    Full Text Available Polish accession to the European Union allowed Polish municipalities to use co-financing of development projects of local infrastructure, environmental protection and improvement of competitiveness of municipalities. The process of transition is sometimes referred to as bridging the development gaps between countries of "old fifteen" and the new member countries. The desire of municipalities to maximize the use of EU funds led to a rapid increase in the debt level of municipalities and changes in levels of risk of long-term liabilities of municipalities. The aim of this article is to empirically confirm thesis that the change in the long-term financial liabilities associated with the prospect of the European Union budget for 2007-2013 is causing a variation of the operating risks of these liabilities. A tool used to verify this hypothesis is the risk model, which is a random vector with components identified with control variables of management process in the handling of long-term financial liabilities. The design of the components of this vector is based on the basic characteristics of the probability distribution of the vector as the ex-pected value and the variance and their ideal and anti-ideal levels.

  16. Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression.

    Science.gov (United States)

    Batterham, Philip J; Christensen, Helen; Mackinnon, Andrew J; Gosling, John A; Thorndike, Frances P; Ritterband, Lee M; Glozier, Nick; Griffiths, Kathleen M

    2017-09-01

    Insomnia treatment using an internet-based cognitive-behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown. To test the following: whether the efficacy of online CBT-I was sustained over 18 months; how rapidly the effects of CBT-I emerged; evidence for distinct trajectories of change in depressive symptoms; and predictors of these trajectories. A randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults ( N =1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community. Depression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for >18 months (between-group Cohen's d =0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement. Online CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained. P.J.B. has received grants from the National Health and Medical Research Council (NHMRC) during the conduct of the study. H.C. has received grants from the NHMRC and the Australian Research Council during the conduct of the study. L.M.R. receives research funding from the National Institutes of Health (NIH) that, in part, focuses on insomnia. F.P.T. and L.M.R. have equity ownership in BeHealth Solutions (Charlottesville, VA, USA), a company that develops and makes available products related to the research reported

  17. Surrogates of Long-Term Vitamin D Exposure and Ovarian Cancer Risk in Two Prospective Cohort Studies

    International Nuclear Information System (INIS)

    Prescott, Jennifer; Bertrand, Kimberly A.; Poole, Elizabeth M.; Rosner, Bernard A.; Tworoger, Shelley S.

    2013-01-01

    Experimental evidence and ecologic studies suggest a protective role of vitamin D in ovarian carcinogenesis. However, epidemiologic studies using individual level data have been inconsistent. We evaluated ultraviolet (UV)-B radiation, vitamin D intake, and predicted plasma 25-hydroxyvitamin D [25(OH)D] levels as long-term surrogates of vitamin D exposure within the Nurses’ Health Study (NHS) and NHSII. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CIs) for risk of overall ovarian cancer and by histologic subtype using Cox proportional hazards models. Between 1976 and 2010 in NHS and 1989 and 2011 in NHSII, we identified a total of 1,225 incident epithelial ovarian cancer cases (NHS: 970, NHSII: 255) over 4,628,648 person-years of follow-up. Cumulative average UV-B exposure was not associated with ovarian cancer risk in NHS (P trend = 0.08), but was associated with reduced risk in NHSII (highest vs. lowest category RR = 0.67; 95% CI: 0.50, 0.89; P trend < 0.01). When stratified by histologic subtype, UV-B flux was positively associated with risk of serous tumors in NHS (P trend < 0.01), but inversely associated in NHSII (P trend = 0.01). Adjusted for confounders, ovarian cancer risk was not associated with vitamin D intake from food or supplements or with predicted 25(OH)D levels. Our study does not strongly support a protective role for vitamin D in ovarian cancer risk

  18. Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study.

    Science.gov (United States)

    Weiss-Faratci, Netanela; Lurie, Ido; Benyamini, Yael; Cohen, Gali; Goldbourt, Uri; Gerber, Yariv

    2017-01-01

    To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI). A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism. The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (Poptimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  19. Surrogates of Long-Term Vitamin D Exposure and Ovarian Cancer Risk in Two Prospective Cohort Studies

    Directory of Open Access Journals (Sweden)

    Jennifer Prescott

    2013-11-01

    Full Text Available Experimental evidence and ecologic studies suggest a protective role of vitamin D in ovarian carcinogenesis. However, epidemiologic studies using individual level data have been inconsistent. We evaluated ultraviolet (UV-B radiation, vitamin D intake, and predicted plasma 25-hydroxyvitamin D [25(OHD] levels as long-term surrogates of vitamin D exposure within the Nurses’ Health Study (NHS and NHSII. We estimated incidence rate ratios (RRs and 95% confidence intervals (CIs for risk of overall ovarian cancer and by histologic subtype using Cox proportional hazards models. Between 1976 and 2010 in NHS and 1989 and 2011 in NHSII, we identified a total of 1,225 incident epithelial ovarian cancer cases (NHS: 970, NHSII: 255 over 4,628,648 person-years of follow-up. Cumulative average UV-B exposure was not associated with ovarian cancer risk in NHS (Ptrend = 0.08, but was associated with reduced risk in NHSII (highest vs. lowest category RR = 0.67; 95% CI: 0.50, 0.89; Ptrend < 0.01. When stratified by histologic subtype, UV-B flux was positively associated with risk of serous tumors in NHS (Ptrend < 0.01, but inversely associated in NHSII (Ptrend = 0.01. Adjusted for confounders, ovarian cancer risk was not associated with vitamin D intake from food or supplements or with predicted 25(OHD levels. Our study does not strongly support a protective role for vitamin D in ovarian cancer risk.

  20. Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

    Science.gov (United States)

    Hölscher, Birgit; Heitmeyer, Christine; Fobker, Manfred; Breithardt, Günter; Schaefer, Roland M; Reinecke, Holger

    2008-01-01

    BACKGROUND: Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes. OBJECTIVES: To prospectively assess predictors of CIN and long-term outcomes of affected patients. METHODS: Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus onetime hemodialysis or hydration plus N-acetylcysteine. RESULTS: Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96). CONCLUSION: From the present prospective trial, performance of post-procedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for

  1. Subjective and objective peer approval evaluations and self-esteem development: A test of reciprocal, prospective, and long-term effects.

    Science.gov (United States)

    Gruenenfelder-Steiger, Andrea E; Harris, Michelle A; Fend, Helmut A

    2016-10-01

    A large body of literature suggests a clear, concurrent association between peer approval and self-esteem in adolescence. However, little empirical work exists on either the prospective or reciprocal relation between peer approval and self-esteem during this age period. Moreover, it is unclear from past research whether both subjectively perceived peer approval and objectively measured peer approval are related to subsequent self-esteem over time (and vice versa) and whether these paths have long-term associations into adulthood. Using data from a large longitudinal study that covers a time span of 2 decades, we examined reciprocal, prospective relations between self-esteem and peer approval during ages 12-16 in addition to long-term relations between these variables and later social constructs at age 35. Cross-lagged regression analyses revealed small but persistent effect sizes from both types of peer approval to subsequent self-esteem in adolescence, controlling for prior self-esteem. However, effects in the reverse direction were not confirmed. These findings support the notion that peer relationships serve an important function for later self-esteem, consistent with many theoretical tenets of the importance of peers for building a strong identity. Finally, we found long-term relations between adult social constructs and adolescent objective and subjective peer approval as well as self-esteem. Therefore, not only do peer relationships play a role in self-esteem development across adolescence, but they remain impactful throughout adulthood. In sum, the current findings highlight the lasting, yet small link between peer relationships and self-esteem development and call for investigations of further influential factors for self-esteem over time. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. Critical decisions for older people with advanced dementia: a prospective study in long-term institutions and district home care

    NARCIS (Netherlands)

    Toscani, F.; Steen, J.T. van der; Finetti, S.; Giunco, F.; Pettenati, F.; Villani, D.; Monti, M.; Gentile, S.; Charrier, L.; Giulio, P. Di

    2015-01-01

    OBJECTIVE: To describe and compare the decisions critical for survival or quality of life [critical decisions (CDs)] made for patients with advanced dementia in nursing homes (NHs) and home care (HC) services. DESIGN: Prospective cohort study with a follow-up of 6 months. SETTING: Lombardy Region

  3. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... inpatient operating costs and capital-related costs for each discharge only following submission of a..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL... education program, blood clotting factors, anesthesia services furnished by hospital-employed nonphysician...

  4. A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers

    DEFF Research Database (Denmark)

    Andersen, Lars Louis; Mortensen, Ole Steen; Hansen, Jørgen Vinsløv

    2011-01-01

    Objective To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers. Method Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000, and fol......Objective To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers. Method Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000......, and followed in 2001-2002 in a national sickness absence register. Cox regression analysis was performed to assess the risk estimates of mutually adjusted severe pain in the neck/shoulder, low back, hand/wrist and knees for onset of LTSA, defined as receiving sickness absence compensation for at least 3...... consecutive weeks. Age, gender, body mass index, smoking and diagnosed disease were controlled for. Results In 2000 the prevalence among blue- and white-collar workers, respectively, of severe pain was 33% and 29% (neck/shoulder), 33% and 25% (low back), 16% and 11% (hand/wrists), and 16% and 12% (knees...

  5. A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers

    DEFF Research Database (Denmark)

    Andersen, Lars Louis; Mortensen, Ole Steen; Hansen, Jørgen Vinsløv

    2011-01-01

    Objective To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers. Method Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000, and fol......Objective To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers. Method Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000...... consecutive weeks. Age, gender, body mass index, smoking and diagnosed disease were controlled for. Results In 2000 the prevalence among blue- and white-collar workers, respectively, of severe pain was 33% and 29% (neck/shoulder), 33% and 25% (low back), 16% and 11% (hand/wrists), and 16% and 12% (knees......). During 2001-2002, the prevalence of LTSA among blue- and white-collar workers was 18% and 12%, respectively. Hand/wrist pain (HR 1.49, 95% CI 1.23 to 1.81) and low back pain (HR 1.30, 95% CI 1.11 to 1.53) were significant risk factors among the total cohort. Neck/shoulder pain was a significant risk...

  6. Surrogates of Long-Term Vitamin D Exposure and Ovarian Cancer Risk in Two Prospective Cohort Studies

    Energy Technology Data Exchange (ETDEWEB)

    Prescott, Jennifer, E-mail: jennifer.prescott@channing.harvard.edu; Bertrand, Kimberly A.; Poole, Elizabeth M.; Rosner, Bernard A.; Tworoger, Shelley S. [Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Ave. Boston, MA 02115 (United States)

    2013-11-22

    Experimental evidence and ecologic studies suggest a protective role of vitamin D in ovarian carcinogenesis. However, epidemiologic studies using individual level data have been inconsistent. We evaluated ultraviolet (UV)-B radiation, vitamin D intake, and predicted plasma 25-hydroxyvitamin D [25(OH)D] levels as long-term surrogates of vitamin D exposure within the Nurses’ Health Study (NHS) and NHSII. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CIs) for risk of overall ovarian cancer and by histologic subtype using Cox proportional hazards models. Between 1976 and 2010 in NHS and 1989 and 2011 in NHSII, we identified a total of 1,225 incident epithelial ovarian cancer cases (NHS: 970, NHSII: 255) over 4,628,648 person-years of follow-up. Cumulative average UV-B exposure was not associated with ovarian cancer risk in NHS (P{sub trend} = 0.08), but was associated with reduced risk in NHSII (highest vs. lowest category RR = 0.67; 95% CI: 0.50, 0.89; P{sub trend} < 0.01). When stratified by histologic subtype, UV-B flux was positively associated with risk of serous tumors in NHS (P{sub trend} < 0.01), but inversely associated in NHSII (P{sub trend} = 0.01). Adjusted for confounders, ovarian cancer risk was not associated with vitamin D intake from food or supplements or with predicted 25(OH)D levels. Our study does not strongly support a protective role for vitamin D in ovarian cancer risk.

  7. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review.

    Directory of Open Access Journals (Sweden)

    John Danesh

    2008-04-01

    Full Text Available The relevance to coronary heart disease (CHD of cytokines that govern inflammatory cascades, such as interleukin-6 (IL-6, may be underestimated because such mediators are short acting and prone to fluctuations. We evaluated associations of long-term circulating IL-6 levels with CHD risk (defined as nonfatal myocardial infarction [MI] or fatal CHD in two population-based cohorts, involving serial measurements to enable correction for within-person variability. We updated a systematic review to put the new findings in context.Measurements were made in samples obtained at baseline from 2,138 patients who had a first-ever nonfatal MI or died of CHD during follow-up, and from 4,267 controls in two cohorts comprising 24,230 participants. Correction for within-person variability was made using data from repeat measurements taken several years apart in several hundred participants. The year-to-year variability of IL-6 values within individuals was relatively high (regression dilution ratios of 0.41, 95% confidence interval [CI] 0.28-0.53, over 4 y, and 0.35, 95% CI 0.23-0.48, over 12 y. Ignoring this variability, we found an odds ratio for CHD, adjusted for several established risk factors, of 1.46 (95% CI 1.29-1.65 per 2 standard deviation (SD increase of baseline IL-6 values, similar to that for baseline C-reactive protein. After correction for within-person variability, the odds ratio for CHD was 2.14 (95% CI 1.45-3.15 with long-term average ("usual" IL-6, similar to those for some established risk factors. Increasing IL-6 levels were associated with progressively increasing CHD risk. An updated systematic review of electronic databases and other sources identified 15 relevant previous population-based prospective studies of IL-6 and clinical coronary outcomes (i.e., MI or coronary death. Including the two current studies, the 17 available prospective studies gave a combined odds ratio of 1.61 (95% CI 1.42-1.83 per 2 SD increase in baseline IL-6

  8. Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study.

    Science.gov (United States)

    Reeves, David; Hann, Mark; Rick, Jo; Rowe, Kelly; Small, Nicola; Burt, Jenni; Roland, Martin; Protheroe, Joanne; Blakeman, Tom; Richardson, Gerry; Kennedy, Anne; Bower, Peter

    2014-09-01

    In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits. To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care. A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning. Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling. The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time. The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning. © British Journal of General Practice 2014.

  9. Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report.

    Science.gov (United States)

    Wang, Chen-Chi; Chang, Ming-Hong; Jiang, Rong-San; Lai, Hsiu-Chin; De Virgilio, Armando; Wang, Ching-Ping; Wu, Shang-Heng; Liu, Shi-An; Liang, Kai-Li

    2015-03-01

    Unilateral vocal fold paralysis (UVFP) is a common voice disorder that may cause glottal closure insufficiency with hoarseness of voice. Laryngeal electromyography (LEMG)-guided hyaluronic acid vocal fold (VF) injection has been proposed as a treatment option to improve glottal closure with a satisfactory short-term effect. To our knowledge, this study reports the first long-term follow-up result of this treatment modality. To present the long-term treatment results of LEMG-guided hyaluronic acid VF injection for UVFP. Prospective study of the treatment results of 74 patients who received LEMG-guided hyaluronic acid VF injection for UVFP at a tertiary referral medical center from March 2010 to February 2013. In the office-based procedure, 1.0 mL of hyaluronic acid was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscles by LEMG guidance. Various glottal closure evaluations such as normalized glottal gap area, maximal phonation time, phonation quotient, mean airflow rate, perceptual GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and Voice Handicap Index were compared before and after injection using the nonparametric Wilcoxon signed rank test within 1 month, at 6 months, and at the last follow-up examination. Sixty patients had been followed up for at least 6 months. Forty-four patients received only 1 injection, and 16 patients received repeated injections (2 injections for 13 patients and 3 for 3 patients). All the glottal closure parameters improved significantly (P injection and 16 (22%) who received repeated injections did not require another treatment after long-term follow-up. Laryngeal electromyography-guided hyaluronic acid VF injection is an option for treating UVFP with satisfactory results.

  10. Long-term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study.

    Science.gov (United States)

    Jang, Jin-Young; Kang, Jae Seung; Han, Youngmin; Heo, Jin Seok; Choi, Seong Ho; Choi, Dong Wook; Park, Sang Jae; Han, Sung-Sik; Yoon, Dong Sup; Park, Joon Seong; Yu, Hee Chul; Kang, Koo Jeong; Kim, Sang Geol; Lee, Hongeun; Kwon, Wooil; Yoon, Yoo-Seok; Han, Ho-Seong; Kim, Sun-Whe

    2017-07-01

    Our previous randomized controlled trial revealed no difference in 2-year overall survival (OS) between extended and standard resection for pancreatic adenocarcinoma. The present study evaluated the 5-year OS and recurrence patterns according to the extent of pancreatectomy. Between 2006 and 2009, 169 consecutive patients were prospectively enrolled and randomized to standard (n = 83) or extended resection (n = 86) groups to compare 5-year OS rate, long-term recurrence patterns and factors associated with long-term survival. The surgical R0 rate was similar between the standard and extended groups (85.5 vs. 90.7%, P = 0.300). Five-year OS (18.4 vs. 14.4%, P = 0.388), 5-year disease-free survival (14.8 vs. 14.0%, P = 0.531), and overall recurrence rates (74.7 vs. 69.9%, P = 0.497) were not significantly different between the two groups, although the incidence of peritoneal seeding was higher in the extended group (25 vs. 8.1%, P = 0.014). Extended pancreatectomy does not have better short-term and long-term survival outcomes, and shows similar R0 rates and overall recurrence rates compared with standard pancreatectomy. Extended pancreatectomy does not have to be performed routinely for all cases of resectable pancreatic adenocarcinoma, especially considering its associated increased morbidity shown in our previous study. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  11. Long-term effects of cranial irradiation on endocrine function in children with brain tumors. A prospective study

    International Nuclear Information System (INIS)

    Duffner, P.K.; Cohen, M.E.; Voorhess, M.L.; MacGillivray, M.H.; Brecher, M.L.; Panahon, A.; Gilani, B.B.

    1985-01-01

    This study prospectively evaluated the endocrine function of 11 children treated with cranial irradiation (CRT) for brain tumors. All tumors were remote from the hypothalamic-pituitary axis. Children were studied before treatment and at 3, 6, and 12 months after the completion of CRT. T4, thyroid-stimulating hormone, prolactin, plasma cortisol, and urinary follicle-stimulating hormone and luteinizing hormone values were normal before and after treatment in all patients. Growth hormone (GH) deficiency was identified in 0 of 7 patients before treatment, in 2 of 7 patients 3 months post-CRT, in 9 of 11 patients 6 months post-CRT, and in 7 of 8 patients 12 months post-CRT. Growth deceleration was identified in five of seven prepubertal patients. GH deficiency is an extremely common sequelae of CRT, beginning as early as 3 months after the completion of CRT. The deficit is progressive over time

  12. Impact of long-term antihypertensive and antidiabetic medications on the prognosis of post-surgical colorectal cancer: the Fujian prospective investigation of cancer (FIESTA) study.

    Science.gov (United States)

    Peng, Feng; Hu, Dan; Lin, Xiandong; Liang, Binying; Chen, Ying; Zhang, Hejun; Xia, Yan; Lin, Jinxiu; Zheng, Xiongwei; Niu, Wenquan

    2018-05-24

    Hypertension and diabetes mellitus are common comorbidities of colorectal cancer. We designed a prospective cohort study aiming to investigate the impact of long-term antihypertensive and antidiabetic medications on colorectal cancer-specific survival and recurrence among 713 post-surgical patients. All participants received radical resection for colorectal cancer during 2000-08, and they were followed up until July 2017. Colorectal cancer patients without hypertension had better survival than those with hypertension (median survival time [MST]: 190.3 months versus 99.0 months, p colorectal cancer survival was statistically significant, that is, patients receiving antidiabetic medications had longer survival time than untreated diabetic patients (MST: 135.8 months versus 80.2 months, p : 0.007), whereas the prognosis was greatly improved in colorectal cancer patients without diabetes mellitus ( p colorectal cancer relative to those without medications, respectively. Our data indicate that long-term antidiabetic medications can significantly prolong the survival and improve the prognosis of post-surgical colorectal cancer.

  13. Prospective long-term follow up of children with anorectal malformation: growth and development until 5years of age.

    Science.gov (United States)

    van den Hondel, Desiree; Sloots, Cornelius E J; Gischler, Saskia J; Meeussen, Conny J H M; Wijnen, Rene M H; IJsselstijn, Hanneke

    2013-04-01

    To evaluate growth and development in children with anorectal malformations and to analyze effects of type of malformation and comorbidities. Non-syndromal children with anorectal malformations were prospectively evaluated at 0.5, 1, 2, and 5 years. Biometrics were obtained at all visits. Mental and psychomotor function development was determined. 108 children (59% male) were included. 49% had a high malformation, and 46% had ≥ 1 additional major comorbidity. All growth parameters were below the norm at all ages (pChildren with ≥ 1 additional major anomaly had lower height at all ages; at 5 years, mean (95% CI) height was -1.83 (-2.7 to -1.1) and -0.70 (-1.3 to -0.1) in children with and without comorbidities, respectively (p=0.019). Mental development was normal, irrespective of the type of malformation or comorbidities. Motor development was delayed at all ages. At 5 years, motor development (n=30) was normal in 70%, borderline in 23%, and 7% had definitive motor problems (p=0.043). Non-syndromal children with anorectal malformations are at risk for growth impairment, especially those with additional major comorbidity. Mental development is normal. Motor development is slightly impaired. Supportive care should focus on growth, dietary management, and motor development besides defecation problems. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study.

    Science.gov (United States)

    Carbucicchio, Corrado; Santamaria, Matteo; Trevisi, Nicola; Maccabelli, Giuseppe; Giraldi, Francesco; Fassini, Gaetano; Riva, Stefania; Moltrasio, Massimo; Cireddu, Manuela; Veglia, Fabrizio; Della Bella, Paolo

    2008-01-29

    Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis in survivors. Catheter ablation has been proposed for treating ES, but its long-term effect in a large population has never been verified. Ninety-five consecutive patients with coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 patients), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (13 patients) undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Short-term efficacy was defined by a complete protocol of programmed electric stimulation and by in-hospital outcome; long-term analysis addressed ES recurrence, cardiac mortality, and VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic and noncontact mapping in 48 and 22 patients, respectively, and percutaneous cardiopulmonary support in 10 patients. An epicardial approach was used in 10 patients. After 1 to 3 procedures, induction of any clinical VT(s) by programmed electrical stimulation was prevented in 85 patients (89%). ES was acutely suppressed in all patients; a minimum period of 7 days with stable rhythm was required before hospital discharge. At a median follow-up of 22 months (range, 1 to 43 months), 87 patients (92%) were free of ES and 63 patients (66%) were free of VT recurrence. Eight of 10 patients with persistent inducibility of clinical VT(s) had ES recurrence; 4 of them died suddenly despite appropriate implantable cardioverter-defibrillator intervention. All together, 11 of 95 patients (12%) died of cardiac-related reasons. In the group of patients presenting with all clinical VTs acutely abolished, no ES recurrence was documented, and cardiac mortality was significantly lower compared with the group of patients showing > or = 1 clinical VT still inducible after catheter ablation. Advanced strategies of catheter ablation

  15. Toward long-term all-sky time domain surveys-SINDICS: a prospective concept for a Seismic INDICes Survey of half a million red giants

    Directory of Open Access Journals (Sweden)

    Michel Eric

    2015-01-01

    Full Text Available CoRoT and Kepler have brought a new and deep experience in long-term photometric surveys and how to use them. This is true for exoplanets characterizing, stellar seismology and beyond for studying several other phenomena, like granulation or activity. Based on this experience, it has been possible to propose new generation projects, like TESS and PLATO, with more specific scientific objectives and more ambitious observational programs in terms of sky coverage and/or duration of the observations. In this context and as a prospective exercise, we explore here the possibility to set up an all-sky survey optimized for seismic indices measurement, providing masses, radii and evolution stages for half a million solar-type pulsators (subgiants and red giants, in our galactic neighborhood and allowing unprecedented stellar population studies.

  16. Low serum magnesium levels are associated with increased risk of fractures: a long-term prospective cohort study.

    Science.gov (United States)

    Kunutsor, Setor Kwadzo; Whitehouse, Michael Richard; Blom, Ashley William; Laukkanen, Jari Antero

    2017-07-01

    Magnesium, which is an essential trace element that plays a key role in several cellular processes, is a major component of bone; however, its relationship with risk of major bone fractures is uncertain. We aimed to investigate the association of baseline serum magnesium concentrations with risk of incident fractures. We analyzed data on 2245 men aged 42-61 years in the Kuopio Ischemic Heart Disease prospective cohort study, with the assessment of serum magnesium measurements and dietary intakes made at baseline. Hazard ratios [95% confidence intervals (CI)] for incident total (femoral, humeral, and forearm) and femoral fractures were assessed. During a median follow-up of 25.6 years, 123 total fractures were recorded. Serum magnesium was non-linearly associated with risk of total fractures. In age-adjusted Cox regression analysis, the hazard ratio (HR) (95% CIs) for total fractures in a comparison of the bottom quartile versus top quartile of magnesium concentrations was 2.10 (1.30-3.41), which persisted on adjustment for several established risk factors 1.99 (1.23-3.24). The association remained consistent on further adjustment for renal function, socioeconomic status, total energy intake, and several trace elements 1.80 (1.10-2.94). The corresponding adjusted HRs for femoral fractures were 2.56 (1.38-4.76), 2.43 (1.30-4.53) and 2.13 (1.13-3.99) respectively. There was no evidence of an association of dietary magnesium intake with risk of any fractures. In middle-aged Caucasian men, low serum magnesium is strongly and independently associated with an increased risk of fractures. Further research is needed to assess the potential relevance of serum magnesium in the prevention of fractures.

  17. Early crisis nontechnical skill teaching in residency leads to long-term skill retention and improved performance during crises: A prospective, nonrandomized controlled study.

    Science.gov (United States)

    Doumouras, Aristithes G; Engels, Paul T

    2017-07-01

    Medical error is common in crises, and the majority of observed errors are nontechnical in nature. The long-term impact of teaching crisis nontechnical skills to residents has not been evaluated. The objective of this study was to determine the effect of simulation-based teaching of crisis nontechnical skills compared to controls one year after initial teaching. This was a prospective study using both historical controls and a before-and-after methodology to evaluate the effect of a high-fidelity simulation curriculum that used crisis resource management principles to teach nontechnical skills. Postgraduate year 2 and 3 residents were invited to take part in a prospective training course over 2 years. The primary outcome was leader performance evaluated by expert raters using the previously validated 7-point Ottawa Global Rating Scale. Overall, 23 residents performed 30 simulations over the 2 years with the intervention group of 7 residents being assessed in both years. After adjustment, the postgraduate year 3 intervention group who received training the previous year had significantly higher overall performance scores than all postgraduate year 2 scores (1.09 95% confidence interval 0.70-1.47, P crisis performance compared to historical postgraduate year 3 controls and untrained postgraduate year 2 residents. There were no significant differences between the crisis performance of postgraduate year 2 residents and the untrained postgraduate year 3 controls. This confirms the beneficial effect and long-term retention after crisis nontechnical skill training. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study.

    Science.gov (United States)

    Hlodversdottir, Heidrun; Thorsteinsdottir, Harpa; Thordardottir, Edda Bjork; Njardvik, Urdur; Petursdottir, Gudrun; Hauksdottir, Arna

    2018-01-01

    Background : More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective : To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method : In a population-based prospective cohort study, data was collected on the adult population ( N  = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group ( N  = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results : In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions : Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

  19. Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials.

    Science.gov (United States)

    Anderson, Niall; Ozakinci, Gozde

    2018-03-27

    Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0-3 months), medium- (3-12 months), and long-term (≥ 12 months) study duration categories. All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.

  20. Long-term treatment with probiotics in primary care patients with irritable bowel syndrome--a randomised, double-blind, placebo controlled trial

    DEFF Research Database (Denmark)

    Begtrup, Luise Mølenberg; de Muckadell, Ove B Schaffalitzky; Kjeldsen, Jens

    2013-01-01

    OBJECTIVE. Meta-analyses have indicated effect of probiotics on irritable bowel syndrome (IBS). However, few long-term trials have been conducted and uncertainty remains as to effectiveness and long-term effect in a primary care setting. We aimed to investigate the effect of probiotics compared...... with placebo in the management of IBS in primary care during a 6-month treatment period and with a 6-month follow-up. MATERIAL AND METHODS. We randomized IBS patients fulfilling Rome III criteria to receive two capsules twice daily either containing placebo or a probiotic mixture of Lactobacillus paracasei ssp....../67) in the probiotic group versus 41% (26/64) in the placebo group, p = 0.18. Overall we found no difference between the groups in change in gastrointestinal symptoms after treatment. Patients improved in HrQOL, but with no statistically significant difference between the groups. CONCLUSION. During a 6-month treatment...

  1. Similar early migration when comparing CR and PS in Triathlon™ TKA: A prospective randomised RSA trial.

    Science.gov (United States)

    Molt, Mats; Toksvig-Larsen, Sören

    2014-10-01

    The objective of this study was to compare the early migration of the cruciate retaining and posterior stabilising versions of the recently introduced Triathlon™ total knee system, with a view to predicting long term fixation performance. Sixty patients were prospectively randomised to receive either Triathlon™ posterior stabilised cemented knee prosthesis or Triathlon™ cruciate retaining cemented knee prosthesis. Tibial component migration was measured by radiostereometric analysis postoperatively and at three months, one year and two years. Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score. There were no differences in rotation around the three coordinal axes or in the maximum total point motion (MTPM) during the two year follow-up. The posterior stabilised prosthesis had more posterior-anterior translation at three months and one year and more caudal-cranial translation at one year and two years. There were no differences in functional outcome between the groups. The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability. Level I. Article focus: This was a prospective randomised trial aiming to compare the single radius posterior stabilised (PS) Triathlon™ total knee arthroplasty (TKA) to the cruciate retaining Triathlon™ TKA system with regard to fixation. Strengths and limitations of this study: Strength of this study was that it is a randomised prospective trial using an objective measuring tool. The sample size of 25-30 patients was reportedly sufficient for the screening of implants using RSA [1]. ClinicalTrials.gov Identifier: NCT00436982. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study.

    Science.gov (United States)

    Storli, Kristian Eeg; Eide, Geir Egil

    2016-01-01

    Laparoscopic complete mesocolic excision (CME) used in the treatment of transverse colon cancer has been questioned on the basis of the technical challenges. The aim of this study was to evaluate the medium- and long-term clinical and survival outcomes after laparoscopic and open CME for transverse colon cancer and to compare the 2 approaches. This study was a retrospective non-randomized study of patients with prospectively registered data on open and laparoscopic CME for transverse colon cancer tumour-node-metastasis stages I-III operated on between 2007 and 2014. This was a single-centre study in a community teaching hospital. A total of 56 patients with transverse colon cancer were included, excluding those with tumours in the colonic flexures. The outcome aims were 4-year time to recurrence (TTR) and cancer-specific survival (CSS). Morbidity was also measured. The 4-year TTR was 93.9% in the laparoscopic group and 91.3% in the open group (p = 0.71). The 4-year CSS was 97.0% in the laparoscopic group and 91.3% in the open group (p = 0.42). This was a prospective single-institution study with a small sample size. Results of the study suggest that the laparoscopic CME approach might be the preferred approach for transverse colon cancer, especially regarding its benefits in terms of short-term morbidity, length of stay and oncological outcome. © 2016 S. Karger AG, Basel.

  3. Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study

    Science.gov (United States)

    Zhu, Pan; He, Ru-Qian; Bao, Yi-Xin; Zheng, Rong-Yuan; Xu, Hui-Qin

    2015-01-01

    Objective To evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs) for monotherapy of adult patients with focal epilepsy in routine clinical practice. Methods Adult patients with focal epilepsy, who were prescribed with carbamazepine (CBZ), valproate (VPA), lamotrigine (LTG), topiramate (TPM), or oxcarbazepine (OXC) as monotherapy, during the period from January 2004 to June 2012 registered in Wenzhou Epilepsy Follow Up Registry Database (WEFURD), were included in the study. Prospective long-term follow-up was conducted until June 2013. The endpoints were time to treatment failure, time to seizure remission, and time to first seizure. Results This study included 654 patients: CBZ (n=125), VPA (n=151), LTG (n=135), TPM (n=76), and OXC (n=167). The retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively. For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs. CBZ, hazard ratio, [HR] 0.80 [95% confidence interval: 0.67-0.96], LTG vs. VPA, 0.53 [0.37-0.74]); TPM was worse than LTG (TPM vs. LTG, 1.77 [1.15-2.74]), and OXC was better than VPA (0.86 [0.78-0.96]). After initial target doses, the seizure remission rates of CBZ, VPA, LTG, TPM, and OXC were 63.0%, 77.0%, 83.6%, 67.9%, and 75.3%, respectively. LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs. OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]). Conclusion LTG was the best, OXC was better than VPA only, while VPA was the worst. The others were equivalent for comparisons between five AEDs regarding the long-term treatment outcomes of monotherapy for adult patients with focal epilepsy in a clinical practice. For selecting AEDs for these patients among the first-line drugs, LTG is an appropriate first choice; others are reservation in the first-line but VPA is not. PMID:26147937

  4. Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Qing-Yi Zeng

    Full Text Available To evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs for monotherapy of adult patients with focal epilepsy in routine clinical practice.Adult patients with focal epilepsy, who were prescribed with carbamazepine (CBZ, valproate (VPA, lamotrigine (LTG, topiramate (TPM, or oxcarbazepine (OXC as monotherapy, during the period from January 2004 to June 2012 registered in Wenzhou Epilepsy Follow Up Registry Database (WEFURD, were included in the study. Prospective long-term follow-up was conducted until June 2013. The endpoints were time to treatment failure, time to seizure remission, and time to first seizure.This study included 654 patients: CBZ (n=125, VPA (n=151, LTG (n=135, TPM (n=76, and OXC (n=167. The retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively. For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs. CBZ, hazard ratio, [HR] 0.80 [95% confidence interval: 0.67-0.96], LTG vs. VPA, 0.53 [0.37-0.74]; TPM was worse than LTG (TPM vs. LTG, 1.77 [1.15-2.74], and OXC was better than VPA (0.86 [0.78-0.96]. After initial target doses, the seizure remission rates of CBZ, VPA, LTG, TPM, and OXC were 63.0%, 77.0%, 83.6%, 67.9%, and 75.3%, respectively. LTG was significantly better than CBZ (1.44 [1.15-1.82] and OXC (LTG vs. OXC, 0.76 [0.63-0.93]; OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40].LTG was the best, OXC was better than VPA only, while VPA was the worst. The others were equivalent for comparisons between five AEDs regarding the long-term treatment outcomes of monotherapy for adult patients with focal epilepsy in a clinical practice. For selecting AEDs for these patients among the first-line drugs, LTG is an appropriate first choice; others are reservation in the first-line but VPA is not.

  5. The PANGAEA study design - a prospective, multicenter, non-interventional, long-term study on fingolimod for the treatment of multiple sclerosis in daily practice.

    Science.gov (United States)

    Ziemssen, Tjalf; Kern, Raimar; Cornelissen, Christian

    2015-06-18

    Fingolimod (Gilenya) is an oral medication for patients with highly active relapsing-remitting Multiple Sclerosis (RRMS). Clinical trials and post-marketing experience on more than 114,000 patients have established a detailed safety profile. Total patient exposure now exceeds 195,000 patient-years as stated in the last financial report (Dec 2014) of the Novartis Pharma AG, Basel, Switzerland. However, less is known about the safety of long-term fingolimod use in daily practice. Here, we describe the study design of PANGAEA (Post-Authorization Non-interventional German sAfety of GilEnyA in RRMS patients), a prospective, multicenter, non-interventional, long-term study to collect safety, efficacy, and pharmacoeconomic data on RRMS patients treated with fingolimod (0.5 mg/daily) under real-world conditions in Germany. PANGAEA is striving to assess a real-world safety and efficacy profile of fingolimod, based on data from 4,000 RRMS patients, obtained during a 60-month observational phase. A pharmacoeconomic sub-study of 800 RRMS patients further collects patient-reported outcome measures of disability, quality of life, compliance, treatment satisfaction, and usage of resources during a 24-month observational phase. Descriptive statistical analyses of the safety set as well as of stratified subgroups such as patients with concomitant diabetes mellitus and pretreated patients (e.g., natalizumab) will be conducted. PANGAEA seeks to confirm the current safety profile of fingolimod obtained in phase I-III clinical trials. The study design presented here will additionally provide guidance on the therapeutic use of fingolimod in clinical practice and possibly assists physicians in making evidence-based decisions.

  6. Short- and long-term changes in perceived work ability after interdisciplinary rehabilitation of chronic musculoskeletal disorders: prospective cohort study among 854 rehabilitants.

    Science.gov (United States)

    Saltychev, Mikhail; Laimi, Katri; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

    2014-06-01

    To investigate the changes in rehabilitants' perceived work ability after rehabilitation for chronic musculoskeletal disorders with respect to the baseline characteristics. Prospective cohort study based on register and repeated survey data. Public sector employees in ten towns and five hospital districts. A total of 854 employees who participated in the rehabilitation programme owing to common chronic musculoskeletal disorders between 1997 and 2009. Interdisciplinary, biopsychosocial, inpatient rehabilitation programme targeting people of working age with common chronic musculoskeletal disorders. The programme was executed in different rehabilitation centres across the country and funded by the Social Insurance Institution of Finland. Differences in perceived work ability level before and after rehabilitation. Data were derived from repeated surveys on average 2.1 years before rehabilitation, and 1.5 years (short-term follow-up) and 6.0 years (long-term follow-up) after rehabilitation. Before the rehabilitation, perceived work ability was 7.13 (SD 1.84) among the rehabilitants and 7.27 (SD 1.72) in the matched reference population. Among rehabilitants, this figure decreased by 0.82 (95% confidence interval -0.98 to -0.67) in the short-term and by 1.26 (95% confidence interval -1.45 to -1.07) in the long-term follow-up. Only slight differences in steepness of this deterioration were observed between subgroups, created based on the participants' baseline characteristics. Perceived work ability of participants, in an interdisciplinary biopsychosocial rehabilitation programme for common musculoskeletal disorders, deteriorated regardless of any studied pretreatment characteristics. The improvement of work ability may be an unrealistic goal for participants in this type of rehabilitation. © The Author(s) 2014.

  7. Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience

    International Nuclear Information System (INIS)

    Zhao, Jun-Gong; Li, Yong-Dong; Li, Ming-Hua; Shang, Ke-Zhong; Cheng, Ying-Sheng; Chen, Ni-Wei; Chen, Wei-Xiong

    2009-01-01

    To prospectively evaluate the long-term clinical safety and efficacy of a newly designed self-expanding metallic stent (SEMS) in the treatment of patients with achalasia. Seventy-five patients with achalasia were treated with a temporary SEMS with a 30-mm diameter. The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4-5 days after stent placement. Follow-up data focused on dysphagia score, technique and clinical success, clinical remissions and failures, and complications and was performed at 6 months, 1 year, and within 3 to 5 years, 5 to 8 years, 8 to 10 years, and >10 years postoperatively. Stent placement was technically successful in all patients. Complications included stent migration (n=4, 5.33%), chest pain (n=28, 38.7%), reflux (n=15, 20%), and bleeding (n=9, 12%). No perforation or 30-day mortality occurred. Clinical success was achieved in all patients 1 month after stent removal. The overall remission rates at 6 months, 1, 1-3, 3-5, 5-8, 8-10, and >10 year follow-up periods were 100%, 96%, 93.9%, 90.9%, 100%, 100%, and 83.3%, respectively. Stent treatment failed in six patients, and the overall remission rate in our series was 92%. The median and mean primary patencies were 2.8 ± 0.28 years (95% CI: 2.25-3.35) and 4.28 ± 0.40 years (95% CI: 3.51-5.05), respectively. The use of temporary SEMSs with 30-mm diameter proved to be a safe and effective approach for managing achalasia with a long-term satisfactory clinical remission rate. (orig.)

  8. Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Jun-Gong; Li, Yong-Dong; Li, Ming-Hua; Shang, Ke-Zhong [Shanghai Tong Ji University, Department of Radiology, Tenth Affiliated People' s Hospital, Shanghai (China); Cheng, Ying-Sheng [Shanghai Tong Ji University, Department of Radiology, Tenth Affiliated People' s Hospital, Shanghai (China); Shanghai Jiao Tong University, Department of Radiology, Sixth Affiliated People' s Hospital, Shanghai (China); Chen, Ni-Wei; Chen, Wei-Xiong [Shanghai Jiao Tong University, Department of Gastroenterology, Sixth Affiliated People' s Hospital, Shanghai (China)

    2009-08-15

    To prospectively evaluate the long-term clinical safety and efficacy of a newly designed self-expanding metallic stent (SEMS) in the treatment of patients with achalasia. Seventy-five patients with achalasia were treated with a temporary SEMS with a 30-mm diameter. The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4-5 days after stent placement. Follow-up data focused on dysphagia score, technique and clinical success, clinical remissions and failures, and complications and was performed at 6 months, 1 year, and within 3 to 5 years, 5 to 8 years, 8 to 10 years, and >10 years postoperatively. Stent placement was technically successful in all patients. Complications included stent migration (n=4, 5.33%), chest pain (n=28, 38.7%), reflux (n=15, 20%), and bleeding (n=9, 12%). No perforation or 30-day mortality occurred. Clinical success was achieved in all patients 1 month after stent removal. The overall remission rates at 6 months, 1, 1-3, 3-5, 5-8, 8-10, and >10 year follow-up periods were 100%, 96%, 93.9%, 90.9%, 100%, 100%, and 83.3%, respectively. Stent treatment failed in six patients, and the overall remission rate in our series was 92%. The median and mean primary patencies were 2.8 {+-} 0.28 years (95% CI: 2.25-3.35) and 4.28 {+-} 0.40 years (95% CI: 3.51-5.05), respectively. The use of temporary SEMSs with 30-mm diameter proved to be a safe and effective approach for managing achalasia with a long-term satisfactory clinical remission rate. (orig.)

  9. Peptic ulcer bleeding patients with Rockall scores ≥6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study.

    Science.gov (United States)

    Yang, Er-Hsiang; Cheng, Hsiu-Chi; Wu, Chung-Tai; Chen, Wei-Ying; Lin, Meng-Ying; Sheu, Bor-Shyang

    2018-01-01

    Patients with high Rockall scores have increased risk of rebleeding and mortality within 30 days after peptic ulcer bleeding, but long-term outcomes deserve follow-up after cessation of proton pump inhibitors. The paper aimed to validate whether patients with high Rockall scores have more recurrent ulcer bleeding in a 3.5-year longitudinal cohort. Between August 2011 and July 2014, 368 patients with peptic ulcer bleeding were prospectively enrolled after endoscopic hemostasis to receive proton pump inhibitors for at least 8 to 16 weeks. These subjects were categorized into either a Rockall scores ≥6 group (n = 257) or a Rockall scores ulcer bleeding. The proportion of patients with rebleeding during the 3.5-year follow-up was higher in patients with Rockall scores ≥6 than in those with scores ulcer (P = 0.04) were three additional independent factors found to increase rebleeding risk. The cumulative rebleeding rate was higher in patients with Rockall scores ≥6 with more than or equal to any two additional factors than in those with fewer than two additional factors (15.69 vs. 7.63 per 100 person-year, P = 0.012, log-rank test). Patients with Rockall scores ≥6 are at risk of long-term recurrent peptic ulcer bleeding. The risk can be independently increased by the presence of activated partial thromboplastin time prolonged ≥1.5-fold, American Society of Anesthesiologists class ≥III, and gastric ulcer in patients with Rockall scores ≥6. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  10. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

    Science.gov (United States)

    Kraaijenga, Sophie A C; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M

    2015-11-01

    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

  11. Long pulsed Nd: YAG laser with inbuilt cool sapphire tip for long term hair reduction on type- IV and V skin: A prospective analysis of 200 patients

    Directory of Open Access Journals (Sweden)

    Nanda Soni

    2010-01-01

    Full Text Available Background: Laser hair reduction has become a very popular means to get rid of unwanted hair. Aims: We conducted the current study to evaluate the safety and efficacy of Nd: YAG laser on dark skin. We also evaluated the effect of increasing the gap between sessions on the long term efficacy of hair reduction achieved with long pulsed Nd: YAG laser. Methods: A prospective study was conducted on 200 consecutive female patients who underwent laser hair reduction for unwanted hair over the face, at Kaya skin clinic Delhi, with long pulsed Nd: YAG laser, from May 2006 to May 2009. The gap between sessions was increased from 2 nd session itself. Results were evaluated 6 months after 6 sessions. Also a note was made of worsening of hair growth or any side effects experienced the patient during any of the sessions. Results: A total of 200 female patients (160 skin type IV and 40 skin type V were followed up. Of these, 64 enrolled for lower face, 88 for chin or upper neck and 48 for upper lip. 6 months after 6 sessions, more than 50% improvement was seen in 68.7% of lower face, 89.69% cases of chin and 59% of upper lip cases. None of the patients had any worsening. Conclusions: The current study shows that long pulsed Nd: YAG is a very safe and effective means of hair reduction in skin types IV and V. Adequate fluences and increasing the gap between sessions from the 2 nd session could be the key to achieving long term hair reduction with Nd: YAG laser. Adequate cooling and proper shaving are the key factors determining the safety.

  12. The influence of speed abilities and technical skills in early adolescence on adult success in soccer: A long-term prospective analysis using ANOVA and SEM approaches

    Science.gov (United States)

    2017-01-01

    Several talent development programs in youth soccer have implemented motor diagnostics measuring performance factors. However, the predictive value of such tests for adult success is a controversial topic in talent research. This prospective cohort study evaluated the long-term predictive value of 1) motor tests and 2) players’ speed abilities (SA) and technical skills (TS) in early adolescence. The sample consisted of 14,178 U12 players from the German talent development program. Five tests (sprint, agility, dribbling, ball control, shooting) were conducted and players’ height, weight as well as relative age were assessed at nationwide diagnostics between 2004 and 2006. In the 2014/15 season, the players were then categorized as professional (n = 89), semi-professional (n = 913), or non-professional players (n = 13,176), indicating their adult performance level (APL). The motor tests’ prognostic relevance was determined using ANOVAs. Players’ future success was predicted by a logistic regression threshold model. This structural equation model comprised a measurement model with the motor tests and two correlated latent factors, SA and TS, with simultaneous consideration for the manifest covariates height, weight and relative age. Each motor predictor and anthropometric characteristic discriminated significantly between the APL (p < .001; η2 ≤ .02). The threshold model significantly predicted the APL (R2 = 24.8%), and in early adolescence the factor TS (p < .001) seems to have a stronger effect on adult performance than SA (p < .05). Both approaches (ANOVA, SEM) verified the diagnostics’ predictive validity over a long-term period (≈ 9 years). However, because of the limited effect sizes, the motor tests’ prognostic relevance remains ambiguous. A challenge for future research lies in the integration of different (e.g., person-oriented or multilevel) multivariate approaches that expand beyond the “traditional” topic of single tests’ predictive

  13. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial

    DEFF Research Database (Denmark)

    Burn, John; Gerdes, Anne-Marie; Macrae, Finlay

    2011-01-01

    Observational studies report reduced colorectal cancer in regular aspirin consumers. Randomised controlled trials have shown reduced risk of adenomas but none have employed prevention of colorectal cancer as a primary endpoint. The CAPP2 trial aimed to investigate the antineoplastic effects of as...

  14. Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial

    NARCIS (Netherlands)

    C.R. van Wetering (Carel); M. Hoogendoorn (Martine); S.J.M. Mol; M.P.M.H. Rutten-van Mölken (Maureen); A.M.W.J. Schols (Annemie)

    2010-01-01

    textabstractBACKGROUND: The effectiveness of pulmonary rehabilitation in advanced COPD is well established, but few data are available in less advanced disease. METHODS: In a 2 year randomised controlled trial, 199 patients with an average moderate airflow obstruction but impaired exercise capacity

  15. Long-term prospective longitudinal evaluation of emotional distress and quality of life in cervical cancer patients who remained disease-free 2-years from diagnosis.

    Science.gov (United States)

    Mantegna, Giovanna; Petrillo, Marco; Fuoco, Gilda; Venditti, Laura; Terzano, Serena; Anchora, Luigi Pedone; Scambia, Giovanni; Ferrandina, Gabriella

    2013-03-18

    A long-term prospective assessment of QoL in cervical cancer patients is still lacking. Here, we provide the first 2-years prospective, longitudinal study evaluating emotional distress and QoL in early stage (ECC) and locally advanced (LACC) cervical cancer patients who remained disease-free 2-years from diagnosis. The questionnaires: Hospital Anxiety and Depression Scale (HADS), Global Health Status items of EORTC QLQ-C30 (GHS), and EORTC QLQ-CX24 (CX24) have been administered by a dedicated team of psycho-oncologists, administered at baseline, and after 3, 6, 12 and 24 months from surgery The Generalized Linear Model for repeated measure was used to analyze modifications of QoL measures over time. In both groups, an early reduction of the percentage of patients with anxiety levels ≥11 was observed at the 3-month evaluation (ECC: 25.7% at baseline Vs 14.7% after 3 months, p value=0.001; LACC: 22.2% at baseline Vs 15.4% after 3 months, p value=0.001). Despite this favorable trend, after 2 years from diagnosis, 11.9% of ECC and 15.6% of LACC patients still showed an anxiety score ≥11. No significant changes over time were observed in term of Depression levels. Focusing on QoL issues, mean GHS and Sexual Activity scores showed an improvement over time in both groups compared to baseline (GHS: 5.7% difference for ECC, p value=0.001, and 11.0% in LACC, p value=0.001; SXA: 13.9% difference for ECC, p value=0.001; and 6.1% in LACC, p value=0.008). On the other hand, Body Image mean scores were significantly impaired by chemoradiation administration in LACC patients, without long-term recovery (7.5% difference, p value=0.001). Finally, in both groups, lymphedema (LY) and menopausal symptoms (MS) showed an early worsening which persisted 2-year after surgery (LY: 19.5% difference for ECC, p value=0.014, and 27.3% in LACC, p value=0.001; MS: 14.4% difference for ECC, p value=0.004, and 16.0% in LACC, p value=0.002). Despite a significant improvement over time, elevated

  16. Efficacy of short-term versus long-term chest tube drainage following talc slurry pleurodesis in patients with malignant pleural effusions: a randomised trial.

    Science.gov (United States)

    Goodman, Anna; Davies, Christopher W H

    2006-10-01

    Talc pleurodesis is commonly used in the palliative treatment of malignant pleural effusions but the shortest and most effective regime has not been determined. In particular, it is not clear when the intercostal drain should be removed following the insertion of sclerosant. We conducted a single-centre, randomised, open trial of drain removal at 24 h versus 72 h following talc slurry pleurodesis. The primary outcome measure was success of pleurodesis (no recurrence of effusion on chest radiograph at 1-month follow-up) and secondary outcome measures included length of hospital stay and mortality. We found no difference between recurrence of pleural effusion in those randomised to drain removal at 24 h and those randomised to drain removal at 72 h (p>0.5). However, length of stay was significantly reduced when the chest drain was removed at 24 h (4 days versus 8 days; p<0.01). Mortality did not differ between the two groups. We conclude that this shorter pleurodesis regime is safe and effective.

  17. Long-term weight loss observed with olanzapine orally disintegrating tablets in overweight patients with chronic schizophrenia. A 1 year open-label, prospective trial.

    Science.gov (United States)

    Chawla, Bharat; Luxton-Andrew, Heather

    2008-04-01

    To investigate the long-term weight loss outcomes during usual clinical practice after switching from olanzapine standard oral tablet (SOT) to olanzapine orally disintegrating tablets (ODT). In this open-label prospective study, 26 patients with schizophrenia who were clinically stable on olanzapine SOT treatment were switched to olanzapine ODT. All other aspects of treatment remained constant. Weight was recorded at 3, 6, and 12 months. Patients incurred an average weight loss of 2.7 +/- 0.7 kg (p = 0.001) after switching patients from olanzapine SOT to olanzapine ODT at 12 months. Peak weight loss was observed at 6 months; however, significant weight loss was achieved as early as 3 months. The majority (81.9%) of patients lost weight, while 18.1% had no weight change or weight gain. Body mass index (BMI) significantly decreased by 1.0 +/- 0.3 kg/m(2) (p = 0.001). Interestingly, patients treated with higher doses of olanzapine (> or = 20 mg) incurred a greater weight loss of their body weight (5.6%), compared to those treated with lower doses (< 20 mg), who lost 1.9% of their body weight (p = 0.04). This study demonstrated that, in usual clinical practice, switching patients from olanzapine SOT to olanzapine ODT treatment resulted in significant weight loss that was maintained over 12 months. 2008 John Wiley & Sons, Ltd.

  18. Risk of malignant arrhythmias in initially symptomatic patients with Wolff-Parkinson-White syndrome: results of a prospective long-term electrophysiological follow-up study.

    Science.gov (United States)

    Pappone, Carlo; Vicedomini, Gabriele; Manguso, Francesco; Baldi, Mario; Pappone, Alessia; Petretta, Andrea; Vitale, Raffaele; Saviano, Massimo; Ciaccio, Cristiano; Giannelli, Luigi; Calovic, Zarko; Tavazzi, Luigi; Santinelli, Vincenzo

    2012-02-07

    The available amount of detailed long-term data in patients with Wolff-Parkinson-White syndrome is limited, and no prospective electrophysiological studies looking at predictors of malignant arrhythmia are available. Among 8575 symptomatic Wolff-Parkinson-White patients with atrioventricular reentrant tachycardia referred for electrophysiological test, 369 (mean age, 23±12.5 years) declined catheter ablation and were followed up. The primary end point of the study was to evaluate over a 5-year follow-up the predictors and characteristics of patients who develop malignant arrhythmias. After a mean follow-up of 42.1±10 months, malignant arrhythmias developed in 29 patients (mean age, 13.9±5.6 years; 26 male), resulting in presyncope/syncope (25 patients), hemodynamic collapse (3 patients), or cardiac arrest caused by ventricular fibrillation (1 patient). Of the remaining 340 patients, 168 (mean age, 34.2±9.0 years) remained asymptomatic up to 5 years, and 172 (mean age, 13.6±5.1 years) had benign recurrence, including sustained atrioventricular reentrant tachycardia (132 patients) or atrial fibrillation (40 patients). Compared with the group with no malignant arrhythmias, the group with malignant arrhythmias showed shorter accessory-pathway effective refractory period (PWolff-Parkinson-White syndrome generally have a good outcome, and predictors of malignant arrhythmias are similar to those reported for asymptomatic patients with ventricular pre-excitation.

  19. Building-level analyses to prospectively detect influenza outbreaks in long-term care facilities: New York City, 2013-2014.

    Science.gov (United States)

    Levin-Rector, Alison; Nivin, Beth; Yeung, Alice; Fine, Annie D; Greene, Sharon K

    2015-08-01

    Timely outbreak detection is necessary to successfully control influenza in long-term care facilities (LTCFs) and other institutions. To supplement nosocomial outbreak reports, calls from infection control staff, and active laboratory surveillance, the New York City (NYC) Department of Health and Mental Hygiene implemented an automated building-level analysis to proactively identify LTCFs with laboratory-confirmed influenza activity. Geocoded addresses of LTCFs in NYC were compared with geocoded residential addresses for all case-patients with laboratory-confirmed influenza reported through passive surveillance. An automated daily analysis used the geocoded building identification number, approximate text matching, and key-word searches to identify influenza in residents of LTCFs for review and follow-up by surveillance coordinators. Our aim was to determine whether the building analysis improved prospective outbreak detection during the 2013-2014 influenza season. Of 119 outbreaks identified in LTCFs, 109 (92%) were ever detected by the building analysis, and 55 (46%) were first detected by the building analysis. Of the 5,953 LTCF staff and residents who received antiviral prophylaxis during the 2013-2014 season, 929 (16%) were at LTCFs where outbreaks were initially detected by the building analysis. A novel building-level analysis improved influenza outbreak identification in LTCFs in NYC, prompting timely infection control measures. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Perceived organizational justice as a predictor of long-term sickness absence due to diagnosed mental disorders: results from the prospective longitudinal Finnish Public Sector Study.

    Science.gov (United States)

    Elovainio, Marko; Linna, Anne; Virtanen, Marianna; Oksanen, Tuula; Kivimäki, Mika; Pentti, Jaana; Vahtera, Jussi

    2013-08-01

    Organizational justice perceptions have been suggested to be associated with symptoms of mental health but the nature of the association is unknown due to reporting bias (measurement error related to response style and reversed causality). In this study, we used prospective design and long-term (>9 days) sickness absence with psychiatric diagnosis as the outcome measure. Participants were 21,221 Finnish public sector employees (the participation rate at baseline in 2000-2002 68%), who responded to repeated surveys of procedural and interactional justice in 2000-2004 along with register data on sickness absence with a diagnosis of depression or anxiety disorders (822 cases). Results from logistic regression analyses showed that a one-unit increase in self-reported and work-unit level co-worker assessed interactional justice was associated with a 25-32% lower odds of sickness absence due to anxiety disorders. These associations were robust to adjustments for a variety of potential individual-level confounders including chronic disease (adjusted OR for self-reported interactional justice 0.77, 95% CI 0.65-0.91) and were replicated using co-worker assessed justice. Only weak evidence of reversed causality was found. The results suggest that low organizational justice is a risk factor for sickness absence due to anxiety disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. [Primary prevention of cardiovascular diseases: long term results of five year long preventive intervention in 12-year old boys (ten year prospective study)].

    Science.gov (United States)

    Rozanov, V B; Aleksandov, A A; Shugaeva, E N; Perova, N V; Maslennikova, G Ia; Smirnova, S G; Olfer'ev, A M

    2007-01-01

    In a longitudinal cohort (prevention group, n=213, comparison group, n=163) of 10-year prospective follow-up we addressed efficacy of 5-year-long multifactor preventive intervention, conducted in a sample of population of 12 year old boys. Preventive intervention was carried out both at populational level and among persons with risk factors of development of cardiovascular diseases with the use of group, individual, and partly family approaches, and was directed at rationalization of nutrition, elevation of physical activity and prevention of harmful habits. During first 3 years of prevention we succeeded to achieve stable statistically significant lowering of mean levels of total cholesterol, low density lipoprotein cholesterol, triglycerides, and atherogeneity index, as well as to affect fatty component of body mass (skinfold thickness). Long term effect of 5-year long preventive intervention manifested as significantly lower level of systolic blood pressure, lower prevalence of low levels of high density lipoprotein cholesterol, smaller increment of low density lipoprotein cholesterol and index of atherogeneity in the prevention group. These results evidence that prevention of main factors of risk of development of cardiovascular diseases (obesity, arterial hypertension, disorders of lipid composition of the blood, and low physical activity) in child and adolescent age in the period of active growth and development is feasible, effective, safe and is able to lead to decrease of levels of these factors in adults, but should last uninterruptedly until formation of stable habits of healthy life style.

  2. Long-term collections

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  3. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia.

    Science.gov (United States)

    Wang, Doris D; Raygor, Kunal P; Cage, Tene A; Ward, Mariann M; Westcott, Sarah; Barbaro, Nicholas M; Chang, Edward F

    2018-01-01

    OBJECTIVE Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD), stereotactic radiosurgery (SRS), and radiofrequency ablation (RFA). Although the efficacy of each procedure has been described, few studies have directly compared these treatment modalities on pain control for TN. Using a large prospective longitudinal database, the authors aimed to 1) directly compare long-term pain control rates for first-time surgical treatments for idiopathic TN, and 2) identify predictors of pain control. METHODS The authors reviewed a prospectively collected database for all patients who underwent treatment for TN between 1997 and 2014 at the University of California, San Francisco. Standardized collection of data on preoperative clinical characteristics, surgical procedure, and postoperative outcomes was performed. Data analyses were limited to those patients who received a first-time procedure for treatment of idiopathic TN with > 1 year of follow-up. RESULTS Of 764 surgical procedures performed at the University of California, San Francisco, for TN (364 SRS, 316 MVD, and 84 RFA), 340 patients underwent first-time treatment for idiopathic TN (164 MVD, 168 SRS, and 8 RFA) and had > 1 year of follow-up. The analysis was restricted to patients who underwent MVD or SRS. Patients who received MVD were younger than those who underwent SRS (median age 63 vs 72 years, respectively; p 5 years of follow-up (60 of 164 and 64 of 168 patients, respectively). Immediate or short-term (making depends upon many factors. This information can help physicians counsel patients with idiopathic TN on treatment selection.

  4. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

    NARCIS (Netherlands)

    den Heijer, M.; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.E.; Tibben, A.

    2012-01-01

    Purpose: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. Methods:

  5. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.

    NARCIS (Netherlands)

    Heijer, M. den; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.; Tibben, A.

    2012-01-01

    PURPOSE: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. METHODS:

  6. Limited effect of thoracoscopic splanchnicectomy in the treatment of severe chronic pancreatitis pain: a prospective long-term analysis of 75 cases.

    NARCIS (Netherlands)

    Buscher, H.C.J.L.; Schipper, E.; Wilder-Smith, O.H.G.; Jansen, J.B.M.J.; Goor, H. van

    2008-01-01

    BACKGROUND: Bilateral thoracoscopic splanchnicectomy is a minimally invasive method of treating pain in patients with chronic pancreatitis. It offers good, short-term pain relief, but long-term success is difficult to predict. We analyze long-term results and identify factors predicting success of

  7. A Prospective Trial of Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer: Long-term Outcomes Compared With Standard Image Guided IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Schild, Michael H. [Midwestern University, Glendale, Arizona (United States); Schild, Steven E., E-mail: sschild@mayo.edu [Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona (United States); Wong, William W.; Vora, Sujay A.; Keole, Sameer R.; Vargas, Carlos E.; Daniels, Thomas B.; Ezzell, Gary A. [Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona (United States); Nguyen, Ba D.; Roarke, Michael C. [Department of Radiology, Mayo Clinic, Scottsdale, Arizona (United States)

    2017-04-01

    Purpose: This report describes the long-term outcomes of a prospective trial of intensity modulated radiation therapy (IMRT), integrating a {sup 111}In capromab pendetide (ProstaScint) scan-directed simultaneous integrated boost (SIB) for localized prostate cancer. Methods and Materials: Seventy-one patients with T1N0M0 to T4N0M0 prostate cancer were enrolled, and their ProstaScint and pelvic computed tomography scans were coregistered for treatment planning. The entire prostate received 75.6 Gy in 42 fractions with IMRT, whereas regions of increased uptake on ProstaScint scans received 82 Gy as an SIB. Patients with intermediate- and high-risk disease also received 6 months and 12 months of adjuvant hormonal therapy, respectively. Results: The study enrolled 31 low-, 30 intermediate-, and 10 high-risk patients. The median follow-up was 120 months (range, 24-150 months). The 10-year biochemical control rates were 85% for the entire cohort and 84%, 84%, and 90% for patients with low-, intermediate-, and high-risk disease, respectively. The 10-year survival rate of the entire cohort was 69%. Pretreatment prostate-specific antigen level >10 ng/mL and boost volume of >10% of the prostate volume were significantly associated with poorer biochemical control and survival. The outcomes were compared with those of a cohort of 302 patients treated similarly but without the SIB and followed up for a median of 91 months (range, 6-138 months). The 5- and 10-year biochemical control rates were 86% and 61%, respectively, in patients without the SIB compared with 94% and 85%, respectively, in patients in this trial who received the SIB (P=.02). The cohort that received an SIB did not have increased toxicity. Conclusions: The described IMRT strategy, integrating multiple imaging modalities to administer 75.6 Gy to the entire prostate with a boost dose of 82 Gy, was feasible. The addition of the SIB was associated with greater biochemical control but not toxicity. Modern

  8. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation.

    Science.gov (United States)

    Elcin, Gonca; Yalici-Armagan, Basak

    2017-12-01

    The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75-100 spot/cm 2 density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.

  9. Long-term results of heart valve replacement with the Edwards Duromedics bileaflet prosthesis: a prospective ten-year clinical follow-up.

    Science.gov (United States)

    Podesser, B K; Khuenl-Brady, G; Eigenbauer, E; Roedler, S; Schmiedberger, A; Wolner, E; Moritz, A

    1998-05-01

    The Edwards Duromedics valve (Baxter Healthcare Corp., Edwards Division, Santa Ana, Calif.) was designed with a self-irrigating hinge mechanism to reduce thromboembolic complications. After good initial clinical results, distribution was suspended in 1988 after reports of valve fracture after 20,000 valves had been implanted. The manufacturer conducted extensive studies to improve the Edwards Duromedics and reintroduced a modified version, which is available as Edwards Tekna. The purpose of the study was the evaluation of long-term results of the original Edwards Duromedics that might be important for the current version, the Edwards Tekna valve. A prospective clinical 10-year follow-up was performed of 508 patients who underwent valve replacement with the Edwards Duromedics valve in the aortic (n = 268), mitral (n = 183), and aortic and mitral (n = 56) position. The perioperative mortality rate was 6.9%; follow-up was 98% complete, comprising 3648 patient-years for a mean follow-up of 86 months (range: 33 to 144 months). The actuarial freedom from complications at the 10-year follow-up and the incidence rate (percent per patient-year) were as follows: late mortality rate, 69.2% +/- 2.4% (3.5% per patient-year); thromboembolism, 90.7% +/- 1.6% (0.96% per patient-year); anticoagulation-related hemorrhage, 87.7% +/- 1.7% (1.34% per patient-year); prosthetic valve endocarditis, 96.7% +/- 0.09% (0.38% per patient-year); valve-related mortality rate, 89.3% +/- 1.6% (1.21% per patient-year); valve failure, 86.2% +/- 1.85% (1.54% per patient-year); and valve-related morbidity and mortality rate, 71.1% +/- 2.3% (3.2% per patient-year). Three leaflet escapes were observed (one lethal, two successful reoperations; 99.1% +/- 0.05% freedom, 0.08% per patient-year). All patients functionally improved (86% in New York Heart Association classes I and II), and incidence of anemia was insignificant. These results confirm that the Edwards Duromedics valve shows excellent performance

  10. The roles of herbal remedies in survival and quality of life among long-term breast cancer survivors - results of a prospective study

    Directory of Open Access Journals (Sweden)

    Sullivan-Halley Jane

    2011-06-01

    Full Text Available Abstract Background Few data exist on survival or health-related quality of life (QOL related to herbal remedy use among long-term breast cancer survivors. The objective of this report is to examine whether herbal remedy use is associated with survival or the health-related QOL of these long-term breast cancer survivors. Methods In 1999-2000, we collected the information of herbal remedy use and QOL during a telephone interview with 371 Los Angeles Non-Hispanic/Hispanic white women who had survived more than 10 years after breast cancer diagnosis. QOL was measured using the Medical Outcomes Study Short Form-36 (SF-36 questionnaire. Patients were followed for mortality from the baseline interview through 2007. 299 surviving patients completed a second telephone interview on QOL in 2002-2004. We used multivariable Cox proportional hazards methods to estimate relative risks (RR and 95% confidence intervals (CI for mortality and applied multivariable linear regression models to compare average SF-36 change scores (follow-up - baseline between herbal remedy users and non-users. Results Fifty-nine percent of participants were herbal remedy users at baseline. The most commonly used herbal remedies were echinacea, herbal teas, and ginko biloba. Herbal remedy use was associated with non-statistically significant increases in the risks for all-cause (44 deaths, RR = 1.28, 95% CI = 0.62-2.64 and breast cancer (33 deaths, RR = 1.78, 95% CI = 0.72-4.40 mortality. Both herbal remedy users' and non-users' mental component summary scores on the SF-36 increased similarly from the first survey to the second survey (P = 0.16, but herbal remedy users' physical component summary scores decreased more than those of non-users (-5.7 vs. -3.2, P = 0.02. Conclusions Our data provide some evidence that herbal remedy use is associated with poorer survival and a poorer physical component score for health-related QOL among women who have survived breast cancer for at least

  11. Genetic testing for BRCA1: effects of a randomised study of knowledge provision on interest in testing and long term test uptake; implications for the NICE guidelines.

    Science.gov (United States)

    Hall, Julia; Gray, Susan; A'Hern, Roger; Shanley, Susan; Watson, Maggie; Kash, Kathryn; Croyle, Robert; Eeles, Rosalind

    2009-01-01

    Interest in searching for mutations in BRCA1 and BRCA2 is high. Knowledge regarding these genes and the advantages and limitations of genetic testing is limited. It is unknown whether increasing knowledge about breast cancer genetic testing alters interest in testing. Three hundred and seventy nine women (260 with a family history of breast cancer; 119 with breast cancer) from The Royal Marsden NHS Foundation Trust were randomised to receive or not receive written educational information on cancer genetics. A questionnaire was completed assessing interest in BRCA1 testing and knowledge on breast cancer genetics and screening. Actual uptake of BRCA1 testing is reported with a six year follow-up. Eighty nine percent of women at risk of breast cancer and 76% of women with breast cancer were interested in BRCA1 testing (P testing, the families of 66% of the at risk group and 13% of the women with breast cancer would be eligible for testing (probability of BRCA1 mutation >or=20%). Within six years of randomisation, genetic testing was actually undertaken on 12 women, only 10 of whom would now be eligible, on the NICE guidelines. There is strong interest in BRCA1 testing. Despite considerable ignorance of factors affecting the inheritance of breast cancer, education neither reduced nor increased interest to undergo testing. The NICE guidelines successfully triage those with a high breast cancer risk to be managed in cancer genetics clinics.

  12. Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial

    NARCIS (Netherlands)

    E.J. Kuipers (Ernst); N. Havu; A. Walan; M. Lamm; G.F. Nelis; E.C. Klinkenberg-Knol; P. Snel; D. Goldfain; J.J. Kolkman (Jeroen); H.P. Festen; J. Dent; P. Zeitoun

    2004-01-01

    textabstractBACKGROUND: Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective

  13. Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Fowler, David; French, Paul; Banerjee, Robin; Barton, Garry; Berry, Clio; Byrne, Rory; Clarke, Timothy; Fraser, Rick; Gee, Brioney; Greenwood, Kathryn; Notley, Caitlin; Parker, Sophie; Shepstone, Lee; Wilson, Jon; Yung, Alison R; Hodgekins, Joanne

    2017-07-11

    Young people who have social disability associated with severe and complex mental health problems are an important group in need of early intervention. Their problems often date back to childhood and become chronic at an early age. Without intervention, the long-term prognosis is often poor and the economic costs very large. There is a major gap in the provision of evidence-based interventions for this group, and therefore new approaches to detection and intervention are needed. This trial provides a definitive evaluation of a new approach to early intervention with young people with social disability and severe and complex mental health problems using social recovery therapy (SRT) over a period of 9 months to improve mental health and social recovery outcomes. This is a pragmatic, multi-centre, single blind, superiority randomised controlled trial. It is conducted in three sites in the UK: Sussex, Manchester and East Anglia. Participants are aged 16 to 25 and have both persistent and severe social disability (defined as engaged in less than 30 hours per week of structured activity) and severe and complex mental health problems. The target sample size is 270 participants, providing 135 participants in each trial arm. Participants are randomised 1:1 using a web-based randomisation system and allocated to either SRT plus optimised treatment as usual (enhanced standard care) or enhanced standard care alone. The primary outcome is time use, namely hours spent in structured activity per week at 15 months post-randomisation. Secondary outcomes assess typical mental health problems of the group, including subthreshold psychotic symptoms, negative symptoms, depression and anxiety. Time use, secondary outcomes and health economic measures are assessed at 9, 15 and 24 months post-randomisation. This definitive trial will be the first to evaluate a novel psychological treatment for social disability and mental health problems in young people presenting with social

  14. Short and long-term effects of irbesartan on intradialytic central haemodynamics: A randomised double-blind placebo-controlled one-year intervention trial (the SAFIR study)

    DEFF Research Database (Denmark)

    Peters, Christian Daugaard; Kjærgaard, Krista Dybtved; Jensen, Jens Dam

    2014-01-01

    ), stroke volume (SV), central blood volume (CBV), total peripheral resistance (TPR), mean arterial BP (MAP), and heart rate (HR) were measured within the first (HDSTART) and last (HDEND) 30 minutes during HD using the Transonic saline dilution technique. Results Eighty-two patients were randomised (placebo....../ARB: 41/41). Predialytic systolic BP decreased significantly, but similarly in both groups during the study period. The total number of IDH episodes was (placebo/ARB) 22/25 (P=0.7). Mean HDSTART and mean HDEND CO, SV, TPR, HR, and MAP were stable and similar in the two groups, whereas CBV increased...... equally and significantly over time. The mean intradialytic haemodynamic response showed decreased CO, SV, MAP, and CBV, whereas HR increased from HDSTART to HDEND. TPR did not change significantly. Overall, this pattern remained stable over time in both groups and there was no significant impact of ARB...

  15. Long-term safety of unopposed estrogen used by women surviving myocardial infarction: 14-year follow-up of the ESPRIT randomised controlled trial.

    Science.gov (United States)

    Cherry, N; McNamee, R; Heagerty, A; Kitchener, H; Hannaford, P

    2014-05-01

    To compare health outcomes during 14-year observational follow-up in women initially randomised to unopposed estrogen or placebo. At recruitment to the Estrogen for the Prevention of Re-Infarction Trial (ESPRIT) women were assigned to estradiol valerate: 2 mg or placebo treatment for 2 years. Women were recruited from 35 hospitals in the northwest of England and Wales in July 1996-February 2000. Women aged 50-69 surviving their first myocardial infarction. All women were followed by data linkage to UK mortality and cancer records; mean follow-up 14.1 and 12.6 years, respectively. In an intention-to-treat analysis, hazard ratios (HRs) were computed, overall and stratified by age at recruitment. Death (all-cause, cardiac disease, stroke or cancer) and cancer incidence (any, breast or endometrium). There were 418 deaths in 1017 women randomised. The all-cause mortality HR of 1.07 (95% CI 0.88-1.29) indicated no significant difference between treatment groups. Women aged 50-59 years at recruitment had lower HRs than women aged 60-69 years for all outcomes except ischaemic heart disease. Among 149 incident cancers there were seven cases of breast cancer in the intervention arm and 15 in the placebo; HR 0.47 (95% CI 0.19-1.15). There were no deaths from endometrial cancer but three incident cases, one in the active arm and two in placebo. These results suggest that unopposed estrogen may be used safely by women with an intact uterus surviving a first myocardial infarction. © 2014 Royal College of Obstetricians and Gynaecologists.

  16. Long-term follow-up of HIV-1-infected adults who received the F4/AS01B HIV-1 vaccine candidate in two randomised controlled trials.

    Science.gov (United States)

    Harrer, Thomas; Dinges, Warren; Roman, François

    2018-05-03

    This Phase I/II, open, long-term follow-up study was conducted in antiretroviral therapy (ART)-naïve (N = 212) and ART-treated (N = 19) human immunodeficiency virus 1 (HIV-1)-infected adults, who received an HIV-1 investigational vaccine (F4/AS01 B ) or placebo in two previous studies (NCT00814762 and NCT01218113). After a minimum of two years and a maximum of four years of follow-up post-vaccination per patient, no significant differences were observed between F4/AS01 B and placebo groups in terms of viral load, CD4 + T-cell count and incidence of specific clinical events. Vaccine-induced polyfunctional CD4 + T-cells persisted up to study end and no relevant vaccine-related safety events were reported in F4/AS01 B groups. This study has been registered at ClinicalTrials.gov (NCT01092611). Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Long-term clinical and prosthetic outcomes of soft liner and clip attachments for bar/implant overdentures: a randomised controlled clinical trial.

    Science.gov (United States)

    ELsyad, M A; Shaheen, N H; Ashmawy, T M

    2017-06-01

    Long-term clinical and prosthetic outcomes of soft liner attachments for bar/implant overdentures were not sufficiently investigated. The aim of this trial was to evaluate clinical and prosthetic outcomes of resilient liner and clip attachments for bar/implant-retained mandibular overdenture after 7 years. Thirty edentulous male participants received two implants in the canine areas of the mandible. Three months later, implants were splinted with a resilient bar. Mandibular overdentures were connected to the bars with either clip (CR group, n = 15) or resilient liner (RR group, n = 15) attachments. Plaque index (PI), gingival index (GI), probing depth (PD), vertical bone loss (VBL), horizontal bone loss (HBLO) and prosthetic complications (PCs) were evaluated at denture delivery (T0), 6 (T 6m ), 12 (T1), 24 (T2), 36 (T3), 48 (T4), 60 (T5), 72 (T6) and 84 (T7) months after insertion. PI and GI increased significantly with time for CR and decreased significantly for RR (P overdentures than clip attachments in terms of peri-implant tissue health and prosthetic complications after 7 years. © 2017 John Wiley & Sons Ltd.

  18. Nuclear Energy, Long Term Requirements

    International Nuclear Information System (INIS)

    Knapp, V.

    2006-01-01

    There are serious warnings about depletion of oil and gas and even more serious warnings about dangers of climate change caused by emission of carbon dioxide. Should developed countries be called to replace CO2 emitting energy sources as soon as possible, and the time available may not be longer then few decades, can nuclear energy answer the call and what are the requirements? Assuming optimistic contribution of renewable energy sources, can nuclear energy expand to several times present level in order to replace large part of fossil fuels use? Paper considers intermediate and long-term requirements. Future of nuclear power depends on satisfactory answers on several questions. First group of questions are those important for near and intermediate future. They deal with economics and safety of nuclear power stations in the first place. On the same time scale a generally accepted concept for radioactive waste disposal is also required. All these issues are in the focus of present research and development. Safer and more economical reactors are targets of international efforts in Generation IV and INPRO projects, but aiming further ahead these innovative projects are also addressing issues such as waste reduction and proliferation resistance. However, even assuming successful technical development of these projects, and there is no reason to doubt it, long term and large-scale nuclear power use is thereby not yet secured. If nuclear power is to play an essential role in the long-term future energy production and in reduction of CO2 emission, than several additional questions must be replied. These questions will deal with long-term nuclear fuel sufficiency, with necessary contribution of nuclear power in sectors of transport and industrial processes and with nuclear proliferation safety. This last issue is more political then technical, thus sometimes neglected by nuclear engineers, yet it will have essential role for the long-term prospects of nuclear power. The

  19. 18F-FDG PET in small-cell cervical cancer: a prospective study with long-term follow-up

    International Nuclear Information System (INIS)

    Chen, Min-Yu; Chou, Hung-Hsueh; Chen, Chao-Yu; Lai, Chyong-Huey; Chang, Ting-Chang; Liu, Feng-Yuan; Yen, Tzu-Chen; Lin, Gigin; Yang, Lan-Yan; Pan, Yu-Bin; Jung, Shih-Ming; Wu, Ren-Chin; Huang, Yi-Ting; Tsai, Jason Chien-Sheng

    2016-01-01

    Small-cell cervical cancer (SCCC) is rare and prone to metastasize. We conducted a prospective study to evaluate the role of 18 F-FDG PET in the management of this aggressive malignancy. Patients with untreated primary, histologically confirmed SCCC were enrolled. 18 F-FDG PET (or PET/CT) was performed immediately after MRI or CT, for primary staging, monitoring response to treatment or restaging when there was suspicion of recurrence. The clinical impact of PET was determined on a scan basis. A total of 25 patients were recruited and 43 PET scans were performed. The PET images were obtained for primary staging (25 patients), monitoring response (10 patients) and restaging when there was suspicion of recurrence (8 patients). The median follow-up time in event-free patients was 109.3 months (range 97.5 - 157.7 months). A positive impact of PET was found in 8 (18.6 %) of the 43 scans, which included detection of additional regions of distal lymph node (LN) metastasis (one primary staging scan, two restaging scans), bone metastasis (two primary staging scans, one monitoring response scan), and exclusion of false-positive lesions on MRI (one primary staging scan, one restaging scan). On the other hand, one negative impact was recorded as one false-positive lesion on a restaging PET scan. One positive impact was noted for monitoring response (bone metastasis). The impact of three scans was indeterminate. The positive impact of down-staging in avoiding overtreatment but finding additional distal LN (except one on restaging) or bone metastases had no beneficial effect on long-term survival. The results of this preliminary study suggest that PET is useful in the management of SCCC. PET could have more value in detecting occult metastases if future novel therapies are able to offer better control of extensive SCCC. (orig.)

  20. Mode of Delivery and Long-Term Health-Related Quality-of-Life Outcomes: A Prospective Population-Based Study.

    Science.gov (United States)

    Petrou, Stavros; Kim, Sung Wook; McParland, Penny; Boyle, Elaine M

    2017-06-01

    Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics. The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32 +0 and 36 +6 weeks' gestation and a sample of term-born controls. Perinatal data were extracted from the mothers' maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes. The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (-0.026; p = 0.038) and among mothers of term-born infants (-0.062; p quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery. © 2016 Wiley Periodicals, Inc.

  1. Long-Term Coffee Consumption and Risk of Cardiovascular Disease: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies

    Science.gov (United States)

    Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B

    2013-01-01

    Background Considerable controversy exists regarding the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk. Methods and Results Pubmed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1,279,804 participants and 36,352 CVD cases. A non-linear relationship of coffee consumption with CVD risk was identified (P for heterogeneity = 0.09, P for trend coffee consumption (median: 0 cups/d), the relative risk of CVD was 0.95 (95% CI, 0.87 to 1.03) for the highest (median: 5 cups/d) category, 0.85 (0.80 to 0.90) for the second highest (median: 3.5 cups/d), and 0.89 (0.84 to 0.94) for the third highest category (median: 1.5 cups/d). Looking at separate outcomes, coffee consumption was non-linearly associated with both CHD (P for heterogeneity = 0.001, P for trend 0.05). Conclusions A non-linear association between coffee consumption with CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups/d, and heavy coffee consumption was not associated with elevated CVD risk. PMID:24201300

  2. Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies.

    Science.gov (United States)

    Wang, Tiange; Heianza, Yoriko; Sun, Dianjianyi; Huang, Tao; Ma, Wenjie; Rimm, Eric B; Manson, JoAnn E; Hu, Frank B; Willett, Walter C; Qi, Lu

    2018-01-10

    To investigate whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight. Prospective cohort study. Health professionals in the United States. 8828 women from the Nurses' Health Study and 5218 men from the Health Professionals Follow-up Study. Genetic predisposition score was calculated on the basis of 77 variants associated with body mass index. Dietary patterns were assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (AMED). Five repeated measurements of four year changes in body mass index and body weight over follow-up (1986 to 2006). During a 20 year follow-up, genetic association with change in body mass index was significantly attenuated with increasing adherence to the AHEI-2010 in the Nurses' Health Study (P=0.001 for interaction) and Health Professionals Follow-up Study (P=0.005 for interaction). In the combined cohorts, four year changes in body mass index per 10 risk allele increment were 0.07 (SE 0.02) among participants with decreased AHEI-2010 score and -0.01 (0.02) among those with increased AHEI-2010 score, corresponding to 0.16 (0.05) kg versus -0.02 (0.05) kg weight change every four years (Pdietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. {sup 18}F-FDG PET in small-cell cervical cancer: a prospective study with long-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Min-Yu; Chou, Hung-Hsueh; Chen, Chao-Yu; Lai, Chyong-Huey; Chang, Ting-Chang [Chang Gung Memorial Hospital and Chang Gung University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China); Liu, Feng-Yuan; Yen, Tzu-Chen [Chang Gung Memorial Hospital and Chang Gung University, Department of Nuclear Medicine, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China); Lin, Gigin [Chang Gung Memorial Hospital and Chang Gung University, Department of Medical Imaging and Intervention, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China); Yang, Lan-Yan [Chang Gung Memorial Hospital and Chang Gung University, Biostatistics Unit, Clinical Trial Center, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China); Pan, Yu-Bin [Chang Gung Memorial Hospital and Chang Gung University, Biostatistics Unit, Clinical Trial Center, Taoyuan (China); Jung, Shih-Ming; Wu, Ren-Chin [Chang Gung Memorial Hospital and Chang Gung University, Department of Pathology, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China); Huang, Yi-Ting; Tsai, Jason Chien-Sheng [Chang Gung Memorial Hospital and Chang Gung University, Department of Radiation Oncology, Taoyuan (China); Chang Gung Memorial Hospital, Gynecologic Cancer Research Center, Taoyuan (China)

    2016-04-15

    Small-cell cervical cancer (SCCC) is rare and prone to metastasize. We conducted a prospective study to evaluate the role of {sup 18}F-FDG PET in the management of this aggressive malignancy. Patients with untreated primary, histologically confirmed SCCC were enrolled. {sup 18}F-FDG PET (or PET/CT) was performed immediately after MRI or CT, for primary staging, monitoring response to treatment or restaging when there was suspicion of recurrence. The clinical impact of PET was determined on a scan basis. A total of 25 patients were recruited and 43 PET scans were performed. The PET images were obtained for primary staging (25 patients), monitoring response (10 patients) and restaging when there was suspicion of recurrence (8 patients). The median follow-up time in event-free patients was 109.3 months (range 97.5 - 157.7 months). A positive impact of PET was found in 8 (18.6 %) of the 43 scans, which included detection of additional regions of distal lymph node (LN) metastasis (one primary staging scan, two restaging scans), bone metastasis (two primary staging scans, one monitoring response scan), and exclusion of false-positive lesions on MRI (one primary staging scan, one restaging scan). On the other hand, one negative impact was recorded as one false-positive lesion on a restaging PET scan. One positive impact was noted for monitoring response (bone metastasis). The impact of three scans was indeterminate. The positive impact of down-staging in avoiding overtreatment but finding additional distal LN (except one on restaging) or bone metastases had no beneficial effect on long-term survival. The results of this preliminary study suggest that PET is useful in the management of SCCC. PET could have more value in detecting occult metastases if future novel therapies are able to offer better control of extensive SCCC. (orig.)

  4. Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies

    Science.gov (United States)

    Wang, Tiange; Heianza, Yoriko; Sun, Dianjianyi; Huang, Tao; Ma, Wenjie; Rimm, Eric B; Manson, JoAnn E; Hu, Frank B; Willett, Walter C

    2018-01-01

    Abstract Objective To investigate whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight. Design Prospective cohort study. Setting Health professionals in the United States. Participants 8828 women from the Nurses’ Health Study and 5218 men from the Health Professionals Follow-up Study. Exposure Genetic predisposition score was calculated on the basis of 77 variants associated with body mass index. Dietary patterns were assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (AMED). Main outcome measures Five repeated measurements of four year changes in body mass index and body weight over follow-up (1986 to 2006). Results During a 20 year follow-up, genetic association with change in body mass index was significantly attenuated with increasing adherence to the AHEI-2010 in the Nurses’ Health Study (P=0.001 for interaction) and Health Professionals Follow-up Study (P=0.005 for interaction). In the combined cohorts, four year changes in body mass index per 10 risk allele increment were 0.07 (SE 0.02) among participants with decreased AHEI-2010 score and −0.01 (0.02) among those with increased AHEI-2010 score, corresponding to 0.16 (0.05) kg versus −0.02 (0.05) kg weight change every four years (Pdietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity. PMID:29321156

  5. Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies.

    Science.gov (United States)

    Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B

    2014-02-11

    Considerable controversy exists on the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk. PubMed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1 279 804 participants and 36 352 CVD cases. A nonlinear relationship of coffee consumption with CVD risk was identified (P for heterogeneity=0.09, P for trend coffee consumption (median, 0 cups per day), the relative risk of CVD was 0.95 (95% confidence interval, 0.87-1.03) for the highest category (median, 5 cups per day) category, 0.85 (95% confidence interval, 0.80-0.90) for the second highest category (median, 3.5 cups per day), and 0.89 (95% confidence interval, 0.84-0.94) for the third highest category (median, 1.5 cups per day). Looking at separate outcomes, coffee consumption was nonlinearly associated with both coronary heart disease (P for heterogeneity=0.001, P for trend 0.05) risks. A nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

  6. Tamsulosin reduces nighttime urine production in benign prostatic hyperplasia patients with nocturnal polyuria: a prospective open-label long-term study using frequency-volume chart.

    Science.gov (United States)

    Kojima, Yoshiyuki; Sasaki, Shoichi; Imura, Makoto; Kubota, Yasue; Hayashi, Yutaro; Kohri, Kenjiro

    2012-01-01

    The effects of tamsulosin treatment on changes in frequency-volume chart (FVC) data, especially nighttime urine production, over time were assessed, and the mechanisms underlying the improvement of nocturia in benign prostatic hyperplasia (BPH) patients with nocturnal polyuria (NP) are discussed. A total of 104 patients with lower urinary tract symptoms secondary to BPH were enrolled. After enrollment in the study, the patients were treated with tamsulosin (0.2 mg) once daily. Visits were scheduled every 4 weeks until week 12 (month 3) after study entry, and then every 12 weeks subsequently. All patients completed the International Prostate Symptom Score (IPSS), quality of life (QOL) index, and 3-day FVC, and underwent uroflowmetry at enrollment and on each visit. Eighty-two patients (mean age: 70.9 ± 7.1 years) were analyzed for 24 months after treatment. Patients were divided into two groups, NP and nonNP, based on FVC outcome. The IPSS, QOL index, and maximum flow rate improved during the 24-month period after treatment in both groups. Mean daytime urine volume significantly increased in the NP group, but no changes were detected in the nonNP group. Mean nighttime urine frequency significantly decreased in the NP group over a 24-month period, and was associated with a significant decrease in nighttime urine volume that was not found in the nonNP group. Maximum voided volume increased most months after treatment in both groups. The present long-term prospective study using FVC demonstrated that tamsulosin reduced nighttime urine production in BPH patients with NP. Copyright © 2011 Wiley Periodicals, Inc.

  7. Association of Long-Term Exposure to Transportation Noise and Traffic-Related Air Pollution with the Incidence of Diabetes: A Prospective Cohort Study.

    Science.gov (United States)

    Clark, Charlotte; Sbihi, Hind; Tamburic, Lillian; Brauer, Michael; Frank, Lawrence D; Davies, Hugh W

    2017-08-31

    Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability. Because diabetes prevalence is increasing and may be on the causal pathway between noise and cardiovascular disease, we examined the influence of long-term residential transportation noise exposure and traffic-related air pollution on the incidence of diabetes using a population-based cohort in British Columbia, Canada. We examined the influence of transportation noise exposure over a 5-y period (1994-1998) on incident diabetes cases in a population-based prospective cohort study (n=380,738) of metropolitan Vancouver (BC) residents who were 45-85 y old, with 4-y of follow-up (1999-2002). Annual average transportation noise (Lden), air pollution [black carbon, particulate matter with aerodynamic diameter Transportation noise was associated with the incidence of diabetes [interquartile range (IQR) increase, 6.8 A-weighted decibels (dBA); OR=1.08 (95% CI: 1.05, 1.10)]. This association remained after adjustment for environmental coexposures including traffic-related air pollutants, greenness, and neighborhood walkability. After adjustment for coexposure to noise, traffic-related air pollutants were not associated with the incidence of diabetes, whereas greenness was protective. We found a positive association between residential transportation noise and diabetes, adding to the growing body of evidence that noise pollution exposure may be independently linked to metabolic health and should be considered when developing public health interventions. https://doi.org/10.1289/EHP1279.

  8. The (cost-effectiveness of an individually tailored long-term worksite health promotion programme on physical activity and nutrition: design of a pragmatic cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Burdorf Alex

    2007-09-01

    Full Text Available Abstract Background Cardiovascular disease is the leading cause of disability and mortality in most Western countries. The prevalence of several risk factors, most notably low physical activity and poor nutrition, is very high. Therefore, lifestyle behaviour changes are of great importance. The worksite offers an efficient structure to reach large groups and to make use of a natural social network. This study investigates a worksite health promotion programme with individually tailored advice in physical activity and nutrition and individual counselling to increase compliance with lifestyle recommendations and sustainability of a healthy lifestyle. Methods/Design The study is a pragmatic cluster randomised controlled trial with the worksite as the unit of randomisation. All workers will receive a standard worksite health promotion program. Additionally, the intervention group will receive access to an individual Health Portal consisting of four critical features: a computer-tailored advice, a monitoring function, a personal coach, and opportunities to contact professionals at request. Participants are employees working for companies in the Netherlands, being literate enough to read and understand simple Internet-based messages in the Dutch language. A questionnaire to assess primary outcomes (compliance with national recommendations on physical activity and on fruit and vegetable intake will take place at baseline and after 12 and 24 months. This questionnaire also assesses secondary outcomes including fat intake, self-efficacy and self-perceived barriers on physical activity and fruit and vegetable intake. Other secondary outcomes, including a cardiovascular risk profile and physical fitness, will be measured at baseline and after 24 months. Apart from the effect evaluation, a process evaluation will be carried out to gain insight into participation and adherence to the worksite health promotion programme. A cost-effectiveness analysis and

  9. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme

    2011-01-01

    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  10. Long-term effects of glucocorticoids on function, quality of life, and survival in patients with Duchenne muscular dystrophy: a prospective cohort study.

    Science.gov (United States)

    McDonald, Craig M; Henricson, Erik K; Abresch, Richard T; Duong, Tina; Joyce, Nanette C; Hu, Fengming; Clemens, Paula R; Hoffman, Eric P; Cnaan, Avital; Gordish-Dressman, Heather

    2018-02-03

    Glucocorticoid treatment is recommended as a standard of care in Duchenne muscular dystrophy; however, few studies have assessed the long-term benefits of this treatment. We examined the long-term effects of glucocorticoids on milestone-related disease progression across the lifespan and survival in patients with Duchenne muscular dystrophy. For this prospective cohort study, we enrolled male patients aged 2-28 years with Duchenne muscular dystrophy at 20 centres in nine countries. Patients were followed up for 10 years. We compared no glucocorticoid treatment or cumulative treatment duration of less than 1 month versus treatment of 1 year or longer with regard to progression of nine disease-related and clinically meaningful mobility and upper limb milestones. We used Kaplan-Meier analyses to compare glucocorticoid treatment groups for time to stand from supine of 5 s or longer and 10 s or longer, and loss of stand from supine, four-stair climb, ambulation, full overhead reach, hand-to-mouth function, and hand function. Risk of death was also assessed. This study is registered with ClinicalTrials.gov, number NCT00468832. 440 patients were enrolled during two recruitment periods (2006-09 and 2012-16). Time to all disease progression milestone events was significantly longer in patients treated with glucocorticoids for 1 year or longer than in patients treated for less than 1 month or never treated (log-rank p<0·0001). Glucocorticoid treatment for 1 year or longer was associated with increased median age at loss of mobility milestones by 2·1-4·4 years and upper limb milestones by 2·8-8·0 years compared with treatment for less than 1 month. Deflazacort was associated with increased median age at loss of three milestones by 2·1-2·7 years in comparison with prednisone or prednisolone (log-rank p<0·012). 45 patients died during the 10-year follow-up. 39 (87%) of these deaths were attributable to Duchenne-related causes in patients with known duration of

  11. Collagenase injections for the treatment of single cords in cases of Dupuytren’s contracture – a prospective intervention study of long-term experience with Xiapex

    Directory of Open Access Journals (Sweden)

    Fischer, Lisa Maria

    2017-04-01

    Full Text Available Introduction: The gold standard in the treatment of Dupuytren’s contracture is surgical therapy. Alternatives are percutaneous needle fasciotomy and radiation in exceptional cases. Injection treatments with Xiapex (Pfizer are a new therapy option. This collagenase, extracted from clostridium histolyticum, is used to break down the affected tissue cords. The objective of this study is to examine the effect and long-term success of treatment with Xiapex.Methods: In this study, Xiapex treatment was conducted on a sample group of 19 patients with Dupuytren’s contracture. The injection was placed either on the cord at the level of the metacarpophalangeal (MCP joint (n=17 or of the proximal interphalangeal (PIP joint (n=7. Break-up of the cord occurred 24 hours after the injection. The neutral zero method was used to assess the extent of movement. The Michigan Hand Outcomes Questionnaire (MHQ was selected for evaluation of the general hand function in 16 patients. The WHO-5 and the EQ-5D VAS Score were used as a measure of the patients’ satisfaction and their state of health. All values were collected both pre-injection as well as 1 year post-injection.Results: Out of 19 patients in our sample group, 16 patients (≈84% benefitted in terms of improvement in mobility. Overall, the range of movement increased by Ø 26° in the affected finger. A separate assessment demonstrated that:The range of movement increased by 77% in the MCP joint. The extent of movement pre-injection was Ø (0-28-78 and post-injection it was Ø (0-9-81 with an improvement of Ø 22°. In the PIP joint, only slight improvement was observed (Ø pre (0-27-93; post (0-24-95.The MHQ increased from Ø 76% (R: 32–97% to 81% (R: 39–100%.The painfulness decreased from Ø 19% (R: 0–55% to Ø11% (R: 0–55%, corresponding to Ø 43%. Satisfaction increased in 72% of patients by Ø 21%.According to WHO-5, patient satisfaction pre-injection was Ø 20 (R: 11–25, and 1 year after

  12. Effect of Membrane Permeability on Cardiovascular Risk Factors and β2m Plasma Levels in Patients on Long-Term Haemodialysis: A Randomised Crossover Trial.

    Science.gov (United States)

    Chazot, Charles; Kirchgessner, Judith; Pham, Jenny; Vo-Van, Cyril; Lorriaux, Christie; Hurot, Jean-Marc; Zaoui, Eric; Grassmann, Aileen; Jean, Guillaume; Marcelli, Daniele

    2015-01-01

    Survival of haemodialysis (HD) patients is influenced by many factors. Mortality is mainly of cardiovascular (CV) origin and related to both traditional and nontraditional CV risk factors. Low plasma Beta2-microglobulin (β2m) levels are associated with improved HD patient survival. HD session times that are longer than the conventional 4 h (i.e., extended dialysis) provide better middle molecule clearance and are also associated with a survival advantage. In this crossover randomised trial, we investigated the effect of membrane flux on CV risk factors and on β2m plasma levels in patients treated with extended dialysis. Dialysis session duration was between 5 and 8 h for all patients. Patients were randomly assigned to the treatment sequences low-flux/high-flux dialysis versus high-flux/low-flux dialysis in a crossover design after a 3-month run-in period, with each phase lasting 9 months. Of the initially enrolled 168 patients, 155 patients started the study after the run-in period, 117 patients completed Phase 1, and 83 patients completed the whole study. Lp(a), homocystein, LDL cholesterol, HDL cholesterol and serum albumin were comparable in the low-flux and high-flux treatments. The average β2m level was 43.3 ± 11.1 mg/l at the end of the low-flux phase. Independent of sequence assignation, average β2m was significantly lower at the end of the high-flux phase (27.5 ± 76.0 mg/l, p < 0.0001 versus end of low-flux phase). Both phosphate and nPNA were significantly lower at the end of the high-flux phase compared to the low-flux phase (p = 0.045 and p = 0.002, respectively). Inclusion of those patients who completed Phase 1 and who dropped out of the study during Phase 2 did not significantly change the results. In conclusion, this study did not find an influence of high-flux filters on several traditional CV risk factors in a population of HD patients treated with extended dialysis. However, high-flux filters are necessary to optimise middle molecule

  13. Effects of long-term weekly iron and folic acid supplementation on lower genital tract infection - a double blind, randomised controlled trial in Burkina Faso.

    Science.gov (United States)

    Brabin, Loretta; Roberts, Stephen A; Gies, Sabine; Nelson, Andrew; Diallo, Salou; Stewart, Christopher J; Kazienga, Adama; Birtles, Julia; Ouedraogo, Sayouba; Claeys, Yves; Tinto, Halidou; d'Alessandro, Umberto; Faragher, E Brian; Brabin, Bernard

    2017-11-23

    Provision of routine iron supplements to prevent anaemia could increase the risk for lower genital tract infections as virulence of some pathogens depends on iron availability. This trial in Burkina Faso assessed whether weekly periconceptional iron supplementation increased the risk of lower genital tract infection in young non-pregnant and pregnant women. Genital tract infections were assessed within a double blind, controlled, non-inferiority trial of malaria risk among nulliparous women, randomised to receive either iron and folic acid or folic acid alone, weekly, under direct observation for 18 months. Women conceiving during this period entered the pregnancy cohort. End assessment (FIN) for women remaining non-pregnant was at 18 months. For the pregnancy cohort, end assessment was at the first scheduled antenatal visit (ANC1). Infection markers included Nugent scores for abnormal flora and bacterial vaginosis (BV), T. vaginalis PCR, vaginal microbiota, reported signs and symptoms, and antibiotic and anti-fungal prescriptions. Iron biomarkers were assessed at baseline, FIN and ANC1. Analysis compared outcomes by intention to treat and in iron replete/deficient categories. A total of 1954 women (mean 16.8 years) were followed and 478 (24.5%) became pregnant. Median supplement adherence was 79% (IQR 59-90%). Baseline BV prevalence was 12.3%. At FIN and ANC1 prevalence was 12.8% and 7.0%, respectively (P Iron-supplemented non-pregnant women received more antibiotic treatments for non-genital infections (P = 0.014; mainly gastrointestinal infections (P = 0.005), anti-fungal treatments for genital infections (P = 0.014) and analgesics (P = 0.008). Weekly iron did not significantly reduce iron deficiency prevalence. At baseline, iron-deficient women were more likely to have normal vaginal flora (P = 0.016). Periconceptional weekly iron supplementation of young women did not increase the risk of lower genital tract infections but did increase

  14. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

    Directory of Open Access Journals (Sweden)

    Nannini C

    2013-01-01

    1 and group 2 was 22 ± 1 months and 21 ± 1.6 months, respectively.Conclusion: Remission of ankylosing spondylitis is possible in at least 50% of patients treated with etanercept 50 mg weekly. After halving of the etanercept dose, remission is maintained in a high percentage of patients during long-term follow-up, with important economic implications.Keywords: ankylosing spondylitis, anti-tumor necrosis factor, etanercept, remission, dose reduction

  15. The use of self-gripping (Progrip™) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study.

    Science.gov (United States)

    Bresnahan, Erin; Bates, Andrew; Wu, Andrew; Reiner, Mark; Jacob, Brian

    2015-09-01

    The use of self-gripping mesh during laparoscopic TEP inguinal hernia repairs may eliminate the need for any additional fixation, and thus reduce post-operative pain without the added concern for mesh migration. Long-term outcomes are not yet prospectively studied in a controlled fashion. Under IRB approval, from January 2011-April 2013, 91 hernias were repaired laparoscopically with self-gripping mesh without additional fixation. Patients were followed for at least 1 year. Demographics and intraoperative data (defect location, size, and mesh deployment time) are recorded. VAS is used in the recovery room (RR) to score pain, and the Carolinas Comfort Scale ™ (CCS), a validated 0-5 pain/quality of life (QoL) score where a mean score of >1.0 means symptomatic pain, is employed at 2 weeks and at 1 year. Morbidities, narcotic usage, days to full activity and return to work, and CCS scores are reported. Sixty two patients, with 91 hernias repaired with self-gripping mesh, completed follow-up at a mean time period of 14.8 months. Seventeen hernias were direct defects (average size 3.0 cm). Mesh deployment time was 193.7 s. RR pain was 1.1/10 using a VAS. Total average oxycodone/acetaminophen (5 mg/325 mg) usage = 5.0 tablets, days to full activity was 1.6, and return to work was 4.2 days. Thirteen small asymptomatic seromas were palpated without any recurrences or groin tenderness, and all seromas resolved by the 6 month visit. Transient testis discomfort was reported in five patients. Urinary retention was 3.2%. Mean CCS™ scores at the first visit for groin pain laying, bending, sitting, walking, and step-climbing were 0.2, 0.5, 0.4, 0.3, and 0.3, respectively. At the first post op visit, 4.8% had symptomatic pain (CCS > 1). At 14.8 months, no patients reported symptomatic pain with CCS scores for all 62 patients averaging 0.02, (range 0-0.43). There are no recurrences thus far. Self-gripping mesh can be safely used during laparoscopic TEP inguinal hernia repairs

  16. Long-term health effects of the Eyjafjallajökull volcanic eruption: a prospective cohort study in 2010 and 2013.

    Science.gov (United States)

    Hlodversdottir, Heidrun; Petursdottir, Gudrun; Carlsen, Hanne Krage; Gislason, Thorarinn; Hauksdottir, Arna

    2016-09-08

    To examine the long-term development of physical and mental health following exposure to a volcanic eruption. Population-based prospective cohort study. In spring 2010, the Icelandic volcano Eyjafjallajökull erupted. Data were collected at 2 time points: in 2010 and 2013. Adult residents in areas close to the Eyjafjallajökull volcano (N=1096), divided according to exposure levels, and a non-exposed sample (n=475), with 80% participation rate in 2013. Physical symptoms in the previous year (chronic) and previous month (recent), and psychological distress (General Health Questionnaire-12-item version, GHQ-12), perceived stress (Perceived Stress Scale, PSS-4) and post traumatic stress disorder (PTSD) symptoms (Primary Care PTSD, PC-PTSD). In the exposed group, certain symptoms were higher in 2013 than in 2010, for example, morning phlegm during winter (OR 2.14; 95% CI 1.49 to 3.06), skin rash/eczema (OR 2.86; 95% CI 1.76 to 4.65), back pain (OR 1.45; 95% CI 1.03 to 2.05) and insomnia (OR 1.53; 95% CI 1.01 to 2.30), in addition to a higher prevalence of regular use of certain medications (eg, for asthma (OR 2.80; 95% CI 1.01 to 7.77)). PTSD symptoms decreased between 2010 and 2013 (OR 0.33; 95% CI 0.17 to 0.61), while the prevalence of psychological distress and perceived stress remained similar. In 2013, the exposed group showed a higher prevalence of various respiratory symptoms than did the non-exposed group, such as wheezing without a cold (high exposure OR 2.35; 95% CI 1.27 to 4.47) and phlegm (high exposure OR 2.81; 95% CI 1.48 to 5.55), some symptoms reflecting the degree of exposure (eg, nocturnal chest tightness (medium exposed OR 3.09; 95% CI 1.21 to 10.46; high exposed OR 3.42; 95% CI 1.30 to 11.79)). The findings indicate that people exposed to a volcanic eruption, especially those most exposed, exhibit increased risk of certain symptoms 3-4 years after the eruption. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  17. Frozen shoulder : long-term outcome following arthrographic distension.

    Science.gov (United States)

    Clement, Rhys G E; Ray, Andrew G; Davidson, Colin; Robinson, C Mike; Perks, Fergus J

    2013-08-01

    Arthrographic distension of the glenohumeral joint was adopted as a mainstream treatment for frozen shoulder before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests mostly on data from cohort studies of which there are few of high quality. Papers reporting long-term results have either excluded diabetic patients or failed to report patient orientated outcomes. The authors present a long-term prospective cohort study of 51 patients (12 diabetics and 39 non-diabetics), with 53 frozen shoulders, who had an arthrographic distension performed by a single radiologist as a primary intervention. Oxford shoulder score (OSS), visual analogue pain score (VAS), and range of movement (ROM) were recorded pre-distension, at 2 days and 1 month post-distension. OSS and VAS were recorded again at a mean of 14 months post distension (range : 8-26 months). OSS improved from a pre-distension mean of 22.3 by 16.9 points at final follow-up (p diabetic patients was the same as in non-diabetic patients. Arthrographic distension is a safe and effective treatment for frozen shoulder; it is also effective in diabetic patients. It gives long-term improvement. The authors believe that the low number of patients requiring a secondary procedure makes arthrographic distension preferable to manipulation under anaesthesia.

  18. The long-term prospects of citizens managing urban green space: From place making to place-keeping? : Special feature:TURFGRASS

    NARCIS (Netherlands)

    Mattijssen, T.J.M.; van der Jagt, A.P.N.; Buijs, A.E.; Elands, B.H.M.; Erlwein, S.; Lafortezza, R.

    2017-01-01

    Abstract This paper discusses the long-term management or ‘place-keeping’ of urban green space by citizens and highlights enabling and constraining factors that play a crucial role in this continuity. While authorities have historically been in charge of managing public green spaces, there is an

  19. Mental health symptoms identify workers at risk of long-term sickness absence due to mental disorders : prospective cohort study with 2-year follow-up

    NARCIS (Netherlands)

    van Hoffen, Marieke F. A.; Joling, Catelijne I.; Heymans, Martijn W.; Twisk, Jos W. R.; Roelen, Corne A. M.

    2015-01-01

    Background: Mental health problems are a leading cause of long-term sickness absence (LTSA). Workers at risk of mental LTSA should preferably be identified before they report sick. The objective of this study was to examine mental health symptoms as predictors of future mental LTSA in non-sicklisted

  20. Return to work from long-term sick leave: a six-year prospective study of the importance of adjustment latitudes at work and home.

    Science.gov (United States)

    Dellve, Lotta; Fallman, Sara L; Ahlstrom, Linda

    2016-01-01

    The aim was to investigate the long-term importance of adjustment latitude for increased work ability and return to work among female human service workers on long-term sick leave. A cohort of female human service workers on long-term sick leave (>60 days) was given a questionnaire four times (0, 6, 12, 60 months). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability and return to work. Having a higher level of adjustment latitude was associated with both increased work ability and return to work. Adjustments related to work pace were strongly associated with increased work ability, as were adjustments to the work place. Having individual opportunities for taking short breaks and a general acceptance of taking short breaks were associated with increased work ability. At home, a higher level of responsibility for household work was related to increased work ability and return to work. Individuals with possibilities for adjustment latitude, especially pace and place at work, and an acceptance of taking breaks had greater increased work ability over time and a greater work ability compared with individuals who did not have such opportunities. This study highlights the importance of opportunities for adjustment latitude at work to increase work ability and return to work among female human service workers who have been on long-term sick leave. The results support push and pull theories for individual decision-making on return to work.

  1. Long-Term Collections

    CERN Multimedia

    Staff Association

    2016-01-01

    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  2. Long-Term Collection

    CERN Multimedia

    Staff Association

    2016-01-01

    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  3. Collectes à long terme

    CERN Multimedia

    Collectes à long terme

    2014-01-01

    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  4. Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Carr, Catherine Elizabeth; O'Kelly, Julian; Sandford, Stephen; Priebe, Stefan

    2017-03-29

    Depression is of significant global concern. Despite a range of effective treatment options it is estimated that around one in five diagnosed with an acute depressive episode continue to experience enduring symptoms for more than 2 years. There is evidence for effectiveness of individual music therapy for depression. However, no studies have as yet looked at a group intervention within an NHS context. This study aims to assess the feasibility of conducting a randomised controlled trial of group music therapy for patients with long-term depression (symptom durations of 1 year or longer) within the community. This is a single-centre randomised controlled feasibility trial of group music therapy versus wait-list control with a nested process evaluation. Thirty participants will be randomised with unbalanced allocation (20 to receive the intervention immediately, 10 as wait-list controls). Group music therapy will be offered three times per week in a community centre with a focus on songwriting. Data will be collected post-intervention, 3 and 6 months after the intervention finishes. We will examine the feasibility of recruitment processes including identifying the number of eligible participants, participation and retention rates and the intervention in terms of testing components, measuring adherence and estimation of the likely intervention effect. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of process measures and end-of-participation interviews with participants and referring staff. Whilst group music therapy is an option in some community mental health settings, this will be the first study to examine group music therapy for this particular patient group. We will assess symptoms of depression, acceptability of the intervention and quality of life. We anticipate potential challenges in the recruitment and retention of participants. It is unclear whether offering the intervention three times per week will be

  5. Virological response and resistance among HIV-infected children receiving long-term antiretroviral therapy without virological monitoring in Uganda and Zimbabwe: Observational analyses within the randomised ARROW trial.

    Directory of Open Access Journals (Sweden)

    Alexander J Szubert

    2017-11-01

    Full Text Available Although WHO recommends viral load (VL monitoring for those on antiretroviral therapy (ART, availability in low-income countries remains limited. We investigated long-term VL and resistance in HIV-infected children managed without real-time VL monitoring.In the ARROW factorial trial, 1,206 children initiating ART in Uganda and Zimbabwe between 15 March 2007 and 18 November 2008, aged a median 6 years old, with median CD4% of 12%, were randomised to monitoring with or without 12-weekly CD4 counts and to receive 2 nucleoside reverse transcriptase inhibitors (2NRTI, mainly abacavir+lamivudine with a non-nucleoside reverse transcriptase inhibitor (NNRTI or 3 NRTIs as long-term ART. All children had VL assayed retrospectively after a median of 4 years on ART; those with >1,000 copies/ml were genotyped. Three hundred and sixteen children had VL and genotypes assayed longitudinally (at least every 24 weeks. Overall, 67 (6% switched to second-line ART and 54 (4% died. In children randomised to WHO-recommended 2NRTI+NNRTI long-term ART, 308/378 (81% monitored with CD4 counts versus 297/375 (79% without had VL <1,000 copies/ml at 4 years (difference = +2.3% [95% CI -3.4% to +8.0%]; P = 0.43, with no evidence of differences in intermediate/high-level resistance to 11 drugs. Among children with longitudinal VLs, only 5% of child-time post-week 24 was spent with persistent low-level viraemia (80-5,000 copies/ml and 10% with VL rebound ≥5,000 copies/ml. No child resuppressed <80 copies/ml after confirmed VL rebound ≥5,000 copies/ml. A median of 1.0 (IQR 0.0,1.5 additional NRTI mutation accumulated over 2 years' rebound. Nineteen out of 48 (40% VLs 1,000-5,000 copies/ml were immediately followed by resuppression <1,000 copies/ml, but only 17/155 (11% VLs ≥5,000 copies/ml resuppressed (P < 0.0001. Main study limitations are that analyses were exploratory and treatment initiation used 2006 criteria, without pre-ART genotypes.In this study, children

  6. Long-term relationships between symptoms of Attention Deficit Hyperactivity Disorder and self-esteem in a prospective longitudinal study of twins.

    Science.gov (United States)

    Edbom, Tobias; Lichtenstein, Paul; Granlund, Mats; Larsson, Jan-Olov

    2006-06-01

    To study the long-term relationship between symptoms of Attention Deficit Hyperactivity Disorder and the developing self-esteem in a population-based sample of twins. The cohort is all twin pair families born in Sweden between May 1985 and December 1986 (n = 1.480). Wave 1 took place in 1994 when the twins were 8 years old and wave 2 in 1999 when the children were 13 years old. In wave 1 and 2 the parents completed questionnaires regarding ADHD-symptoms about their children. In wave 2 the twins completed a questionnaire about self-esteem and Youth Self Report (YSR). ADHD-symptoms and self-esteem were analyzed in the total study group. There was a long-term relationship between high scores of parental-reported ADHD-symptoms at 8 and 13 years of age and low scores in measures of self-reported self-esteem at 13 years of age. In the cotwin control method controlling for YSR internalizing problem, paired comparisons within the twin pairs revealed that a high score of ADHD-symptoms at age 8 was related to significantly lower scores at age 13 in the self-esteem. The long-term relationships between ADHD-symptoms and a low self-esteem in a population-based sample were confirmed by the co-twin analyses.

  7. Happiness and life satisfaction prospectively predict self-rated health, physical health, and the presence of limiting, long-term health conditions.

    Science.gov (United States)

    Siahpush, Mohammad; Spittal, Matt; Singh, Gopal K

    2008-01-01

    To examine the effect of happiness and life satisfaction on health. Longitudinal data from waves 1 and 3, conducted in 2001 and 2004, respectively, of the Household Income and Labour Dynamics in Australia survey. Australia. A total of 9981 respondents aged 18 years and older. Outcomes were self-reported health; the absence of long-term, limiting health conditions; and physical health. Happiness was assessed with the following question: "During the past 4 weeks, have you been a happy person"? Life satisfaction was determined with the following question: "All things considered, how satisfied are you with your life"? We used multiple regression analysis to estimate odds ratios (ORs), beta coefficients (beta), and 95% confidence intervals (CIs) for the associations between baseline happiness or life satisfaction and health at wave 3. Baseline happiness and life satisfaction both were positively associated at wave 3 with excellent, very good, or good health (OR = 1.50, CI = 1.33-1.70, p < .0001; and OR = 1.62, CI = 1.27-2.08, p < .0001, respectively); with the absence of long-term, limiting health conditions (OR = 1.53, CI = 1.35-1.75, p < .0001; and OR = 1.51, CI = 1.25-1.82, p < .0001, respectively); and with higher physical health levels (beta = .99, CI = .60-1.39, p < .0001; and beta = .99, CI = .20-1.78, p < .0145, respectively). This study showed that happier people and those who were more satisfied with their lives at baseline reported better health (self-rated health; absence of limiting, long-term conditions; and physical health) at the 2-year follow-up when adjusted for baseline health and other relevant covariates.

  8. The role of gender in long-term sickness absence and transition to permanent disability benefits. Results from a multiregister based, prospective study in Norway 1990-1995.

    Science.gov (United States)

    Gjesdal, Sturla; Bratberg, Espen

    2002-09-01

    The aim of the study was to identify predictors for the transition from long-term sickness absence into disability pension with a special focus on gender. The study used data from a national database containing a 10% random sample of the Norwegian adult population (The KIRUT database). The study population were all individuals in the database who on 1 January 1990 were eligible for sick pay from the Norwegian National Insurance System: 83,398 men and 75,586 women. Individuals below 60 years with long-term sickness absence starting in 1990 and 1991 were identified, 6,434 men and 8,233 women, and followed up for three years. Background data were used as independent variables in a logistic regression of the probability for receiving disability pension during follow-up. Annual cumulative incidence of long-term sickness absence was 6.5% for women and 4.9% for men. During follow-up, 12.4% of the women and 12.6% of the men received disability pension. Among full-time employed women only 10.3% had become disability pensioners, while the corresponding proportion for women working part-time was 15.5%. For men the figures were 12.1% (full-time) and 18.1% (part-time). In the logistic regression of the whole sample the female odds ratio was insignificant. The dominant predictive factors for disability pension were age and duration of the sickness spells. Working part-time also increased the risk. Higher levels of education and having children below 7 years reduced the probability for disability pension. Separate regressions for men and women showed that the 'protective' effect of having small children only remained for women.

  9. The work ability index and single-item question: associations with sick leave, symptoms, and health--a prospective study of women on long-term sick leave.

    Science.gov (United States)

    Ahlstrom, Linda; Grimby-Ekman, Anna; Hagberg, Mats; Dellve, Lotta

    2010-09-01

    This study investigated the association between the work ability index (WAI) and the single-item question on work ability among women working in human service organizations (HSO) currently on long-term sick leave. It also examined the association between the WAI and the single-item question in relation to sick leave, symptoms, and health. Predictive values of the WAI, the changed WAI, the single-item question and the changed single-item question were investigated for degree of sick leave, symptoms, and health. This cohort study comprised 324 HSO female workers on long-term (>60 days) sick leave, with follow-ups at 6 and 12 months. Participants responded to questionnaires. Data on work ability, sick leave, health, and symptoms were analyzed with regard to associations and predictability. Spearman correlation and mixed-model analysis were performed for repeated measurements over time. The study showed a very strong association between the WAI and the single-item question among all participants. Both the WAI and the single-item question showed similar patterns of associations with sick leave, health, and symptoms. The predictive value for the degree of sick leave and health-related quality of life (HRQoL) was strong for both the WAI and the single-item question, and slightly less strong for vitality, neck pain, both self-rated general and mental health, and behavioral and current stress. This study suggests that the single-item question on work ability could be used as a simple indicator for assessing the status and progress of work ability among women on long-term sick leave.

  10. Factors associated with conversion of long-term non-progressors to progressors: A prospective study of HIV perinatally infected paediatric survivors

    Directory of Open Access Journals (Sweden)

    Muttineni Radhakrishna

    2013-01-01

    Full Text Available Background & objectives : Survival pattern among children infected with the human immune deficiency virus (HIV follows a bimodel distribution. Some children survive beyond 9 years age and are known as long term survivers (LTS while others had a more rapid course to death during the first few years of life. In the LTS group of children, two sub-populations have emerged, the long term non-progressors (LTNP who have remained asymptomatic over a period of years and those who have survived despite clinical and laboratory evidence of disease progression, the long term progressors (LTP. The aim of the present study was to determine the factors influencing the conversion of LTNPs to LTPs in a group of perinatally HIV infected children who were followed up for five years. Methods : A total of 26 HIV seropositive paediatric patients were monitored from 2006 to 2011 with CD4 cell counts, onset of clinical manifestations, body weight, biochemical, haematological and immunological parameters. Statistical analyses, both qualitative and quantitative, were used to determine the degree of conversion of non-progressors to progressors. Results : All 26 (13 female and 13 male perinatally HIV infected children, born during1991-1996 were healthy until 2006. But by 2011, 18 were placed in progressors group with antiretroviral therapy (ART, while six remained in non progressors group and two died. As per the Kaplan-Meier survival analysis, AIDS free median survival period (years in LTP group (CD4 count of the cohort was 10΁0.66 (350, P=<0.05. Intercurrent and opportunistic infections (OIs were observed in LTPs only. The incidence of OI in LTPs was higher when compared to general paediatric population. Interpretation & conclusions : Our findings show that CD4 counts and OIs play an important role in influencing the survival chances of perinatally HIV infected children.

  11. Early predictors of the long-term outcome of low back pain - results of a 22-year prospective cohort study from general practice

    DEFF Research Database (Denmark)

    Lonnberg, F.; Pedersen, P.; Siersma, V.

    2010-01-01

    , use of painkillers for low back pain, use of health care providers, impairments due to low back pain and unfitness for work caused by low back pain. The influence of the predictors was assessed by relative risks. RESULTS: After 22 years, four out of five patients still experienced low back pain....... The perception of poor working conditions correlates with recurrent low back pain, intake of painkillers and limitations to daily life. CONCLUSION: Compared with pain history and clinical findings, the perception of workload is a better predictor of the long-term outcome of low back pain Udgivelsesdato: 2010/8/3...

  12. Introduction: Long term prediction

    International Nuclear Information System (INIS)

    Beranger, G.

    2003-01-01

    Making a decision upon the right choice of a material appropriate to a given application should be based on taking into account several parameters as follows: cost, standards, regulations, safety, recycling, chemical properties, supplying, transformation, forming, assembly, mechanical and physical properties as well as the behaviour in practical conditions. Data taken from a private communication (J.H.Davidson) are reproduced presenting the life time range of materials from a couple of minutes to half a million hours corresponding to applications from missile technology up to high-temperature nuclear reactors or steam turbines. In the case of deep storage of nuclear waste the time required is completely different from these values since we have to ensure the integrity of the storage system for several thousand years. The vitrified nuclear wastes should be stored in metallic canisters made of iron and carbon steels, stainless steels, copper and copper alloys, nickel alloys or titanium alloys. Some of these materials are passivating metals, i.e. they develop a thin protective film, 2 or 3 nm thick - the so-called passive films. These films prevent general corrosion of the metal in a large range of chemical condition of the environment. In some specific condition, localized corrosion such as the phenomenon of pitting, occurs. Consequently, it is absolutely necessary to determine these chemical condition and their stability in time to understand the behavior of a given material. In other words the corrosion system is constituted by the complex material/surface/medium. For high level nuclear wastes the main features for resolving problem are concerned with: geological disposal; deep storage in clay; waste metallic canister; backfill mixture (clay-gypsum) or concrete; long term behavior; data needed for modelling and for predicting; choice of appropriate solution among several metallic candidates. The analysis of the complex material/surface/medium is of great importance

  13. Long-Term Symbolic Learning

    National Research Council Canada - National Science Library

    Kennedy, William G; Trafton, J. G

    2007-01-01

    What are the characteristics of long-term learning? We investigated the characteristics of long-term, symbolic learning using the Soar and ACT-R cognitive architectures running cognitive models of two simple tasks...

  14. Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study.

    Science.gov (United States)

    Hennigs, André; Biehl, Hannah; Rauch, Geraldine; Golatta, Michael; Tabatabai, Patrik; Domschke, Christoph; Schott, Sarah; Wallwiener, Markus; Schütz, Florian; Sohn, Christof; Heil, Jörg

    2016-05-01

    We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS). This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis. The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p procedures.

  15. Long-Term Use of Probiotics Lactobacillus and Bifidobacterium Has a Prophylactic Effect on the Occurrence and Severity of Pouchitis: A Randomized Prospective Study

    Directory of Open Access Journals (Sweden)

    Banasiewicz Tomasz

    2014-01-01

    Full Text Available Aim. The aim of the study was to assess the impact of the long-term use of the composite probiotics in patients after restorative proctocolectomy. Method. Forty-three patients (20 females and 23 males, aged 21 to 68 years after restorative proctocolectomy were included in the study. After randomization patients were divided into placebo group and treatment group with oral intake of probiotic containing Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus. Patients were investigated during initial visit and during final visit after 9 months. All patients were subjected to standard clinical and endoscopic examination with microscopic study of the specimens. Concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK were determined in all cases. Results. The average severity of pouchitis and the number of patients with pouchitis significantly decrease after 9 months of the probiotic taking. The concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK significantly decreased after the therapy. Conclusions. Nine months of the probiotic treatment (Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus reduced the number of patients with pouchitis, decreased the PDAI score, and also decreased the fecal pyruvate kinase and calprotectin. The long-term probiotics use is safe and well accepted and can be an effective method of the pouchitis prevention.

  16. LONG TERM COLLECTIONS

    CERN Multimedia

    STAFF ASSOCIATION

    2010-01-01

    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  17. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term non-steroidal anti-inflammatory drug (NSAID) therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial.

    Science.gov (United States)

    Sugano, Kentaro; Kontani, Teiji; Katsuo, Shinichi; Takei, Yoshinori; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Asaka, Masahiro; Matsui, Shigeyuki; Kanto, Tatsuya; Soen, Satoshi; Takeuchi, Tsutomu; Hiraishi, Hideyuki; Hiramatsu, Naoki

    2012-05-01

    Low-dose lansoprazole has not been intensively evaluated for its efficacy in the prevention of recurrent gastric or duodenal ulcers in patients receiving long-term non-steroidal anti-inflammatory drug (NSAID) therapy for pain relief in such diseases as rheumatoid arthritis, osteoarthritis, and low back pain. This multi-center, prospective, double-blind, randomized, active-controlled study involving 99 sites in Japan was designed to compare the efficacy of lansoprazole (15 mg daily) with gefarnate (50 mg twice daily). Patients with a history of gastric or duodenal ulcers who required long-term NSAID therapy were randomized to receive lansoprazole 15 mg daily (n = 185) or gefarnate 50 mg twice daily (n = 181) and followed up for 12 months or longer prospectively. The cumulative incidence of gastric or duodenal ulcer at days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 3.3, 5.9, and 12.7%, respectively, in the lansoprazole group versus 18.7, 28.5, and 36.9%, respectively, in the gefarnate group. The risk for ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.2510 (95% CI 0.1400-0.4499). A long-term follow-up study showed an acceptable safety profile for low-dose lansoprazole therapy, with diarrhea as the most frequent adverse event. Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term NSAID therapy.

  18. Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial.

    Science.gov (United States)

    Cullington, Helen; Kitterick, Padraig; DeBold, Lisa; Weal, Mark; Clarke, Nicholas; Newberry, Eva; Aubert, Lisa

    2016-05-13

    Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources. This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT. Ethical approval was received from North West-Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329). Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports

  19. Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study.

    Science.gov (United States)

    Zhou, Yongfang; Jin, Xiaodong; Kang, Yan; Liang, Guopeng; Liu, Tingting; Deng, Ni

    2014-06-16

    Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients. A total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events. The incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P memory of the uncomfortable events was lower than in group M (11.7% versus 25.0%, P memory was similar (P >0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01). Sequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical

  20. Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study.

    Science.gov (United States)

    Kyriakakis, Nikolaos; Lynch, Julie; Gilbey, Stephen G; Webb, Susan M; Murray, Robert D

    2017-06-01

    Patients with acromegaly demonstrate impaired quality of life (QoL), but data on long-term QoL changes in treated acromegaly are limited. This study evaluates and identifies factors that influence QoL in patients with long-term biochemical remission. The study consists of a cross-sectional arm comparing QoL between patients with treated and controlled acromegaly and healthy controls; and a longitudinal arm assessing QoL changes in patients with biochemically stable disease during 5.7±0.6 years of follow-up. A total of 58 patients and 116 matched controls were recruited for the cross-sectional arm; 28 patients completed the longitudinal arm. Three generic questionnaires (Psychological General Well-Being Schedule [PGWBS], 36-item Short-Form [SF-36], EuroQoL [EQ-5D]) and the disease-specific acromegaly QoL questionnaire (AcroQoL) were applied. Quality of life assessment was performed 11.6±8.2 years following diagnosis and treatment of acromegaly. Patients with treated acromegaly had lower QoL scores compared with controls in all questionnaires with the exception of the PGWBS "Anxiety" subscale. The AcroQoL "Appearance" subscale and the "Physical Function" subscales of the remaining questionnaires were the most underscored domains. No difference in the total and subscale scores of all questionnaires was observed between baseline and follow-up, with the exception of the SF-36 "Physical Function," where a decline was found (58.5±24.7% vs 43.1±31.1%; P=.002). However, after adjusting for covariates, no significant change in any of the QoL scores was seen. Duration of IGF-1/GH control was positively correlated with QoL scores in most questionnaires at baseline, whereas use of GH lowering therapy at the time of QoL assessment was a negative predictive factor of QoL. Patients with biochemically controlled acromegaly demonstrate impaired QoL, which persists despite long-term disease control. This primarily consists of impaired physical function and secondly of impaired

  1. Evaluating long term forecasts

    Energy Technology Data Exchange (ETDEWEB)

    Lady, George M. [Department of Economics, College of Liberal Arts, Temple University, Philadelphia, PA 19122 (United States)

    2010-03-15

    The U.S. Department of Energy's Energy Information Administration (EIA), and its predecessor organizations, has published projections of U.S. energy production, consumption, distribution and prices annually for over 30 years. A natural issue to raise in evaluating the projections is an assessment of their accuracy compared to eventual outcomes. A related issue is the determination of the sources of 'error' in the projections that are due to differences between the actual versus realized values of the associated assumptions. One way to do this would be to run the computer-based model from which the projections are derived at the time the projected values are realized, using actual rather than assumed values for model assumptions; and, compare these results to the original projections. For long term forecasts, this approach would require that the model's software and hardware configuration be archived and available for many years, possibly decades, into the future. Such archival creates many practical problems; and, in general, it is not being done. This paper reports on an alternative approach for evaluating the projections. In the alternative approach, the model is run many times for cases in which important assumptions are changed individually and in combinations. A database is assembled from the solutions and a regression analysis is conducted for each important projected variable with the associated assumptions chosen as exogenous variables. When actual data are eventually available, the regression results are then used to estimate the sources of the differences in the projections of the endogenous variables compared to their eventual outcomes. The results presented here are for residential and commercial sector natural gas and electricity consumption. (author)

  2. A new era in palaeomicrobiology: prospects for ancient dental calculus as a long-term record of the human oral microbiome.

    Science.gov (United States)

    Warinner, Christina; Speller, Camilla; Collins, Matthew J

    2015-01-19

    The field of palaeomicrobiology is dramatically expanding thanks to recent advances in high-throughput biomolecular sequencing, which allows unprecedented access to the evolutionary history and ecology of human-associated and environmental microbes. Recently, human dental calculus has been shown to be an abundant, nearly ubiquitous, and long-term reservoir of the ancient oral microbiome, preserving not only microbial and host biomolecules but also dietary and environmental debris. Modern investigations of native human microbiota have demonstrated that the human microbiome plays a central role in health and chronic disease, raising questions about changes in microbial ecology, diversity and function through time. This paper explores the current state of ancient oral microbiome research and discusses successful applications, methodological challenges and future possibilities in elucidating the intimate evolutionary relationship between humans and their microbes.

  3. A new era in palaeomicrobiology: prospects for ancient dental calculus as a long-term record of the human oral microbiome

    Science.gov (United States)

    Warinner, Christina; Speller, Camilla; Collins, Matthew J.

    2015-01-01

    The field of palaeomicrobiology is dramatically expanding thanks to recent advances in high-throughput biomolecular sequencing, which allows unprecedented access to the evolutionary history and ecology of human-associated and environmental microbes. Recently, human dental calculus has been shown to be an abundant, nearly ubiquitous, and long-term reservoir of the ancient oral microbiome, preserving not only microbial and host biomolecules but also dietary and environmental debris. Modern investigations of native human microbiota have demonstrated that the human microbiome plays a central role in health and chronic disease, raising questions about changes in microbial ecology, diversity and function through time. This paper explores the current state of ancient oral microbiome research and discusses successful applications, methodological challenges and future possibilities in elucidating the intimate evolutionary relationship between humans and their microbes. PMID:25487328

  4. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: long-term symptomatic follow-up of a prospective randomized controlled trial.

    Science.gov (United States)

    Kummerow Broman, Kristy; Phillips, Sharon E; Faqih, Adil; Kaiser, Joan; Pierce, Richard A; Poulose, Benjamin K; Richards, William O; Sharp, Kenneth W; Holzman, Michael D

    2018-04-01

    Our prior randomized controlled trial of Heller myotomy alone versus Heller plus Dor fundoplication for achalasia from 2000 to 2004 demonstrated comparable postoperative resolution of dysphagia but less gastroesophageal reflux after Heller plus Dor. Patient-reported outcomes are needed to determine whether the findings are sustained long-term. We actively engaged participants from the prior randomized cohort, making up to six contact attempts per person using telephone, mail, and electronic messaging. We collected patient-reported measures of dysphagia and gastroesophageal reflux using the Dysphagia Score and the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) instrument. Patient-reported re-interventions for dysphagia were verified by obtaining longitudinal medical records. Among living participants, 27/41 (66%) were contacted and all completed the follow-up study at a mean of 11.8 years postoperatively. Median Dysphagia Scores and GERD-HRQL scores were slightly worse for Heller than Heller plus Dor but were not statistically different (6 vs 3, p = 0.08 for dysphagia, 15 vs 13, p = 0.25 for reflux). Five patients in the Heller group and 6 in Heller plus Dor underwent re-intervention for dysphagia with most occurring more than five years postoperatively. One patient in each group underwent redo Heller myotomy and subsequent esophagectomy. Nearly all patients (96%) would undergo operation again. Long-term patient-reported outcomes after Heller alone and Heller plus Dor for achalasia are comparable, providing support for either procedure.

  5. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial.

    Science.gov (United States)

    Belgaid, Djouhar Roufeida; Khan, Zara; Zaidi, Mariam; Hobbs, Adrian

    2016-09-15

    Assessing the safety and effectiveness of left atrial appendage (LAA) (pouch found in the upper chambers of the heart) occlusion, using the Watchman device compared to long term warfarin therapy (drug that reduces clot formation), in preventing the risk of stroke in patients with atrial fibrillation (most common type of irregular heart beat). 90% of strokes in atrial fibrillation arise from clots forming in this pouch. By mechanically blocking it using the device less clots are suggested to be formed. This is an alternative to taking warfarin especially in patients who cannot take it. 50 sites in the United States enrolled 407 participants. After being randomly allocated, the device group had 269 participants and warfarin group (comparator)had 138 participants. Patients with atrial fibrillation and at high risk of stroke were randomly allocated a group after they were deemed eligible. Patients in the device group had to take warfarin and aspirin for 45days till the complete closure of the LAA. The oral anticoagulant was followed by dual antiplatelet therapy until 6months and then ASA. Patients in the warfarin group have to take it for life and were continually monitored. The study ran for 26months. The trial assessed the rate of adverse events using three endpoints: The PREVAIL trial was not designed to show superiority, but non-inferiority. It met the safety endpoint and one efficacy endpoint for the watchman device compared to long term warfarin for overall efficacy of the device. The results established that LAA occlusion is not worse than warfarin intake for the prevention of stroke more than 1week after randomization. Compared to previous trials, the safety of the device has also improved. LAA occlusion is a reasonable alternative to chronic warfarin therapy in stroke prevention for patients with atrial fibrillation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: a prospective observational study.

    Science.gov (United States)

    Hong, Soonchang; Yi, Gijong; Youn, Young-Nam; Lee, Sak; Yoo, Kyung-Jong; Chang, Byung-Chul

    2013-11-01

    The effect of prosthesis-patient mismatch (PPM) on clinical outcomes after aortic valve replacement remains controversial. We evaluated effect of PPM on long-term clinical outcomes after isolated aortic valve replacement in patients with predominant aortic stenosis. We analyzed data from patients with predominant aortic stenosis who underwent isolated aortic valve replacement between January 1995 and July 2010. The indexed effective orifice area, obtained by dividing the in vivo effective orifice area by the patient's body surface area, was used to define PPM as clinically nonsignificant (group I, 224 patients), mild (group II, 52 patients), moderate (group III, 39 patients), and severe (group IV, 36 patients). Early survival was not significantly different among the groups, but overall survival was decreased gradually in group IV. Overall survival at 12 years was lower in group IV than in group I (92.8% ± 2.7% vs 67.0 ± 10.1, respectively; P = .001). Cardiac-related-death-free survival at 12 years was lower in patients with severe PPM. Left ventricular mass index decreased during the follow-up period in all groups. But left ventricular mass index was less decreased in group IV compared with groups I, II, and III. Age, severe PPM, and ejection fraction <40%, and New York Heart Association Functional Class IV were independent risk factors of overall survival on multivariate analysis. Severe PPM was an independent risk factor for cardiac-related death. Severe PPM showed an adverse effect on long-term survival, and was an independent risk factor for cardiac-related death. In addition, patients with severe PPM showed less decreasing left ventricular mass index during follow-up. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. Low Carbohydrate-Diet Scores and Long-term Risk of Type 2 Diabetes Among Women With a History of Gestational Diabetes Mellitus: A Prospective Cohort Study.

    Science.gov (United States)

    Bao, Wei; Li, Shanshan; Chavarro, Jorge E; Tobias, Deirdre K; Zhu, Yeyi; Hu, Frank B; Zhang, Cuilin

    2016-01-01

    Low-carbohydrate diets (LCDs) may improve short-term glycemic control in patients with gestational diabetes mellitus (GDM), but the long-term effect on progression from GDM to type 2 diabetes mellitus (T2DM) is unknown. We aimed to examine the long-term risk of T2DM in association with a low-carbohydrate dietary pattern among women with a history of GDM. Overall, 4,502 women with a history of GDM from the Nurses' Health Study II (NHSII) cohort, as part of the Diabetes & Women's Health (DWH) study, were followed up from 1991 to 2011. Overall, animal, or vegetable LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed every 4 years since 1991 by validated food-frequency questionnaires. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs. We documented 722 incident cases of T2DM during 68,897 person-years of observation. The multivariable-adjusted HRs (95% CIs) of T2DM, comparing the highest with lowest quintiles, were 1.36 (1.04-1.78) for overall LCD score (P = 0.003 for trend), 1.40 (1.06-1.84) for animal LCD score (P = 0.004 for trend), and 1.19 (0.91-1.55) for vegetable LCD score (P = 0.50 for trend). Among women with a history of GDM, a low-carbohydrate dietary pattern, particularly with high protein and fat intake mainly from animal-source foods, is associated with higher T2DM risk, whereas a low-carbohydrate dietary pattern with high protein and fat intake from plant-source foods is not significantly associated with risk of T2DM. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  8. A 4-year prospective study on long-term complications of type 2 diabetic patients: the Thai DMS diabetes complications (DD.Comp.) project.

    Science.gov (United States)

    Potisat, Somkiat; Krairittichai, Udom; Jongsareejit, Amporn; Sattaputh, Charnvate; Arunratanachote, Woranut

    2013-06-01

    To assess the clinical course of long-term diabetic complications; diabetic retinopathy, nephropathy, and foot problems in Thai patients with type 2 diabetes. Patients with type 2 diabetes were followed for four years between March 2006 and September 2010. Seven hospitals in all levels of care under the Ministry of Public Health Thailand were included in the present study. A physical examination and a diabetic complications assessment were performed each year during the study period, by physician specialists in the related areas. Among 1,120 patients who participated in the present study, 705 (62.95%) patients completed the 4-year follow-up time. There were 88 (7.86%) patients reported deaths during the present study period. The mean age was 59.14 +/- 10.12 years. The average duration of diabetes was 7.30 +/- 6.14 years. Approximately 57.32% of patients had a family history of diabetes. The average plasma glucose level and HbA1C were 153 to 160 mg/dl and 8.25 to 8.75%. Moreover less than one-fourth of patients had HbA1C below 7%. The prevalence for diabetic retinopathy and nephropathy were approximately 23.7% and 38.3%. In addition, more than 15% of patients had diabetic foot problems, loss of protective sensation and pedal pulse deficit. Finally, the incidence rates were 80.1 per 1,000 person-years (95% CI 69.7, 91.8) for diabetic retinopathy, and 91.1 per 1,000 person-years (95% CI 78.8, 105.1) for diabetic nephropathy Problems regarding poor diabetes control exist in Thai diabetes patients. It results in high prevalence and incidence of diabetic complications. As such, it is crucial to establish the country's diabetes management plan as well as evaluate the long-term complications in diabetic patients annually, in order for patients to receive the benefits of early treatment and prevent further complications.

  9. Long-Term Secondary Care Costs of Endometrial Cancer: A Prospective Cohort Study Nested within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available There is limited evidence on the costs of Endometrial Cancer (EC by stage of disease. We estimated the long-term secondary care costs of EC according to stage at diagnosis in an English population-based cohort.Women participating in UKCTOCS and diagnosed with EC following enrolment (2001-2005 and prior to 31st Dec 2009 were identified to have EC through multiple sources. Survival was calculated through data linkage to death registry. Costs estimates were derived from hospital records accessed from Hospital Episode Statistics (HES with additional patient level covariates derived from case notes and patient questionnaires. Missing and censored data was imputed using Multiple Imputation. Regression analysis of cost and survival was undertaken.491 of 641 women with EC were included. Five year total costs were strongly dependent on stage, ranging from £9,475 (diagnosis at stage IA/IB to £26,080 (diagnosis at stage III. Stage, grade and BMI were the strongest predictors of costs. The majority of costs for stage I/II EC were incurred in the first six months after diagnosis while for stage III / IV considerable costs accrued after the first six months.In addition to survival advantages, there are significant cost savings if patients with EC are detected earlier.

  10. Which of the technologies for producing hydrogen is the most prospective in Korea?: Evaluating the competitive priority of those in near-, mid-, and long-term

    International Nuclear Information System (INIS)

    Chung, Yanghon; Hong, Sungjun; Kim, Jongwook

    2014-01-01

    In order to evaluate the alternative technologies for producing hydrogen in Korea stage by stage, we searched for impact factors, calculated the weights of them and evaluated the hydrogen production technologies in Korea using analytic hierarchy process (AHP) approach. The AHP is a useful method for resolving multi-criteria decision making problems. We investigated 4 criteria (technical characteristics, economic efficiency, marketability, internal capability) and 11 sub-criteria (scale, efficiency, key barriers, carbon dioxide reduction, current production cost, expected production cost in 2017, feed-stock, technical maturity, R and D competitive level, technology gap with competing agencies, and domestic infrastructure). And the alternatives are natural gas reforming technology, coal gasification technology, biomass gasification technology, water electrolysis technology, thermochemical production technology, photoelectrochemical hydrogen production technology, and biological hydrogen production technology. In order to maintain the objectivity of the analysis result and observe the difference among the groups, the questionnaire survey targets were divided into the R and D professional group and policy professional group. This result of study is expected to serve as important basic information in the establishment of a national R and D strategy to prepare for the imminent hydrogen economy era. - highlights: • We evaluated the alternatives for producing hydrogen in Korea using AHP approach in near-, mid-, and long-term. • The framework is consist of goal, 4 criteria, 11 sub-criteria, and 7 alternatives. • The questionnaire survey targets and results were divided into the R and D professional group and policy professional group

  11. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2015-11-15

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  12. Effect of inpatient rehabilitation on quality of life and exercise capacity in long-term lung transplant survivors: a prospective, randomized study.

    Science.gov (United States)

    Ihle, Franziska; Neurohr, Claus; Huppmann, Patrick; Zimmermann, Gregor; Leuchte, Hanno; Baumgartner, Rainer; Kenn, Klaus; Sczepanski, Bernd; Hatz, Rudolf; Czerner, Stephan; Frey, Lorenz; Ueberfuhr, Peter; Bittmann, Iris; Behr, Jürgen

    2011-08-01

    The purpose of this study was to examine the effect of an inpatient rehabilitation program on health-related quality of life (HRQOL) and exercise capacity (EC) in long-term (>1 year after lung transplantation) survivors (LTSs) in comparison to a control group (CG). Sixty LTSs, 4.5 ± 3.2 years after lung transplantation (LTx), were randomly assigned to two equally sized groups that were stratified for gender and underlying disease. Thirty LTSs (age 49 ± 13 years, 13 male and 17 females, 19 double LTxs, 7 BOS Stage ≥ 1) attended an inpatient rehabilitation program (intervention group, IG) for 23 ± 5 days. The CG (age 50 ± 12 years, 13 males and 17 females, 20 double LTxs, 2 BOS Stage ≥ 1) received medical standard therapy (physiotherapy). Patients were evaluated by cardiopulmonary exercise testing, 6-minute walk test (6MWT), SF-36, SGRQ and the Quality of Life Profile for Chronic Diseases questionnaire before and after (18 ± 3 days) the program. The groups were statistically indistinguishable in terms of clinical data. Each treatment group significantly improved their sub-maximal EC (6MWT: IG, 493 ± 90 m vs 538 ± 90 m, p exercise tolerance in LTS. Our study results did not demonstrate a significant benefit of an inpatient over an outpatient exercise program. Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  13. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    International Nuclear Information System (INIS)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K.

    2015-01-01

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  14. Long Term Financing of Infrastructure

    OpenAIRE

    Sinha, Sidharth

    2014-01-01

    Infrastructure projects, given their long life, require long term financing. The main sources of long term financings are insurance and pension funds who seek long term investments with low credit risk. However, in India household financial savings are mainly invested in bank deposits. Insurance and pension funds account for only a small percentage of household financial savings. In addition most infrastructure projects do not qualify for investment by insurance and pension funds because of t...

  15. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-10-01

    Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).

  16. A Cognitive- Behavioral Therapeutic Program for Patients with Obesity and Binge Eating Disorder: Short- and Long- Term Follow-Up Data of a Prospective Study

    Science.gov (United States)

    Vanderlinden, Johan; Adriaensen, An; Vancampfort, Davy; Pieters, Guido; Probst, Michel; Vansteelandt, Kristof

    2012-01-01

    The goal of this study is to investigate the efficacy of a manualized cognitive-behavioral therapeutic (CBT) approach for patients with obesity and binge eating disorder (BED) on the short and longer term. A prospective study without a control group consisting of three measurements (a baseline measurement and two follow-up assessments up to 5…

  17. Subjective and Objective Peer Approval Evaluations and Self-Esteem Development: A Test of Reciprocal, Prospective, and Long-Term Effects

    Science.gov (United States)

    Gruenenfelder-Steiger, Andrea E.; Harris, Michelle A.; Fend, Helmut A.

    2016-01-01

    A large body of literature suggests a clear, concurrent association between peer approval and self-esteem in adolescence. However, little empirical work exists on either the prospective or reciprocal relation between peer approval and self-esteem during this age period. Moreover, it is unclear from past research whether both "subjectively…

  18. What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study.

    Science.gov (United States)

    Davies, Neil M; Taylor, Gemma; Taylor, Amy E; Thomas, Kyla H; Windmeijer, Frank; Martin, Richard M; Munafò, Marcus R

    2015-11-05

    Smoking is a major avoidable cause of ill-health and premature death. Treatments that help patients successfully quit smoking have an important effect on health and life expectancy. Varenicline is a medication that can help smokers successfully quit smoking. However, there are concerns that it may cause adverse effects, such as increase in the occurrence of depression, self-harm and suicide and cardiovascular disease. In this study we aim to examine the effects of varenicline versus other smoking cessation pharmacotherapies on smoking cessation, health service use, all-cause and cause-specific mortality and physical and mental health conditions. In this project we will investigate the effects of varenicline compared to nicotine replacement therapies on: (1) long-term smoking cessation and whether these effects differ by area level deprivation; and (2) the following clinically-important outcomes: rate of general practice and hospital attendance; all-cause mortality and death due to diseases of the respiratory system and cardiovascular disease; and a primary care diagnosis of respiratory illness, myocardial infarction or depression and anxiety. The study is based on a cohort of patients prescribed these smoking cessation medications from the Clinical Practice Research Datalink (CPRD). We will use three methods to overcome confounding: multivariable adjusted Cox regression, propensity score matched Cox regression, and instrumental variable regression. The total expected sample size for analysis will be at least 180,000. Follow-up will end with the earliest of either an 'event' or censoring due to the end of registration or death. Ethics approval was not required for this study. This project has been approved by the CPRD's Independent Scientific Advisory Committee (ISAC). We will disseminate our findings via publications in international peer-reviewed journals and presentations at international conferences. Published by the BMJ Publishing Group Limited. For permission

  19. The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study.

    Science.gov (United States)

    Biederman, J; Petty, C R; Dolan, C; Hughes, S; Mick, E; Monuteaux, M C; Faraone, S V

    2008-07-01

    A better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications. Subjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan-Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age. ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder. These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.

  20. Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Jaen, Javier, E-mail: javier.jaen.sspa@juntadeandalucia.es [Unidad de Atencion Integral al Cancer, Hospital Universitario Puerta del Mar, Cadiz (Spain); Vazquez, Gonzalo [Servicio de Oncologia Radioterapica, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid (Spain); Alonso, Enrique; De Las Penas, Maria D.; Diaz, Laura [Unidad de Atencion Integral al Cancer, Hospital Universitario Puerta del Mar, Cadiz (Spain); De Las Heras, Manuel [Servicio de Oncologia Radioterapica, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid (Spain); Perez-Regadera, Jose F. [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain)

    2012-12-01

    Purpose: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. Methods and Materials: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. Results: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (-3.5%, -3.8%, and -5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT ({Delta}PFT) values at 7 years. Conclusions: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical

  1. Long-term MRI cell tracking after intraventricular delivery in a patient with global cerebral ischemia and prospects for magnetic navigation of stem cells within the CSF.

    Directory of Open Access Journals (Sweden)

    Miroslaw Janowski

    Full Text Available The purpose of the study was to evaluate the long-term clinical tracking of magnetically labeled stem cells after intracerebroventricular transplantation as well as to investigate in vitro feasibility for magnetic guidance of cell therapy within large fluid compartments.After approval by our Institutional Review Board, an 18-month-old patient, diagnosed as being in a vegetative state due to global cerebral ischemia, underwent cell transplantation to the frontal horn of the lateral ventricle, with umbilical cord blood-derived stem cells labeled with superparamagnetic iron oxide (SPIO contrast agent. The patient was followed over 33 months with clinical examinations and MRI. To evaluate the forces governing the distribution of cells within the fluid compartment of the ventricular system in vivo, a gravity-driven sedimentation assay and a magnetic field-driven cell attraction assay were developed in vitro.Twenty-four hours post-transplantation, MR imaging (MRI was able to detect hypointense cells in the occipital horn of the lateral ventricle. The signal gradually decreased over 4 months and became undetectable at 33 months. In vitro, no significant difference in cell sedimentation between SPIO-labeled and unlabeled cells was observed (p = NS. An external magnet was effective in attracting cells over distances comparable to the size of human lateral ventricles.MR imaging of SPIO-labeled cells allows monitoring of cells within lateral ventricles. While the initial biodistribution is governed by gravity-driven sedimentation, an external magnetic field may possibly be applied to further direct the distribution of labeled cells within large fluid compartments such as the ventricular system.

  2. A prospective study of long-term results and the red blood cell immune adherence function following 131I treatment of Graves' disease

    International Nuclear Information System (INIS)

    Sun Zengjun; Ma Yuqin; Liu Junqing; Zhang Xia

    2003-01-01

    Objective: To observe the long-term curative effect and red blood cell immune function in patients with Graves' Disease (GD) after radioactive iodine ( 131 I) treatment. Methods: To observe the hyperthyroid symptoms, physical signs and to measure the concentration of FT3, FT4, FSH by radioimmunoassay, the percent of RBC-C 3b R-YR(%), RBC-IC-YR(%). Results: Patients with GD treated by 131 I after three month, these hyperthyroid symptoms, Physical signs are alleviated and even vanished in patients who were treated by 131 I after 1.5 years, RBC-C 3b R-YR(%) are normal in all patients, but RBC-IC-YR(%) are higher than before treatment with 131 I, then become lower after three months, treatment by 131 I but they were higher than those in normal group, when treated with 131 I after 1.5 years, RBC-IC-YR(%) are normal, the relationship between RBC-C 3b R-YR(%) and RBC-IC-YR(%) are positively interacted. Conclusion: The 131 I treatment produces a good rapid curative effect for GD patients, the disorder state of the red cell immune adherence system is rapidly corrected and this effect is unidirectional. So RBC-C 3b R-YR(%), RBC-IC-YR(%) are the useful predictors of GD remission and their relationship, RBC-IC-YR(%) are helpful in explaining the mechanism of radioactive iodine therapy and are the predictors of GD remission after 131 I treatment

  3. Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients

    Directory of Open Access Journals (Sweden)

    Landheim Anne

    2007-06-01

    Full Text Available Abstract Background A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for. Methods A consecutive sample of substance dependent in- and outpatients (n = 287 from two counties of Norway were assessed at baseline (T1 with the Composite International Diagnostic Interview (Axis I, Millon's Clinical Multiaxial Inventory (Axis II, and the Hopkins Symptom Checklist (HSCL-25 (mental distress. At follow-up (T2, 48% (137/287 subjects, 29% women were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test. Results The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder, the number of and specific Axis II disorders (anxious and impulsive personality disorders, and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up. Conclusion These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in

  4. The long-term impact of early life poverty on orbitofrontal cortex volume in adulthood: results from a prospective study over 25 years.

    Science.gov (United States)

    Holz, Nathalie E; Boecker, Regina; Hohm, Erika; Zohsel, Katrin; Buchmann, Arlette F; Blomeyer, Dorothea; Jennen-Steinmetz, Christine; Baumeister, Sarah; Hohmann, Sarah; Wolf, Isabella; Plichta, Michael M; Esser, Günter; Schmidt, Martin; Meyer-Lindenberg, Andreas; Banaschewski, Tobias; Brandeis, Daniel; Laucht, Manfred

    2015-03-01

    Converging evidence has highlighted the association between poverty and conduct disorder (CD) without specifying neurobiological pathways. Neuroimaging research has emphasized structural and functional alterations in the orbitofrontal cortex (OFC) as one key mechanism underlying this disorder. The present study aimed to clarify the long-term influence of early poverty on OFC volume and its association with CD symptoms in healthy participants of an epidemiological cohort study followed since birth. At age 25 years, voxel-based morphometry was applied to study brain volume differences. Poverty (0=non-exposed (N=134), 1=exposed (N=33)) and smoking during pregnancy were determined using a standardized parent interview, and information on maternal responsiveness was derived from videotaped mother-infant interactions at the age of 3 months. CD symptoms were assessed by diagnostic interview from 8 to 19 years of age. Information on life stress was acquired at each assessment and childhood maltreatment was measured using retrospective self-report at the age of 23 years. Analyses were adjusted for sex, parental psychopathology and delinquency, obstetric adversity, parental education, and current poverty. Individuals exposed to early life poverty exhibited a lower OFC volume. Moreover, we replicated previous findings of increased CD symptoms as a consequence of childhood poverty. This effect proved statistically mediated by OFC volume and exposure to life stress and smoking during pregnancy, but not by childhood maltreatment and maternal responsiveness. These findings underline the importance of studying the impact of early life adversity on brain alterations and highlight the need for programs to decrease income-related disparities.

  5. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial.

    Science.gov (United States)

    Blauvelt, Andrew; de Bruin-Weller, Marjolein; Gooderham, Melinda; Cather, Jennifer C; Weisman, Jamie; Pariser, David; Simpson, Eric L; Papp, Kim A; Hong, H Chih-Ho; Rubel, Diana; Foley, Peter; Prens, Errol; Griffiths, Christopher E M; Etoh, Takafumi; Pinto, Pedro Herranz; Pujol, Ramon M; Szepietowski, Jacek C; Ettler, Karel; Kemény, Lajos; Zhu, Xiaoping; Akinlade, Bolanle; Hultsch, Thomas; Mastey, Vera; Gadkari, Abhijit; Eckert, Laurent; Amin, Nikhil; Graham, Neil M H; Pirozzi, Gianluca; Stahl, Neil; Yancopoulos, George D; Shumel, Brad

    2017-06-10

    Dupilumab (an anti-interleukin-4-receptor-α monoclonal antibody) blocks signalling of interleukin 4 and interleukin 13, type 2/Th2 cytokines implicated in numerous allergic diseases ranging from asthma to atopic dermatitis. Previous 16-week monotherapy studies showed that dupilumab substantially improved signs and symptoms of moderate-to-severe atopic dermatitis with acceptable safety, validating the crucial role of interleukin 4 and interleukin 13 in atopic dermatitis pathogenesis. We aimed to evaluate the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids versus placebo with topical corticosteroids in adults with moderate-to-severe atopic dermatitis. In this 1-year, randomised, double-blinded, placebo-controlled, phase 3 study (LIBERTY AD CHRONOS), adults with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids were enrolled at 161 hospitals, clinics, and academic institutions in 14 countries in Europe, Asia-Pacific, and North America. Patients were randomly assigned (3:1:3) to subcutaneous dupilumab 300 mg once weekly (qw), dupilumab 300 mg every 2 weeks (q2w), or placebo via a central interactive voice/web response system, stratified by severity and global region. All three groups were given concomitant topical corticosteroids with or without topical calcineurin inhibitors where inadvisable for topical corticosteroids. Topical corticosteroids could be tapered, stopped, or restarted on the basis of disease activity. Coprimary endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-point or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week 16. Week 16 efficacy and week 52 safety analyses included all randomised patients; week 52 efficacy included patients who completed treatment by US regulatory submission cutoff. This study is registered with ClinicalTrials.gov, NCT02260986. Between Oct 3, 2014

  6. A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity?

    Science.gov (United States)

    Tanriverdi, Fatih; De Bellis, Annamaria; Ulutabanca, Halil; Bizzarro, Antonio; Sinisi, Antonio A; Bellastella, Giuseppe; Amoresano Paglionico, Vanda; Dalla Mora, Liliana; Selcuklu, Ahmed; Unluhizarci, Kursad; Casanueva, Felipe F; Kelestimur, Fahrettin

    2013-08-15

    Traumatic brain injury (TBI) has been recently recognized as a common cause of pituitary dysfunction. However, there are not sufficient numbers of prospective studies to understand the natural history of TBI induced hypopituitarism. The aim was to report the results of five years' prospective follow-up of anterior pituitary function in patients with mild, moderate and severe TBI. Moreover, we have prospectively investigated the associations between TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women) were included who were prospectively evaluated 12 months and five years after TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH) deficiency is the most common pituitary hormone deficit at one, three, and five years after TBI. Although most of the pituitary hormone deficiencies improve over time, there were substantial percentages of pituitary hormone deficiencies at the fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin deficiencies). Pituitary dysfunction was significantly higher in strongly AHA- and APA-positive (titers ≥1/16) patients at the fifth year. In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over time in a considerable number of patients but, although rarely, may also worsen over the five-year period. However in severe TBI, ACTH and GH status of the patients at the first year evaluation persisted at the fifth year. Therefore, screening pituitary function after TBI for five years is important, especially in patients with mild TBI. Moreover, close strong associations between the presence of high titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the first time.

  7. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

    Science.gov (United States)

    Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

    2015-04-25

    Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

  8. Long-term urethral catheterisation.

    Science.gov (United States)

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  9. Postdiagnostic physical activity, sleep duration, and TV watching and all-cause mortality among long-term colorectal cancer survivors: a prospective cohort study.

    Science.gov (United States)

    Ratjen, Ilka; Schafmayer, Clemens; di Giuseppe, Romina; Waniek, Sabina; Plachta-Danielzik, Sandra; Koch, Manja; Burmeister, Greta; Nöthlings, Ute; Hampe, Jochen; Schlesinger, Sabrina; Lieb, Wolfgang

    2017-10-25

    Lifestyle recommendations for cancer survivors are warranted to improve survival. In this study, we aimed to examine the association of total physical activity, different types of physical activity, hours of sleeping at day and night, and hours spent watching television (TV) with all-cause mortality in long-term colorectal cancer (CRC) survivors. We assessed physical activity in 1376 CRC survivors (44% women; median age, 69 years) at median 6 years after CRC diagnosis using a validated questionnaire. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality according to categories of physical activities, sleep duration, and TV watching. During a median follow-up time of 7 years, 200 participants had died. Higher total physical activity was significantly associated with lower all-cause mortality (HR: 0.53; 95% CI: 0.36-0.80, 4th vs. 1st quartile). Specifically, sports, walking, and gardening showed a significant inverse association with all-cause mortality (HR: 0.34; 95% CI: 0.20-0.59, HR: 0.65; 95% CI: 0.43-1.00, and HR: 0.62; 95% CI: 0.42-0.91, respectively for highest versus lowest category). Individuals with ≥2 h of sleep during the day had a significantly increased risk of all-cause mortality compared to individuals with no sleep at day (HR: 2.22; 95% CI: 1.43-3.44). TV viewing of ≥4 h per day displayed a significant 45% (95% CI: 1.02-2.06) higher risk of dying compared to ≤2 h per day of watching TV. Physical activity was inversely related to all-cause mortality; specific activity types might be primarily responsible for this association. More hours of sleep during the day and a higher amount of TV viewing were each associated with higher all-cause mortality. Based on available evidence, it is reasonable to recommend CRC survivors to engage in regular physical activity.

  10. Preoperative Chemoradiation Therapy With Capecitabine/Oxaliplatin and Cetuximab in Rectal Cancer: Long-Term Results of a Prospective Phase 1/2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Fokas, Emmanouil, E-mail: emmanouil.fokas@kgu.de [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Conradi, Lena [Department of General Surgery, University Medical Center of Göttingen (Germany); Weiss, Christian [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Sprenger, Thilo [Department of General Surgery, University Medical Center of Göttingen (Germany); Middel, Peter [Institute for Pathology, University Medical Center, Göttingen (Germany); Rau, Tillman [Institute of Pathology, University Hospital Erlangen, Erlangen (Germany); Dellas, Kathrin [Department of Radiotherapy, Lübeck University (Germany); Kitz, Julia [Institute for Pathology, University Medical Center, Göttingen (Germany); Rödel, Franz [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Sauer, Rolf [Department of Radiation Oncology, University of Erlangen (Germany); Rüschoff, Josef [Targos Molecular Pathology, Kassel (Germany); Beissbarth, Tim [Department of Medical Statistics, University Medical Center of Göttingen (Germany); Arnold, Dirk [Tumor Biology Center Freiburg, University of Freiburg (Germany); Ghadimi, B. Michael [Department of General Surgery, University Medical Center of Göttingen (Germany); Rödel, Claus [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Liersch, Torsten [Department of General Surgery, University Medical Center of Göttingen (Germany)

    2013-12-01

    Purpose: We have previously shown that the addition of cetuximab to chemoradiation therapy failed to improve complete response rates (pCR) in rectal cancer. Here we report the long-term results of the cetuximab added to preoperative radiation therapy with capecitabine and oxaliplatin (CET-CAPOX-RT) phase 1/2 study that evaluated preoperative chemoradiation with cetuximab, capecitabine, and oxaliplatin in patients with rectal cancer. Methods and Materials: The median follow-up was 63 months (range, 5-73 months). Sixty patients were enrolled; 3 patients were excluded due to protocol violation, and 4 died before surgery. Total mesorectal excision was performed in 53 patients, in 85% (n=45) with curative intention (M0-status). Secondary end points including overall survival (OS) disease-free survival (DFS) and cancer-specific survival (CSS) were calculated. The prognostic value of KRAS mutation status was also assessed. Results: Histopathological examination confirmed ypUICC stages 0 (n=4; pCR), I (n=17), II (n=10), III (n=14), and IV (n=8). For patients who underwent surgery (n=53), OS at 1, 3, and 5 years was 88.7%, 83%, and 75.5%, respectively, whereas CSS rates were 94.1%, 88.1%, and 78.1%, respectively. In the 45 patients who were treated with curative intent (M0), the OS rates at 1, 3, and 5 years were 91.1%, 88.9%, and 86.7%, respectively; whereas CSS rates were 97.6%, 95.2%, and 90.3%, respectively; and DFS rates were 90.7%, 88.3%, and 88.3%, respectively. We did not find any locoregional failure in patients with M0-status (n=45). Chronic toxicity was rare. KRAS mutations, as detected in 33.3%, showed no correlation with the clinicopathological parameters nor significance for either OS (P=.112), CSS (P=.264), or DFS (P=.565). Conclusions: Taken together, chemoradiation therapy combined with cetuximab is safe, feasible, and offers excellent survival rates. KRAS mutation status was not a predictive factor. Importantly, lack of improvement in pCR rate did not

  11. Preoperative Chemoradiation Therapy With Capecitabine/Oxaliplatin and Cetuximab in Rectal Cancer: Long-Term Results of a Prospective Phase 1/2 Study

    International Nuclear Information System (INIS)

    Fokas, Emmanouil; Conradi, Lena; Weiss, Christian; Sprenger, Thilo; Middel, Peter; Rau, Tillman; Dellas, Kathrin; Kitz, Julia; Rödel, Franz; Sauer, Rolf; Rüschoff, Josef; Beissbarth, Tim; Arnold, Dirk; Ghadimi, B. Michael; Rödel, Claus; Liersch, Torsten

    2013-01-01

    Purpose: We have previously shown that the addition of cetuximab to chemoradiation therapy failed to improve complete response rates (pCR) in rectal cancer. Here we report the long-term results of the cetuximab added to preoperative radiation therapy with capecitabine and oxaliplatin (CET-CAPOX-RT) phase 1/2 study that evaluated preoperative chemoradiation with cetuximab, capecitabine, and oxaliplatin in patients with rectal cancer. Methods and Materials: The median follow-up was 63 months (range, 5-73 months). Sixty patients were enrolled; 3 patients were excluded due to protocol violation, and 4 died before surgery. Total mesorectal excision was performed in 53 patients, in 85% (n=45) with curative intention (M0-status). Secondary end points including overall survival (OS) disease-free survival (DFS) and cancer-specific survival (CSS) were calculated. The prognostic value of KRAS mutation status was also assessed. Results: Histopathological examination confirmed ypUICC stages 0 (n=4; pCR), I (n=17), II (n=10), III (n=14), and IV (n=8). For patients who underwent surgery (n=53), OS at 1, 3, and 5 years was 88.7%, 83%, and 75.5%, respectively, whereas CSS rates were 94.1%, 88.1%, and 78.1%, respectively. In the 45 patients who were treated with curative intent (M0), the OS rates at 1, 3, and 5 years were 91.1%, 88.9%, and 86.7%, respectively; whereas CSS rates were 97.6%, 95.2%, and 90.3%, respectively; and DFS rates were 90.7%, 88.3%, and 88.3%, respectively. We did not find any locoregional failure in patients with M0-status (n=45). Chronic toxicity was rare. KRAS mutations, as detected in 33.3%, showed no correlation with the clinicopathological parameters nor significance for either OS (P=.112), CSS (P=.264), or DFS (P=.565). Conclusions: Taken together, chemoradiation therapy combined with cetuximab is safe, feasible, and offers excellent survival rates. KRAS mutation status was not a predictive factor. Importantly, lack of improvement in pCR rate did not

  12. Long-term survival of patients with primary oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study; 5-Jahres-Ueberlebenswahrscheinlichkeit von Patienten mit primaeren Plattenepithelkarzinomen der Mundhoehle. Vergleich von zwei Behandlungsstrategien in einer prospektiven Studie

    Energy Technology Data Exchange (ETDEWEB)

    Kessler, P.; Bloch-Birkholz, A.; Neukam, F.W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Mund-, Kiefer-, Gesichtschirurgie; Grabenbauer, G.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Leher, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Medizininformatik, Biometrie und Epidemiologie; Vairaktaris, E. [Univ. of Athens Medical School (Greece). Dept. of Maxillofacial Surgery

    2007-04-15

    Background and Purpose: In recent years, different concepts for the treatment of oral squamous cell carcinomas (OSCC) have been developed; these include preoperative simultaneous neoadjuvant radiochemotherapy and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that multimodality treatment based on a neoadjuvant radiochemotherapy is superior to adjuvant therapy concepts based on a surgical approach with postoperative irradiation. The aim of this study was to discuss the 5-year survival rate in a neoadjuvant and an adjuvant combination treatment in patients with primary OSCC. Patients and Methods: This nonrandomized longitudinal study prospectively evaluates the long-term tumor-free survival in 128 patients with oral cancer. Two groups consisting of 74 neoadjuvantly and 54 primarily surgically treated patients were formed. 99 patients suffered from stage III and IV disease according to the UICC criteria. Long-term survival was estimated according to the Kaplan-Meier assumption. Results: The neoadjuvant treatment increases the prospect of a long-term tumor-free survival. According to Kaplan-Meier assumption the estimation for a 5-year tumor-free survival in OSCC in category T1 is 83.1% in neoadjuvant, and 70.1% in adjuvant treatment, in T2 79.6% and 57.7%, in T3 68.2% and 33.2%, in T4 51.4% and 30.5%, respectively. Significance (p < 0.05) could be proven for T1 (p = 0.002), T2 (p = 0.028), and T4 (p < 0.0001) tumors. The effectiveness of the preoperative radiochemotherapy was demonstrated in the pathohistological result of tumor-free resection specimens in 28 patients of the neoadjuvant treatment group (37.8%). On the other hand, four patients died during the preoperative combination therapy. 64.8% of the patients in the adjuvant and 71.6% in the neoadjuvant treatment group survived the observation period. Conclusion: Neoadjuvant therapy is highly effective and results in a better 5-year

  13. Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial

    International Nuclear Information System (INIS)

    Eltabbakh, Gamal H.; Piver, M. Steven; Hempling, Ronald E.; Shin, Kyu H.

    1997-01-01

    Purpose: The value of adjuvant radiation therapy and staging pelvic lymphadenectomy in patients with low-risk, early-stage endometrial cancer is controversial. The aim of this study was to report the long-term survival, rate of recurrences, and complications in patients with Stage I endometrial cancer, Grade 1-2, with <50% myometrial invasion treated with hysterectomy (without formal staging pelvic and periaortic lymph node sampling or lymph-adenectomy) and postoperative vaginal brachytherapy. Methods and Materials: A total of 303 patients with pathologic Stage I endometrial cancer, Grade 1-2, with <50% myometrial invasion and nonmalignant peritoneal cytology, were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and postoperative vaginal brachytherapy (30 Gy to point 0.5 cm depth) in a prospective study extending from 1958 to 1994. In addition, 29 additional Stage I, Grade 1-2 patients with <50% myometrial invasion and malignant peritoneal cytology were treated with 1 year of progesterone therapy. Patients were followed for 1.2-32 years (median 8.1 y). Results: Six patients had recurrences and died secondary to disease. There were no vaginal recurrences. The 5-, 10-, 20-, and 30-year disease-free survivals of the 303 patients with nonmalignant peritoneal cytology were 98.9%, 97.8%, 96.7%, and 96.7%, respectively. Patients with malignant peritoneal cytology had a 5- and 10-year disease-free survival of 100%. Significant radiation complications occurred in 2.1% of the patients. Conclusion: In patients with low-risk, Stage I endometrial cancer, hysterectomy and adjuvant postoperative vaginal brachytherapy provide excellent long-term survival, eliminate vaginal recurrences, and are not associated with significant complications. The addition of 1 year of progesterone therapy to patients with malignant cytology provides 100% long-term survival. Based on these results, patients with low-risk, Stage I endometrial adenocarcinoma do not need

  14. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term low-dose aspirin therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial.

    Science.gov (United States)

    Sugano, Kentaro; Matsumoto, Yasushi; Itabashi, Tsukasa; Abe, Sumihisa; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Chiba, Tsutomu; Matsui, Shigeyuki; Kanto, Tatsuya; Shimada, Kazuyuki; Uchiyama, Shinichiro; Uemura, Naomi; Hiramatsu, Naoki

    2011-06-01

    The efficacy of low-dose lansoprazole has not been established for the prevention of recurrent gastric or duodenal ulcers in those receiving long-term low-dose aspirin (LDA) for cardiovascular and cerebrovascular protection. This study sought to examine the efficacy of low-dose lansoprazole (15 mg once daily) for the secondary prevention of LDA-associated gastric or duodenal ulcers. Patients were randomized to receive lansoprazole 15 mg daily (n = 226) or gefarnate 50 mg twice daily (n = 235) for 12 months or longer in a prospective, multicenter, double-blind, randomized active-controlled trial, followed by a 6-month follow-up study with open-label lansoprazole treatment. The study utilized 94 sites in Japan and 461 Japanese patients with a history of gastric or duodenal ulcers who required long-term LDA therapy for cardiovascular and cerebrovascular disease. The primary endpoint was the development of gastric or duodenal ulcers. The cumulative incidence of gastric or duodenal ulcers on days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 1.5, 2.1, and 3.7%, respectively, in the lansoprazole group versus 15.2, 24.0, and 31.7%, respectively, in the gefarnate group. The risk of ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.099 (95% confidence interval [CI] 0.042-0.230). Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term LDA therapy.

  15. Long-term effect of coffee consumption on autosomal dominant polycystic kidneys disease progression: results from the Suisse ADPKD, a Prospective Longitudinal Cohort Study.

    Science.gov (United States)

    Girardat-Rotar, Laura; Puhan, Milo A; Braun, Julia; Serra, Andreas L

    2018-02-01

    Previous in vitro experiments of human polycystic kidney disease (PKD) cells reported that caffeine is a risk factor for the promotion of cyst enlargement in patients with autosomal dominant PKD (ADPKD). The relentless progression of ADPKD inclines the majority of physicians to advocate minimization of caffeine consumption despite the absence of clinical data supporting such a recommendation so far. This is the first clinical study to assess prospectively the association between coffee consumption and disease progression in a longitudinal ADPKD cohort. Information on coffee consumption and disease progression was collected at each follow-up visit using standardized measurement methods. The main model for the outcomes, kidney size (height-adjusted total kidney volume, htTKV) and kidney function (estimated glomerular filtration rate, eGFR), was a linear mixed model. Patients entered the on-going Swiss ADPKD study between 2006 and June 2014 and had at least 1 visit every year. The sample size of the study population was 151 with a median follow-up of 4 visits per patient and a median follow-up time of 4.38 years. After multivariate adjustment for age, smoking, hypertension, sex, body mass index and an interaction term (coffee*visit), coffee drinkers did not have a statistically significantly different kidney size compared to non-coffee drinkers (difference of -33.03 cm 3 height adjusted TKV, 95% confidence interval (CI) from -72.41 to 6.34, p = 0.10). After the same adjustment, there was no statistically significant difference in eGFR between coffee and non-coffee drinkers (2.03 ml/min/1.73 m 2 , 95% CI from -0.31 to 4.31, p = 0.089). Data derived from our prospective longitudinal study do not confirm that drinking coffee is a risk factor for ADPKD progression.

  16. Long-term effect of latanoprost/timolol fixed combination in patients with glaucoma or ocular hypertension: A prospective, observational, noninterventional study

    Directory of Open Access Journals (Sweden)

    Schwenn Oliver

    2010-09-01

    Full Text Available Abstract Background Prospective, observational studies that enroll large numbers of patients with few exclusion criteria may better reflect actual ongoing clinical experience than randomized clinical trials. Our purpose was to obtain efficacy and safety information from a cohort of subjects exposed to latanoprost/timolol fixed combination (FC for ≥18 months using a prospective, observational design. Methods In all, 577 office-based ophthalmologists in Germany switched 2339 patients with glaucoma or ocular hypertension to latanoprost/timolol FC for medical reasons. Follow-up visits were scheduled for every 6 months over 24 months; physicians followed usual care routines. Intraocular pressure (IOP, visual field status, optic nerve head findings, and adverse events were recorded. Efficacy parameters were evaluated for the per protocol (PP population; the safety population included subjects receiving ≥1 drop of FC. Physicians rated efficacy, tolerability, and subject compliance at month 24. Results Of the 2339 subjects switched to latanoprost/timolol FC (safety population, the primary reasons for switching were inadequate IOP reduction (78.2% and desire to simplify treatment with once-daily dosing (29.4%; multiple reasons possible. In all, 1317 (56.3% subjects completed the study, and 1028 (44.0% were included in the PP population. Most discontinuations were due to loss to follow-up. Change in mean IOP from baseline to month 6 was -4.0 ± 4.31 mmHg, a reduction that was maintained throughout (P Conclusions Over 24 months, latanoprost/timolol FC effectively lowers IOP levels and is well tolerated in patients with glaucoma or ocular hypertension who change from their previous ocular hypotensive therapy for medical reasons. Investigator assessments found optic disc parameters and visual field to be stable throughout 24 months of follow-up.

  17. Long-term economic outlook. Annual review

    Energy Technology Data Exchange (ETDEWEB)

    1988-01-01

    This review provides economic growth forecast tables for Ontario, Canada, the US, Western Europe, and Japan. Economic growth, government policy, the long-term prospects for inflation, interest rates and foreign exchange rates, trends in the Canadian dollar, and energy markets and prices are also reviewed. Data generally cover 1965-2025. Appendices give a summary of historical and forecast data. 18 figs., 16 tabs.

  18. Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II.

    Science.gov (United States)

    Campos, Carlos M; van Klaveren, David; Farooq, Vasim; Simonton, Charles A; Kappetein, Arie-Pieter; Sabik, Joseph F; Steyerberg, Ewout W; Stone, Gregg W; Serruys, Patrick W

    2015-05-21

    To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI. Published on behalf of the European Society of Cardiology. All rights reserved. © The

  19. Comparative Evaluation of the Safety and Efficacy of Long-Term Use of Imidafenacin and Solifenacin in Patients with Overactive Bladder: A Prospective, Open, Randomized, Parallel-Group Trial (the LIST Study

    Directory of Open Access Journals (Sweden)

    Masayoshi Zaitsu

    2011-01-01

    Full Text Available Objectives. Overactive bladder (OAB is a chronic disease, but comparative trials of anticholinergics, which are commonly used for treatment of OAB, have generally been performed for up to 12 weeks only. There is no comparative study of a long-term intervention. Methods. We conducted a 52-week prospective randomized comparative study to evaluate the efficacy and tolerability of two anticholinergics. Results. Forty-one Japanese patients with untreated OAB were randomly assigned to imidafenacin and solifenacin groups. There was no difference in OABSS and KHQ scores between the two groups, but the severity and incidence of adverse events caused by the anticholinergics showed increased differences between the groups with time. The severity of dry mouth and the incidence of constipation were significantly lower in the imidafenacin group (=0.0092 and =0.0013, resp.. Conclusions. This study is the first long-term trial to show differences in the properties of anticholinergics that were not detected in short-term studies. Since OAB is a chronic disease, we conclude that imidafenacin is preferable to solifenacin from a perspective of safety.

  20. Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women.

    Science.gov (United States)

    Tobias, Deirdre K; Stuart, Jennifer J; Li, Shanshan; Chavarro, Jorge; Rimm, Eric B; Rich-Edwards, Janet; Hu, Frank B; Manson, JoAnn E; Zhang, Cuilin

    2017-12-01

    Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors including body weight and lifestyle. To prospectively evaluate history of GD in relation to incident CVD risk. The Nurses' Health Study II (NHS II) is an observational cohort study of US female nurses established in 1989, with ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. Multivariable Cox models estimated the hazard ratio (HR) and 95% CI for CVD risk. We included 89 479 women who reported at least 1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for more than 90% of eligible participants. History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years. We observed 1161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records. Participants had a mean (SD) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71). Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.

  1. Myocardial technetium-99m sestamibi single-photon emission tomography as a prognostic tool in coronary artery disease: multivariate analysis in a long-term prospective study

    International Nuclear Information System (INIS)

    Zanco, P.; Zampiero, A.; Favero, A.; Borsato, N.; Chierichetti, F.; Rubello, D.; Saitta, B.; Ferlin, G.

    1995-01-01

    A prospective study was started in 1988 and at present 176 consecutive, and thus unselected, patients have been enrolled. All of them have been submitted to stress-rest MIBI SPET for the diagnosis or evaluation of CAD; 147 patients (121 males and 26 females, aged 53±9 years) have completed a surveillance period of at least 36 months following the scintigraphic study (range 36-60 months, mean 43). Sixty-one patients had a documented previous myocardial infarction. The mean pre-test likelihood of CAD was 44% in the patients without prior infarction. The main anamnestic, clinical, EKG and scintigraphic findings were evaluated and statistically correlated with the incidence of ensuing cardiac events using both univariate (chi-square test) and multivariate analysis (logistic regression model). Twenty-nine patients suffered from a cardiac event during the follow-up period (i.e. three cardiac deaths, six myocardial infarctions and 20 cases of unstable angina). Statistical multivariate analysis identified MIBI scan as the only highly significant and independent prognostic predictor. In detail, the most important scintigraphic parameters were the presence of a reversible defect and the extension of the stress perfusion defect. The presence of typical angina proved to be a slightly significant predictor, while no other examined parameter showed a significant correlation with a bad prognosis. In conclusion, MIBI SPET can be considered a useful tool in the risk stratification of CAD patients. (orig.). With 3 tabs

  2. Prospects for the medium- and long-term development of China`s electric power industry and analysis of the potential market for superconductivity technology

    Energy Technology Data Exchange (ETDEWEB)

    Li, Z. [Bob Lawrence and Associates, Inc., Alexandria, VA (United States)

    1998-05-01

    First of all, overall economic growth objectives in China are concisely and succinctly specified in this report. Secondly, this report presents a forecast of energy supply and demand for China`s economic growth for 2000--2050. In comparison with the capability of energy construction in China in the future, a gap between supply and demand is one of the important factors hindering the sustainable development of Chain`s economy. The electric power industry is one of China`s most important industries. To adopt energy efficiency through high technology and utilizing energy adequately is an important technological policy for the development of China`s electric power industry in the future. After briefly describing the achievements of China`s electric power industry, this report defines the target areas and policies for the development of hydroelectricity and nuclear electricity in the 2000s in China, presents the strategic position of China`s electric power industry as well as objectives and relevant plans of development for 2000--2050. This report finds that with the discovery of superconducting electricity, the discovery of new high-temperature superconducting (HTS) materials, and progress in materials techniques, the 21st century will be an era of superconductivity. Applications of superconductivity in the energy field, such as superconducting storage, superconducting transmission, superconducting transformers, superconducting motors, its application in Magneto-Hydro-Dynamics (MHD), as well as in nuclear fusion, has unique advantages. Its market prospects are quite promising. 12 figs.

  3. The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: a prospective observational cohort study.

    Science.gov (United States)

    Risco, Ester; Cabrera, Esther; Jolley, David; Stephan, Astrid; Karlsson, Staffan; Verbeek, Hilde; Saks, Kai; Hupli, Maija; Sourdet, Sandrine; Zabalegui, Adelaida

    2015-05-01

    Dementia is a progressive neurological disorder that causes a high degree of dependency. This dependency has been defined as an increased need for assistance due to deterioration in cognition and physical functioning, and changes in behavior. Highly dependent people with dementia are more likely to be institutionalized. To investigate the association between specific categories of physical dependency and the presence of neuropsychiatric symptoms in people with dementia admitted to a long-term care institution. A prospective observational cohort study. Home care and long-term care institutions in eight European countries. People with dementia living at home but at risk of institutionalization and recently institutionalized people with dementia. Baseline and 3-month follow-up interviews were performed between November, 2010 and April, 2012. The sample consisted of 116 recently institutionalized dementia sufferers and 949 people with dementia still living at home. Physical dependency was measured using the Katz Activity of Daily Living index, and neuropsychiatric symptoms were assessed through The Neuropsychiatric Inventory. Specific categories of dependency were analyzed by performing a logistic regression analysis. This followed examination of baseline characteristics to define the degree of physical dependency, as factors associated with institutionalization, and evaluation of the same characteristics at 3-month follow-up to detect changes in the degree of physical dependency and neuropsychiatric symptoms associated with recent admission to a long-term care institution. Toileting, dressing and continence dependency was higher in institutionalized people than in those receiving home-care. Delusion, hallucination, agitation, anxiety, apathy, motor-disturbances, night-time behavior and eating disorders were also worse in the institutionalized. Logistic regression analysis showed that independent factors significantly associated with being recently institutionalized

  4. Long term complications of diabetes

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000327.htm Long-term complications of diabetes To use the sharing features on this page, ... other tests. All these may help you keep complications of diabetes away. You will need to check your blood ...

  5. Immediate and long-term relationship between severe maternal morbidity and health-related quality of life: a prospective double cohort comparison study

    Directory of Open Access Journals (Sweden)

    Mohd Noor Norhayati

    2016-08-01

    Full Text Available Abstract Background Given the growing interest in severe maternal morbidity (SMM, the need to assess its effects on quality of life is pressing. The objective of this study was to compare the quality of life scores between women with and without SMM at 1-month and 6-month postpartum in Kelantan, Malaysia. Methods A prospective double cohort study design was applied at two tertiary referral hospitals over a 6-month period. The study population included all postpartum women who delivered in 2014. Postpartum women with and without SMM were selected as the exposed and non-exposed groups, respectively. For each exposed case identified, a non-exposed case with a similar mode of delivery was selected. The main outcome measures used were scores from the Short Form-12 Health Survey (SF-12. Results The study measured 145 exposed and 187 non-exposed women. The group-time interaction of the repeated measure analysis of variance (RM ANOVA showed no significant difference in the mean overall SF-12 physical component summary score changes (P = 0.534 between women with and without SMM. Similarly, the group-time interaction of the RM ANOVA showed no significant difference in the mean overall SF-12 mental component summary score changes (P = 0.674 between women with and without SMM. However, women with SMM scored significantly lower on a general health perceptions subscale at 1-month (P = 0.031, role limitations due to physical health subscale at 6-month (P = 0.019, vitality subscale at 1-month (P = 0.007 and 6-month (P = 0.008, and role limitations due to emotional problems subscales at 6-month (P = 0.008. Conclusions Women with severe maternal morbidity demonstrated comparable quality of life during the 6-month postpartum period compared to women without severe maternal morbidity.

  6. Long-term impact of childhood disadvantage on late-life functional decline among older Japanese: Results from the JAGES prospective cohort study.

    Science.gov (United States)

    Murayama, Hiroshi; Fujiwara, Takeo; Tani, Yukako; Amemiya, Airi; Matsuyama, Yusuke; Nagamine, Yuiko; Kondo, Katsunori

    2017-09-11

    Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study. Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height and educational level. The sample was stratified by age at baseline (65-69 y, 70-74 y, 75-79 y, and ≥ 80 y). A total of 11,601 respondents were analyzed. In the 65-69 y group, lower childhood SES was associated with functional decline, but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79 y group, lower childhood SES was associated with functional decline. However, in the ≥ 80 y group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74 y group. Higher education was related to functional decline in all age groups except the ≥ 80 y group. These findings suggest that childhood disadvantage affects functional decline, but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. The Clinical Research Center for Depression Study: Baseline Characteristics of a Korean Long-Term Hospital-Based Observational Collaborative Prospective Cohort Study

    Science.gov (United States)

    Kim, Tae-Suk; Jeong, Seung Hee; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Yim, Hyeon-Woo

    2011-01-01

    Objective The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort. Methods Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant. Results One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode. Conclusion The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression. PMID:21519530

  8. Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study.

    Science.gov (United States)

    Christie, Deborah; Thompson, Rebecca; Sawtell, Mary; Allen, Elizabeth; Cairns, John; Smith, Felicity; Jamieson, Elizabeth; Hargreaves, Katrina; Ingold, Anne; Brooks, Lucy; Wiggins, Meg; Oliver, Sandy; Jones, Rebecca; Elbourne, Diana; Santos, Andreia; Wong, Ian C K; O'Neill, Simon; Strange, Vicki; Hindmarsh, Peter; Annan, Francesca; Viner, Russell

    2014-03-01

    Type 1 diabetes (T1D) in children and young people is increasing worldwide with a particular increase in children under the age of 5 years. Fewer than one in six children and young people achieve glycosylated fraction of haemoglobin (HbA1c) values in the range identified as providing best future outcomes. There is an urgent need for clinic-based pragmatic, feasible and effective interventions that improve both glycaemic control and quality of life (QoL). The intervention offers both structured education, to ensure young people know what they need to know, and a delivery model designed to motivate self-management. To assess the feasibility of providing a clinic-based structured educational group programme incorporating psychological approaches to improve long-term glycaemic control, QoL and psychosocial functioning in a diverse range of young people. The study was a pragmatic, cluster randomised control trial with integral process and economic evaluation. Twenty-eight paediatric diabetes services across London, south-east England and the Midlands. Minimised by clinic size, age (paediatric or adolescent) and specialisation (district general hospital clinic or teaching hospital/tertiary clinic). Half of the sites were randomised to the intervention arm and half to the control arm. Allocation was concealed until after clinics had consented and the first participant was recruited. Where possible, families were blind to allocation until recruitment finished. Forty-three health-care practitioners (14 teams) were trained in the intervention. The study recruited 362 children aged 8-16 years, diagnosed with T1D for > 12 months, with a mean 12-month HbA1c level of ≥ 8.5%. Two 1-day workshops taught intervention delivery. A detailed manual and resources were provided. The intervention consists of four group education sessions led by a paediatric diabetes specialist nurse with another team member. The primary outcome was glycaemic control, assessed at the individual level

  9. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

    Science.gov (United States)

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy

    2014-01-01

    BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1

  10. Chemoradiation With Concomitant Boosts Followed by Radical Surgery in Locally Advanced Cervical Cancer: Long-term Results of the ROMA-2 Prospective Phase 2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Ferrandina, Gabriella, E-mail: gabriella.ferrandina@libero.it [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Gambacorta, Antonietta [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Gallotta, Valerio [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Smaniotto, Daniela [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Fagotti, Anna [Gynecologic Surgery, University of Perugia, Terni (Italy); Tagliaferri, Luca [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Foti, Elvira; Fanfani, Francesco [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Autorino, Rosa [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Scambia, Giovanni [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Valentini, Vincenzo [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy)

    2014-11-15

    Purpose: This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials: Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with CBs (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m{sup 2}, days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m{sup 2}/daily, orally) during the first 2 and the last 2 weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if >45 pCR were registered (α error = 0.05; β error = 0.1). Results: pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36 months (range: 7-85 months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or 2. Conclusions: Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by radical surgery results in a high rate of pathologically assessed complete response to CRT and a very

  11. Long-Term Single and Joint Effects of Excessive Daytime Napping on the HOMA-IR Index and Glycosylated Hemoglobin: A Prospective Cohort Study.

    Science.gov (United States)

    Li, Xue; Pang, Xiuyu; Zhang, Qiao; Qu, Qiannuo; Hou, Zhigang; Liu, Zhipeng; Lv, Lin; Na, Guanqiong; Zhang, Wei; Sun, Changhao; Li, Ying

    2016-02-01

    This prospective cohort study was conducted to assess the duration of daytime napping and its effect combined with night sleep deprivation on the risk of developing high HOMA-IR (homeostasis model assessment of insulin resistance) index and disadvantageous changes in glycosylated hemoglobin (HbA1c) levels.A total of 5845 diabetes-free subjects (2736 women and 3109 men), 30 to 65 years of age, were targeted for this cohort study since 2008. Multiple adjusted Cox regression models were performed to evaluate the single and joint effects of daytime napping on the risk of an elevated HbA1c level and high HOMA-IR index.After an average of 4.5 years of follow-up, >30 minutes of daytime napping was significantly associated with an increased risk of an elevated HbA1c level (>6.5%) in men and women (all P trend HOMA-IR index in the entire cohort, men, and women were 1.33 (1.10-1.62), 1.46 (1.08-1.98), and 1.47 (1.12-1.91), respectively. The combination of sleep deprivation with no naps or >30 minutes napping and the combination of no sleep deprivation with >30 minutes daytime napping were all associated with an HbA1c level >6.5% (HR = 2.08, 95% CI = 1.24-3.51; HR = 4.00, 95% CI = 2.03-7.90; and HR = 2.05, 95% CI = 1.29-3.27, respectively). No sleep deprivation combined with >30 minutes daytime napping correlated with a high risk of an HbA1c level between 5.7% and 6.4% and high HOMA-IR index (HR = 2.12, 95% CI = 1.48-3.02; and HR = 1.35, 95% CI = 1.10-1.65, respectively).Daytime napping >30 minutes was associated with a high risk of an elevated HbA1c level and high HOMA-IR index. No sleep deprivation combined with napping >30 minutes carries a risk of abnormal glucose metabolism. Sleep deprivation combined with brief daytime napping HOMA-IR index.

  12. The Long-Term Effects of Maternal Postnatal Depression on a Child's Intelligence Quotient: A Meta-Analysis of Prospective Cohort Studies Based on 974 Cases.

    Science.gov (United States)

    Sui, Guoyuan; Pan, Bochen; Liu, Guangcong; Liu, Guangying; Wang, Lie

    2016-11-01

    Epidemiologists have explored the relationship between maternal postnatal depression (PND) and the intelligence quotient (IQ) of the resulting offspring, but the results remain inconclusive. This study aims to analyze the literature regarding the association between maternal PND and a child's IQ. A search of articles in PubMed, Web of Science, and MEDLINE databases from inception to September 2015 was conducted and supplemented by a manual search of relevant reference lists. The following search terms were used: (postpartum OR postnatal OR puerperal) AND (depression OR depressive symptoms OR blues OR dysthymia OR disorders OR psychosis) AND (intelligence quotient OR IQ OR intelligence tests OR intelligence OR cognitive OR cognition) AND (children OR child OR adolescent OR offspring) AND (cohort OR prospective OR follow-up OR follow OR longitudinal). Articles exploring the association between maternal PND and IQ of offspring aged 2 years and older were included. A total of 510 records were retrieved. Two authors independently selected eligible studies and extracted data. Three authors assessed the quality of the studies. To explore the associations between maternal PND and full IQ and verbal IQ, random-effects meta-analyses were performed, followed by subgroup analysis of impact on full IQ. Nine articles were eligible for review. On the basis of the Newcastle-Ottawa Scale, 7 studies were considered to be of high quality. When one study of participants aged 3.8 years was excluded from the meta-analysis, the pooled weighted mean difference of full IQ between the children of PND mothers and non-PND mothers was -4.086 (95% CI, -6.578 to -1.594), and the pooled standard mean difference of verbal IQ between the children of PND mothers and non-PND mothers was -0.361 (95% CI, -0.564 to -0.158). Subgroup analysis showed that the child's age at evaluation, diagnostic method of PND, study quality, and socioeconomic status did not affect the mean difference in full IQ between

  13. Efficacy and safety of early tacrolimus conversion to sirolimus after kidney transplantation: Long-term results of a prospective randomized study

    Directory of Open Access Journals (Sweden)

    A E El-Agroudy

    2017-01-01

    Full Text Available We report a prospective, open-label, randomized study to evaluate the safety and efficacy of converting patients with a stable renal function from tacrolimus (Tac-based regimen to a sirolimus (SRL-based regimen after kidney transplantation. Fifty-eight low-risk renal allograft recipients who receiving Tac 6 months posttransplant, were randomly assigned to continue Tac (n = 29 or convert to SRL (n = 29. We evaluated the 3-year outcomes including patient and graft survival, graft function, and safety profile. Three-year patient and graft survival in SRL and Tac groups were 93.1% versus 100% (P = 0.32, and 89.7% versus 100% (P = 0.11, respectively. However, the SRL group had a significantly better renal function, from the 2nd year posttransplant until the last follow-up. Four (13.8% patients in the SRL group and 3 (10.3% in the Tac group (P = 0.5 developed biopsy-proven acute rejection. Mean urinary protein excretion increased significantly after SRL conversion. Diastolic blood pressure was significantly lower at the end of the study in patients who eliminated Tac (80.4 vs. 75.6 mmHg in Tac and SRL group, respectively (P = 0.03. Mean hemoglobin concentrations decreased after SRL conversion and remained significantly lower from 12 months to 36 months (P = 0.01. The mean serum cholesterol (540 ± 44 mg/dl and triglyceride (177 ± 27 mg/dl increased significantly in the SRL group, compared to Tac group (487 ± 62 mg/dl (P = 0.03 and (141 ± 26 mg/dl (P = 0.04. Our experience demonstrates that conversion to SRL from calcineurin inhibitors-based therapy may result in better renal function and blood pressure control in renal transplant recipients without an increased risk of acute rejection. However, these benefits have not resulted in a growing advantage in graft or patient survival.

  14. Prevalence of cardiovascular risk factors in long-term survivors of childhood cancer: 16 years follow up from a prospective registry.

    Science.gov (United States)

    Felicetti, Francesco; D'Ascenzo, Fabrizio; Moretti, Claudio; Corrias, Andrea; Omedè, Pierluigi; Marra, Walter Grosso; Arvat, Emanuela; Fagioli, Franca; Brignardello, Enrico; Gaita, Fiorenzo

    2015-06-01

    Childhood cancer survivors (CCSs) have an increased risk of overweight and dyslipidaemia, but the distribution and the potential relationships between anticancer therapies and cardiovascular risk factors have been heterogeneously and not prospectively described. All consecutive CCSs with primary cancer diagnosed between 1973-2007 and subsequently referred to our outpatient clinic were enrolled. Hypercholesterolaemia (total cholesterol >200 and/or low density lipoprotein (LDL)>160 mg/dl) was the primary end point, hypertriglyceridaemia (triglycerides >200 mg/dl) and body mass index >30 kg/m(2) the secondary end points. Cox multivariate adjustments were performed to account for differences in cancer and treatments. A total of 340 patients were included (197 male, 143 female; mean age at last follow-up 24.1 ± 3.2). The most common diagnosis were haematological malignancies (n = 227) and brain tumours (n = 51). After a median follow-up of 16.1 years, hypercholesterolaemia was diagnosed in 67 CCSs (20%), hypertriglyceridaemia in 20 CCSs (6%) and obesity in 28 CCSs (8%). Total body irradiation and growth hormone deficiency increased the risk of both hypercholesterolaemia (hazard ratio (HR) = 2.7; confidence interval (CI) 1.2-4.4 and HR = 2.3; CI 1.1-4.9; all p < 0.05) and hypertriglyceridaemia (HR = 6.5; CI 1.4-31 and HR = 7.2; CI 1.1-43; all p < 0.05). The risk of hypercholesterolaemia was also higher in CCSs who underwent autologous haematopoietic stem cell transplantation (HR = 3.2; CI 1.7-5.9; p < 0.001) or platinum-based chemotherapy (HR = 2.7; CI 1.5-4.9; p < 0.001), whereas a previous diagnosis of brain tumour (HR = 10; CI 1.2-45; p < 0.05) and anthracyclines exposure (HR = 1.3; CI 1.2-26; p < 0.05) significantly predicted obesity. CCSs show a high and variable risk for developing dyslipidaemia and obesity, depending on cancer diagnosis and treatments. Therefore, they need accurate and tailored control of their cardiovascular risk profile. © The European Society

  15. [Long-term psychiatric hospitalizations].

    Science.gov (United States)

    Plancke, L; Amariei, A

    2017-02-01

    Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

  16. Long-term outcomes after disease activity-guided dose reduction of TNF inhibition in rheumatoid arthritis: 3-year data of the DRESS study - a randomised controlled pragmatic non-inferiority strategy trial

    NARCIS (Netherlands)

    Bouman, Chantal Am; van Herwaarden, Noortje; van den Hoogen, Frank Hj; Fransen, Jaap; van Vollenhoven, Ronald F.; Bijlsma, Johannes Wj; Maas, Aatke van der; den Broeder, Alfons A.

    2017-01-01

    Tumour necrosis factor inhibitors (TNFi) are effective in rheumatoid arthritis (RA), but disadvantages include adverse events (AEs) and high costs. This can be improved by disease activity-guided dose reduction (DR). We aimed to assess long-term outcomes of TNFi DR in RA by using 3-year data from

  17. Long-term outcomes after disease activity-guided dose reduction of TNF inhibition in rheumatoid arthritis: 3-year data of the DRESS study - a randomised controlled pragmatic non-inferiority strategy trial

    NARCIS (Netherlands)

    Bouman, C.A.M.; Herwaarden, N. van; Hoogen, F.H.J. van den; Fransen, J.; Vollenhoven, R.F. van; Bijlsma, J.W.; Maas, A.V.; Broeder, A.A. den

    2017-01-01

    OBJECTIVE: Tumour necrosis factor inhibitors (TNFi) are effective in rheumatoid arthritis (RA), but disadvantages include adverse events (AEs) and high costs. This can be improved by disease activity-guided dose reduction (DR). We aimed to assess long-term outcomes of TNFi DR in RA by using 3-year

  18. Short- and long-term effects of real-time medication monitoring with short message service (SMS) reminders for missed doses on the refill adherence of people with Type 2 diabetes: evidence from a randomised controlled trial.

    NARCIS (Netherlands)

    Vervloet, M.; Dijk, L. van; Bakker, D.H. de; Souverein, P.C.; Santen-Reestman, J.; Vlijmen, B. van; Aarle, M.C.W. van; Hoek, L.S. van der; Bouvy, M.L.

    2014-01-01

    Aims: To investigate short- and long-term effects of real-time monitoring medication use combined with short message service (SMS) reminders for missed doses on refill adherence to oral anti-diabetic medication. Methods: A randomized controlled trial with two intervention groups and one control

  19. Clinical and social characteristics associated with reduced visual acuity at presentation in Australian patients with neovascular age-related macular degeneration: a prospective study from a long-term observational data set. The Fight Retinal Blindness! Project.

    Science.gov (United States)

    Nguyen, Vuong; Daien, Vincent; Guymer, Robyn H; McAllister, Ian L; Morlet, Nigel; Barthelmes, Daniel; Gillies, Mark C

    2018-04-01

    Identifying variables that influence presenting visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) is important because it is a strong predictor of long-term outcomes. To assess the clinical and social characteristics associated with low presenting VA in nAMD patients. The present study is a cross-sectional analysis from a prospective, observational database. We identified 3242 treatment-naïve patients from 54 Australian practices in the Fight Retinal Blindness! registry. Age, gender, ethnicity and VA were recorded at the baseline visit. Socio-economic status was determined using the Australian Bureau of Statistics socio-economic indexes for areas. Association between clinical and socio-economic characteristics with presenting VA was identified. Poor VA (≤35 letters) in the presenting eye was associated with older age (adjusted odds ratio [AOR]: 1.33 for patients aged ≥80 years vs. <80 years [95% confidence interval, CI: 1.04, 1.71]), treatment at a public practice (AOR: 1.91 for public vs. private practices [95% CI: 1.46, 2.50]) and intermediate (36-69 letters) VA in the fellow eye (AOR: 0.67 [95% CI: 0.47, 0.95] and 0.64 [95% CI: 0.48, 0.85] for poor [≤35 letters] and good [≥70 letters] VA vs. intermediate VA in the fellow eye). Gender, ethnicity and socio-economic status were not independently associated with VA at presentation. Poor presenting vision is detrimental to the long-term outcomes of nAMD. Poor presentation of nAMD in Australia may not be related to socio-economic circumstances, but due to systems of care. Further research is warranted to determine why patients at public practices present with worse vision compared with private practices in Australia. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  20. Implant rehabilitation of the atrophic edentulous maxilla including immediate fixed provisional restoration without the use of bone grafting: a review of 1-year outcome data from a long-term prospective clinical trial.

    Science.gov (United States)

    Toljanic, Joseph A; Baer, Russell A; Ekstrand, Karl; Thor, Andreas

    2009-01-01

    The literature suggests that predictable integration can be achieved when dental implant placement is combined with immediate fixed provisional restoration in a variety of clinical situations. Fewer data are available, however, regarding outcomes for immediate provisional restoration of implants in the edentulous maxilla. This report presents 1-year data acquired from a long-term prospective clinical trial designed to assess outcomes following the immediate provisional fixed restoration of implants in the atrophic edentulous maxilla without the use of bone augmentation. Fifty-one subjects diagnosed with an atrophic edentulous maxilla received a total of 306 implants (six implants per subject) followed by fixed provisional restoration within 24 hours of implant placement. No subjects underwent grafting to enhance bone volume in preparation for implant treatment. Data acquired included bone quantity and quality, implant dimensions, implant locations, and implant placement stability. Subjects returned for 1-year follow-up examinations to assess implant integration and restoration function. Periapical radiographs were obtained and compared to baseline images to assess marginal bone height maintenance. At the 3-month follow-up examination, 294 of 306 implants placed in 51 subjects were found to be integrated. This represents a cumulative implant survival rate of 96%. At the 1-year follow-up examination, mean marginal bone loss of 0.5 mm was noted, with no further loss of implants. These results support the contention that predictable long-term outcomes may be obtained for the atrophic edentulous maxilla when treated with an implant rehabilitation protocol that includes immediate fixed provisional restoration without the use of bone grafting. This strategy offers a promising treatment alternative for the patient with an atrophic edentulous maxilla.

  1. Psychological and psychosocial functioning of children with burn scarring using cosmetic camouflage: a multi-centre prospective randomised controlled trial.

    Science.gov (United States)

    Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

    2014-02-01

    Burns leave patients with long-term physical scarring. Children with scarring are required to face challenges of reintegration into their community, including acceptance of an altered appearance and acceptance by others. This can be difficult given society's preoccupation with physical appearance. Limited research exists investigating validity of cosmetic camouflage as a psychosocial intervention for children with scarring. This study investigated whether using cosmetic camouflage (Microskin™) had a positive impact on health-related quality of life, self-concept and psychopathology for children and adolescents (8-17 years) with burn scarring. A prospective multi-centre randomised controlled trial was conducted across Australian and New Zealand paediatric hospitals. 63 participants (49 females, mean age 12.7 ± 2.1 years) were enrolled. Data points were baseline (Time 1) and at 8 weeks (Time 2) using reliable and valid psychometric measures. Findings indicate there were significant improvements in socialisation, school and appearance scales on the Paediatric Quality of Life Inventory and psychopathology scores particularly peer problems decreased. However self-concept remained stable from baseline throughout intervention use. Cosmetic camouflage appears to have a positive impact on quality of life particularly socialisation. Cosmetic camouflage is a valid tool to assist children with scarring to actively participate socially within their communities. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  2. Comparison of the long-term skeletal stability between a biodegradable and a titanium fixation system following BSSO advancement - A cohort study based on a multicenter randomised controlled trial

    NARCIS (Netherlands)

    van Bakelen, N. B.; Boermans, B. D. A.; Buijs, G. J.; Jansma, J.; Pruim, G. J.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; Stegenga, B.; Bos, R. R. M.

    2014-01-01

    Biodegradable fixation systems could reduce or eliminate the problems associated with removal of titanium plates. A multicenter randomised controlled trial (RCT) was performed in the Netherlands from December 2006-July 2009, and originally 230 injured and orthognathic patients were included. The

  3. Analysing long term discursive processes

    DEFF Research Database (Denmark)

    Horsbøl, Anders

    which extend beyond the single interaction, for instance negotiations or planning processes, seems to have played a less important role, with studies such as Iedema 2001 and Wodak 2000 as exceptions. These long term processes, however, are central to the constitution and workings of organizations......What do timescales - the notion that processes take place or can be viewed within a shorter or longer temporal range (Lemke 2005) - mean for the analysis of discourse? What are the methodological consequences of analyzing discourse at different timescales? It may be argued that discourse analysis...... in general has favored either the analysis of short term processes such as interviews, discussions, and lessons, or the analysis of non-processual entities such as (multimodal) texts, arguments, discursive repertoires, and discourses (in a Foucaultian sense). In contrast, analysis of long term processes...

  4. A 5-year multicenter prospective cohort study on the long-term visual prognosis and predictive factors for visual outcome in Japanese patients with age-related macular degeneration: the AMD2000 study.

    Science.gov (United States)

    Akagi-Kurashige, Yumiko; Tsujikawa, Akitaka; Yuzawa, Mitsuko; Ishibashi, Tatsuro; Nakanishi, Hideo; Nakatani, Eiji; Teramukai, Satoshi; Fukushima, Masanori; Yoshimura, Nagahisa

    2018-03-01

    In this study (AMD2000), we aimed to determine the visual prognosis of Japanese patients with age-related macular degeneration (AMD). This was a multicenter prospective observational cohort study. In total, 460 patients with AMD were recruited from April 2006 to March 2009 from 18 clinical trial sites in Japan. They were followed up for 5 years, as they continued to receive medical treatment. Of the 409 study eyes followed up for at least 1 year, 243 eyes (59.4%) were treated with photodynamic therapy (PDT) using verteporfin, and 58 eyes (14.2%) were treated with intravitreal injections of antivascular endothelial growth factor agents as the initial treatment. The mean best-corrected visual acuities (BCVA) for typical AMD (tAMD; 0.688 ± 0.498) and polypoidal choroidal vasculopathy (PCV; 0.451 ± 0.395) were significantly less at 2 years (tAMD, 0.779 ± 0.632, P macular edema as well as the lesion size was associated with 5-year maintenance of the baseline BCVA. In some patients, the diagnosis changed: of the 192 eyes initially diagnosed with typical AMD, 19 were newly diagnosed with PCV during follow-up. Maintaining the baseline BCVA over the long term is difficult in Japanese eyes with wet AMD.

  5. Comparing long term energy scenarios

    International Nuclear Information System (INIS)

    Cumo, M.; Simbolotti, G.

    2001-01-01

    Major projection studies by international organizations and senior analysts have been compared with reference to individual key parameters (population, energy demand/supply, resources, technology, emissions and global warming) to understand trends and implications of the different scenarios. Then, looking at the long term (i.e., 2050 and beyond), parameters and trends have been compared together to understand and quantify whether and when possible crisis or market turbulence might occur due to shortage of resources or environmental problems [it

  6. Long term radioactive waste management

    International Nuclear Information System (INIS)

    Lavie, J.M.

    1984-01-01

    In France, waste management, a sensitive issue in term of public opinion, is developing quickly, and due to twenty years of experience, is now reaching maturity. With the launching of the French nuclear programme, the use of radioactive sources in radiotherapy and industry, waste management has become an industrial activity. Waste management is an integrated system dealing with the wastes from their production to the long term disposal, including their identification, sortage, treatment, packaging, collection and transport. This system aims at guaranteing the protection of present and future populations with an available technology. In regard to their long term management, and the design of disposals, radioactive wastes are divided in three categories. This classification takes into account the different radioisotopes contained, their half life and their total activity. Presently short-lived wastes are stored in the shallowland disposal of the ''Centre de la Manche''. Set up within the French Atomic Energy Commission (CEA), the National Agency for waste management (ANDRA) is responsible within the framework of legislative and regulatory provisions for long term waste management in France [fr

  7. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

    Science.gov (United States)

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-10-07

    To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

  8. Long term mortality from cardiac disease and lung cancer after radiotherapy for breast cancer: a prospective cohort study of 7 711 women treated and followed-up at Institute Gustave Roussy (France)

    Energy Technology Data Exchange (ETDEWEB)

    Boukheris, H.; Rubino, C.; Le, M.; Giardini, M.; Brindel, P.; Doyon, F.; Paoletti, C.; Labbe, M.; Haouari, Z.; Vathaire, F. de [Institut Gustave Roussy, Unite 605 INSERM, 94 - Villejuif (France)

    2006-07-01

    Full text of publication follows: Women who are treated for early breast cancer with adjuvant radiation have a decreased risk of local recurrence but an increased risk of mortality from heart disease and lung cancer. Patients with left -sided breast tumors receive a higher dose of radiation to the heart than patients with right-sided tumors. In a previous study of about 300000 women treated for breast cancer during 1973-2001 and followed-up prospectively for cause-specific mortality until January 1, 2002, Sarah Darby showed that for women diagnosed during 1973-1982 and irradiated, the cardiac mortality ratio (left versus right tumor laterality) was 1.20 [1.04-1.38] less then 10 years afterwards, and 1.58 [1.29 - 1.95] after 15 years or more. Because radiation techniques have improved over time, such risks are expected to be reduced. A cohort was performed at Institute Gustave Roussy to investigate long term effects of breast cancer treatments. This cohort comprise 7711 women treated for beast cancer between 1954 and 1984. Mean age at the first treatment was 55 years [21 - 91], 61% were diagnosed before 1977 vs 39% after, 50.4% were left -sided breast cancer, 4832 (73.2 %) were recorded as having received external-beam radiotherapy as part of the initial treatment and 516 (8%) radiotherapy in association with chemotherapy. The aim of the present study is to investigate long term mortality and effects of radiotherapy on mortality from cardiac disease and second cancers. The originality of our study comparing to similar others is the homogeneity of the population studied and the longer follow-up. Vital status and causes of death of women of the cohort were obtained as well as mortality rates in the general French population. The cut off date was January 1, 2001. External and internal analysis were performed. Persons years at risk have been calculated for the entire follow-up period, less then 10 years, 10-19 years, 20-29 years, and 30 or more years afterwards. To

  9. Long term mortality from cardiac disease and lung cancer after radiotherapy for breast cancer: a prospective cohort study of 7 711 women treated and followed-up at Institute Gustave Roussy (France)

    International Nuclear Information System (INIS)

    Boukheris, H.; Rubino, C.; Le, M.; Giardini, M.; Brindel, P.; Doyon, F.; Paoletti, C.; Labbe, M.; Haouari, Z.; Vathaire, F. de

    2006-01-01

    Full text of publication follows: Women who are treated for early breast cancer with adjuvant radiation have a decreased risk of local recurrence but an increased risk of mortality from heart disease and lung cancer. Patients with left -sided breast tumors receive a higher dose of radiation to the heart than patients with right-sided tumors. In a previous study of about 300000 women treated for breast cancer during 1973-2001 and followed-up prospectively for cause-specific mortality until January 1, 2002, Sarah Darby showed that for women diagnosed during 1973-1982 and irradiated, the cardiac mortality ratio (left versus right tumor laterality) was 1.20 [1.04-1.38] less then 10 years afterwards, and 1.58 [1.29 - 1.95] after 15 years or more. Because radiation techniques have improved over time, such risks are expected to be reduced. A cohort was performed at Institute Gustave Roussy to investigate long term effects of breast cancer treatments. This cohort comprise 7711 women treated for beast cancer between 1954 and 1984. Mean age at the first treatment was 55 years [21 - 91], 61% were diagnosed before 1977 vs 39% after, 50.4% were left -sided breast cancer, 4832 (73.2 %) were recorded as having received external-beam radiotherapy as part of the initial treatment and 516 (8%) radiotherapy in association with chemotherapy. The aim of the present study is to investigate long term mortality and effects of radiotherapy on mortality from cardiac disease and second cancers. The originality of our study comparing to similar others is the homogeneity of the population studied and the longer follow-up. Vital status and causes of death of women of the cohort were obtained as well as mortality rates in the general French population. The cut off date was January 1, 2001. External and internal analysis were performed. Persons years at risk have been calculated for the entire follow-up period, less then 10 years, 10-19 years, 20-29 years, and 30 or more years afterwards. To

  10. Long-term biodosimetry Redux

    International Nuclear Information System (INIS)

    Simon, Steven L.; Bouville, Andre

    2016-01-01

    This paper revisits and reiterates the needs, purposes and requirements of bio-dosimetric assays for long-term dose and health risk assessments. While the most crucial need for bio-dosimetric assays is to guide medical response for radiation accidents, the value of such techniques for improving our understanding of radiation health risk by supporting epidemiological (long-term health risk) studies is significant. As new cohorts of exposed persons are identified and new health risk studies are undertaken with the hopes that studying the exposed will result in a deeper understanding of radiation risk, the value of reliable dose reconstruction is underscored. The ultimate application of biodosimetry in long-term health risk studies would be to completely replace model-based dose reconstruction-a complex suite of methods for retrospectively estimating dose that is commonly fraught with large uncertainties due to the absence of important exposure-related information, as well as imperfect models. While biodosimetry could potentially supplant model-based doses, there are numerous limitations of presently available techniques that constrain their widespread application in health risk research, including limited ability to assess doses received far in the past, high cost, great inter-individual variability, invasiveness, higher than preferred detection limits and the inability to assess internal dose (for the most part). These limitations prevent the extensive application of biodosimetry to large cohorts and should be considered a challenge to researchers to develop new and more flexible techniques that meet the demands of long-term health risk research. Events in recent years, e.g. the Fukushima reactor accident and the increased threat of nuclear terrorism, underscore that any event that results in significant radiation exposures of a group of people will also produce a much larger population, exposed at lower levels, but that likewise needs (or demands) an exposure

  11. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P; Gao, B [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  12. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study

    OpenAIRE

    Mithoefer, Michael C; Wagner, Mark T; Mithoefer, Ann T; Jerome, Lisa; Martin, Scott F; Yazar-Klosinski, Berra; Michel, Yvonne; Brewerton, Timothy D; Doblin, Rick

    2013-01-01

    We report follow-up data evaluating the long-term outcomes for the first completed trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for chronic, treatment-resistant post-traumatic stress disorder (PTSD) (Mithoefer et al., 2011). All of the 19 subjects who received MDMA-assisted treatment in the original trial participated in the long-term follow-up (LTFU), with 16 out of 19 completing all of the long-term outcome measures, which were administered from 17 to 74 months a...

  13. Short- and long-term performance of a tripolar down-sized single lead for implantable cardioverter defibrillator treatment: a randomized prospective European multicenter study. European Endotak DSP Investigator Group.

    Science.gov (United States)

    Sandstedt, B; Kennergren, C; Schaumann, A; Herse, B; Neuzner, J

    1998-11-01

    A new, thinner (10 Fr) and more flexible, single-pass transvenous endocardial ICD lead, Endotak DSP, was compared with a conventional lead, Endotak C, as a control in a prospective randomized multicenter study in combination with a nonactive can ICD. A total of 123 patients were enrolled, 55 of whom received a down-sized DSP lead. Lead-alone configuration was successfully implanted in 95% of the DSP patients vs 88% in the control group. The mean defibrillation threshold (DFT) was determined by means of a step-down protocol, and was identical in the two groups, 10.5 +/- 4.8 J in the DSP group versus 10.5 +/- 4.8 J in the control group. At implantation, the DSP mean pacing threshold was lower, 0.51 +/- 0.18 V versus 0.62 +/- 0.35 V (p < 0.05) in the control group, and the mean pacing impedance higher, 594 +/- 110 omega vs 523 +/- 135 omega (p < 0.05). During the follow-up period, the statistically significant difference in thresholds disappeared, while the difference in impedance remained. Tachyarrhythmia treatment by shock or antitachycardia pacing (ATP) was delivered in 53% and 41%, respectively, of the patients with a 100% success rate. In the DSP group, all 28 episodes of polymorphic ventricular tachycardia or ventricular fibrillation were converted by the first shock as compared to 57 of 69 episodes (83%) in the control group (p < 0.05). Monomorphic ventricular tachycardias were terminated by ATP alone in 96% versus 94%. Lead related problems were minor and observed in 5% and 7%, respectively. In summary, both leads were safe and efficacious in the detection and treatment of ventricular tachyarrhythmias. There were no differences between the DSP and control groups regarding short- or long-term lead related complications.

  14. The LIBERTY study: Design of a prospective, observational, multicenter trial to evaluate the acute and long-term clinical and economic outcomes of real-world endovascular device interventions in treating peripheral artery disease.

    Science.gov (United States)

    Adams, George L; Mustapha, Jihad; Gray, William; Hargus, Nick J; Martinsen, Brad J; Ansel, Gary; Jaff, Michael R

    2016-04-01

    Most peripheral artery disease (PAD) clinical device trials are supported by commercial manufacturers and designed for regulatory device approval, with extensive inclusion/exclusion criteria to support homogeneous patient populations. High-risk patients with advanced disease, including critical limb ischemia (CLI), are often excluded leading to difficulty in translating trial results into real-world clinical practice. As a result, physicians have no direct guidance regarding the use of endovascular devices. There is a need for objectively assessed studies to evaluate clinical, functional, and economic outcomes in PAD patient populations. LIBERTY is a prospective, observational, multicenter study sponsored by Cardiovascular Systems Inc (St Paul, MN) to evaluate procedural and long-term clinical and economic outcomes of endovascular device interventions in patients with symptomatic lower extremity PAD. Approximately 1,200 patients will be enrolled and followed up to 5 years: 500 patients in the "Claudicant Rutherford 2-3" arm, 600 in the "CLI Rutherford 4-5" arm, and 100 in the "CLI Rutherford 6" arm. The study will use 4 core laboratories for independent analysis and will evaluate the following: procedural and lesion success, rates of major adverse events, duplex ultrasound interpretations, wound status, quality of life, 6-minute walk test, and economic analysis. The LIBERTY Patient Risk Score(s) will be developed as a clinical predictor of outcomes to provide guidance for interventions in this patient population. LIBERTY will investigate real-world PAD patients treated with endovascular revascularization with rigorous study guidelines and independent oversight of outcomes. This study will provide observational, all-comer patient clinical data to guide future endovascular therapy. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Energy in 2010 - 2020. Long term challenges; Energie 2010-2020. Les defis du long terme

    Energy Technology Data Exchange (ETDEWEB)

    Dessus, Benjamin [ed.] [Centre National de la Recherche Scientifique (CNRS), 75 - Paris (France)

    2000-02-02

    This report presents the results of a workshop intending to anticipate the long term challenges, to guide better the short term power options, to understand the available political, economical and technical assumptions for the prospective world situation, to give some strategic hints on the necessary transition. Indeed, the difficult issue which the workshop tried to tackle was how should we prepare to reveal the energetic challenge of the development of the eight to ten billion inhabitants of our Planet in the next century without jeopardizing its existence. The energetic problems, a hardcore of the international preoccupation of both growth and environment, as it was recently evidenced by the climatic conference in Kyoto, have ever been the object of a particular attention on the part of General Commissariat of Plan. Thus, the commission 'Energy in 2010 - 2020' has been instituted in April 1996 in order to update the works done in 1990 - 1991 by the commission 'Energy 2010'. Soon it occurred to this new commission the task of illuminating its works by a long term (2050 - 2100) world prospective analysis of the challenges and problems linked to energy, growth and environment. In conclusion, this document tried to find answers to questions like: - which are the risks the energy consumption augmentation entail? - can we control them by appropriate urbanism and transport policies or technological innovation?. Four options for immediate action are suggested: - the energy efficiency should become a priority objective of policies; -coping with the long term challenges requires acting at present; - building the transition between governmental leadership and market; - taking profit of all the possible synergies between short and long term planning.

  16. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis.

    Science.gov (United States)

    Möbius, C; Max, D; Uhlmann, D; Gumpp, K; Behrbohm, J; Horvath, K; Hauss, J; Witzigmann, H

    2007-05-01

    Three prospective randomised studies were conducted to compare pancreatoduodenectomy (PD) with duodenum-preserving pancreatic head resection (DPPHR) in patients suffering from chronic pancreatitis (cP). In these three series, the superiority of the duodenum-preserving technique with regard to quality of life (QOL) and pain relief has been demonstrated. Long-term follow-up investigations have not been published so far. The present paper reports on a 5-year follow-up study of a prospective, non-randomised trial comparing classic Whipple procedure (PD) with Beger DPPHR. Seventy patients were initially enrolled in this study. Fifty-one patients were left for the present long-term outcome analysis (PD, n = 24; DPPHR, n = 27). The follow-up included the following parameters: QOL, pain intensity, endocrine and exocrine function, and body mass index (BMI). The median follow-up was 63.5 (range 56-67) months. Two patients in the DPPHR group and none in the PD group underwent a re-operation. The QOL scores of the relevant symptom scales (nausea, pain, diarrhoea) and functional parameters (physical status, working ability, global QOL) were significantly better in the DPPHR group than in the PD group. Pain intensity as self-assessed by the patients was less pronounced in the DPPHR group (P Whipple procedure in terms of QOL and pain intensity as self-assessed by the patients.

  17. Navigating Long-Term Care

    Directory of Open Access Journals (Sweden)

    James D. Holt MD

    2017-03-01

    Full Text Available Americans over age 65 constitute a larger percentage of the population each year: from 14% in 2010 (40 million elderly to possibly 20% in 2030 (70 million elderly. In 2015, an estimated 66 million people provided care to the ill, disabled, and elderly in the United States. In 2000, according to the Centers for Disease Control and Prevention (CDC, 15 million Americans used some form of long-term care: adult day care, home health, nursing home, or hospice. In all, 13% of people over 85 years old, compared with 1% of those ages 65 to 74, live in nursing homes in the United States. Transitions of care, among these various levels of care, are common: Nursing home to hospital transfer, one of the best-studied transitions, occurs in more than 25% of nursing home residents per year. This article follows one patient through several levels of care.

  18. Long-term effects on haemostatic variables of three ad libitum diets differing in type and amount of fat and carbohydrate: a 6-month randomised study in obese individuals

    DEFF Research Database (Denmark)

    Bladbjerg, Else-Marie; Larsen, Thomas M; Due, Anette

    2010-01-01

    Diet is important in the prevention of CVD, and it has been suggested that a diet high in MUFA is more cardioprotective than a low-fat diet. We hypothesised that the thrombotic risk profile is improved most favourably by a high-MUFA diet compared with a low-fat diet. This was tested in a parallel...... randomised intervention trial on overweight individuals (aged 28·2 (sd 4·6) years) randomly assigned to a diet providing a moderate amount of fat (35-45 % of energy; >20 % of fat as MUFA) (MUFA diet; n 39), to a low-fat (LF; 20-30 % of energy) diet (n 43), or to a control diet (35 % of energy as fat; n 24...

  19. A long-term randomised trial on tenoxicam and piroxicam in osteoarthritis of the hip or knee: a 24-month interim report focusing on the 12-24 month interval

    DEFF Research Database (Denmark)

    Lund, B; Andersen, R B; Fossgreen, J

    1987-01-01

    The long-acting antiphlogistics tenoxicam (Ro 12-0068, Tilcotil) and piroxicam in single daily oral doses of 20 mg are compared in a double-blind, group-comparative, randomised trial planned to last for five years. Results of 12 months' treatment of 108 patients with osteoarthritis of the hip...... or knee have been reported. This interim analysis focuses mainly on the 12 to 24 month interval. The clinical improvements obtained within the first 12 months persisted during the second year in the 55 patients remaining on treatment. After 24 months, 53 patients had been withdrawn prematurely, three......-quarters because of inefficacy or intolerance. Only six patients were withdrawn between 12 and 24 months, three for lack of efficacy, two for side-effects and one for reasons unrelated to therapy. There was no difference between the treatment groups with regard to incidence, time or reason for withdrawal, and only...

  20. Long-term follow-up in dogs with idiopathic eosinophilic bronchopneumopathy treated with inhaled steroid therapy.

    Science.gov (United States)

    Canonne, A M; Bolen, G; Peeters, D; Billen, F; Clercx, C

    2016-10-01

    Treatment of canine idiopathic eosinophilic bronchopneumopathy mainly consists of long-term oral corticosteroid therapy. To avoid side effects, inhaled steroid therapy has been increasingly used but long-term clinical response and potential side effects are sparsely described. Description of clinical response and side effects with long-term fluticasone in dogs with eosinophilic bronchopneumopathy. Case series of dogs with eosinophilic bronchopneumopathy and treated with fluticasone monotherapy for at least 6 months. Clinical response and side effects assessed by physical examination, standardised questionnaire and ACTH (corticotropin) stimulation test. Eight dogs were treated for between 6 months and 5 years. Cough initially improved in all dogs; two dogs remained free of clinical signs, three were well controlled, but three showed severe relapse. Pituitary-adrenal axis inhibition occurred in two dogs treated with fluticasone monotherapy for more than 2 years; only one dog had clinical signs of iatrogenic hyperadrenocorticism. Fluticasone monotherapy allows initial improvement or remission in the majority of dogs but long-term treatment fails to resolve the cough in some individuals. In addition, such therapy may induce pituitary-adrenal axis inhibition. Prospective larger and randomised studies including both fluticasone and orally-treated dogs are needed to define the optimal treatment. © 2016 British Small Animal Veterinary Association.

  1. Strategies to meet the need for long-term data.

    Science.gov (United States)

    Chalmers, John; Woodward, Mark; Borghi, Claudio; Manolis, Athanasios; Mancia, Giuseppe

    2016-08-01

    Chronic diseases afflict patients for many years, often to the end of life, and there is increasing need for estimating lifelong risk and for evaluating the effects of treatment in the long term. Yet recommendations for lifelong treatment are most frequently based on findings from randomized clinical trials lasting only a few years. There is therefore a clear need for much longer term data, and here we present the advantages and disadvantages of many strategies, including the use of long-term posttrial follow-up, of long-term prospective cohort studies, registry databases, and of administrative databases. We also emphasize the need for long-term cost-effectiveness studies. One of the most promising strategies comes from linkage of data gathered through the ever-expanding pool of administrative databases worldwide with data from other sources, including randomized trials and the many forms of observational study.

  2. Long-term risks of kidney living donation

    DEFF Research Database (Denmark)

    Maggiore, Umberto; Budde, Klemens; Heemann, Uwe

    2017-01-01

    Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science...... and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information...... to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors...

  3. Fluorodeoxyglucose Uptake on Positron Emission Tomography Is a Useful Predictor of Long-Term Pain Control After Palliative Radiation Therapy in Patients With Painful Bone Metastases: Results of a Single-Institute Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Takatoshi, E-mail: taka.t-may7@med.Tottori-u.ac.jp [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Fujii, Shinya; Ogawa, Toshihide; Michimoto, Koichi; Fukunaga, Takeru; Tanino, Tomohiko; Uchida, Nobue [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Matsuki, Tsutomu; Sakamoto, Hiroaki [Division of Radiology, Tottori Municipal Hospital, Tottori (Japan)

    2016-02-01

    Purpose: To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) before and after palliative radiation therapy (RT) can predict long-term pain control in patients with painful bone metastases. Methods and Materials: Thirty-one patients with bone metastases who received RT were prospectively included. Forty painful metastatic treatment fields were evaluated. All patients had undergone pre-RT and post-RT PET/CT scanning. We evaluated the relationships between the pre-RT, post-RT, and changes in maximum standardized uptake value (SUV{sub max}) and the pain response, and between SUV{sub max} and pain relapse of the bone metastases in the treatment field. In addition, we compared the SUV{sub max} according to the length of time from the completion of RT to pain relapse of the bone metastases. Results: Regarding the pain response at 4 weeks after the completion of RT, there were 36 lesions of 27 patients in the responder group and 4 lesions of 4 patients in the nonresponder group. Changes in the SUV{sub max} differed significantly between the responder and nonresponder groups in both the early and delayed phases (P=.0292 and P=.0139, respectively), but no relationship was observed between the pre-RT and post-RT SUV{sub max} relative to the pain response. The responder group was evaluated for the rate of relapse. Thirty-five lesions of 26 patients in the responder group were evaluated, because 1 patient died of acute renal failure at 2 months after RT. Twelve lesions (34%) showed pain relapse, and 23 lesions (66%) did not. There were significant differences between the relapse and nonrelapse patients in terms of the pre-RT (early/delayed phases: P<.0001/P<.0001), post-RT (P=.0199/P=.0261), and changes in SUV{sub max} (P=.0004/P=.004). Conclusions: FDG-PET may help predict the outcome of pain control in the treatment field after palliative RT for painful bone metastases.

  4. Long term study of mechanical

    Directory of Open Access Journals (Sweden)

    Ahmed M. Diab

    2016-06-01

    Full Text Available In this study, properties of limestone cement concrete containing different replacement levels of limestone powder were examined. It includes 0%, 5%, 10%, 15%, 20% and 25% of limestone powder as a partial replacement of cement. Silica fume was added incorporated with limestone powder in some mixes to enhance the concrete properties. Compressive strength, splitting tensile strength and modulus of elasticity were determined. Also, durability of limestone cement concrete with different C3A contents was examined. The weight loss, length change and cube compressive strength loss were measured for concrete attacked by 5% sodium sulfate using an accelerated test up to 525 days age. The corrosion resistance was measured through accelerated corrosion test using first crack time, cracking width and steel reinforcement weight loss. Consequently, for short and long term, the use of limestone up to 10% had not a significant reduction in concrete properties. It is not recommended to use blended limestone cement in case of sulfate attack. The use of limestone cement containing up to 25% limestone has insignificant effect on corrosion resistance before cracking.

  5. Long-term competence restoration.

    Science.gov (United States)

    Morris, Douglas R; DeYoung, Nathaniel J

    2014-01-01

    While the United States Supreme Court's Jackson v. Indiana decision and most state statutes mandate determinations of incompetent defendants' restoration probabilities, courts and forensic clinicians continue to lack empirical evidence to guide these determinations and do not yet have a consensus regarding whether and under what circumstances incompetent defendants are restorable. The evidence base concerning the restoration likelihood of those defendants who fail initial restoration efforts is even further diminished and has largely gone unstudied. In this study, we examined the disposition of a cohort of defendants who underwent long-term competence restoration efforts (greater than six months) and identified factors related to whether these defendants were able to attain restoration and adjudicative success. Approximately two-thirds (n = 52) of the 81 individuals undergoing extended restoration efforts were eventually deemed restored to competence. Lengths of hospitalization until successful restoration are presented with implications for the reasonable length of time that restoration efforts should persist. Older individuals were less likely to be restored and successfully adjudicated, and individuals with more severe charges and greater factual legal understanding were more likely to be restored and adjudicated. The significance of these findings for courts and forensic clinicians is discussed.

  6. Uranium ... long-term confidence

    International Nuclear Information System (INIS)

    Anon.

    1983-01-01

    Half way through 1983 the outlook for the world's uranium producers was far from bright if one takes a short term view. The readily accessible facts present a gloomy picture. The spot prices of uranium over the past few years decreased from a high of $42-$43/lb to a low of $17 in 1982. It now hovers between $23 and $24. the contract prices negotiated between producers and consumers are not so accessible but they do not reflect the spot price. The reasons why contractual uranium prices do not follow the usual dictates of supply and demand are related to the position in which uranium and associated power industries find themselves. There is public reaction with strong emotional overtones as well as much reduced expectations about the electric power needs of the world. Furthermore the supply of uranium is not guaranteed despite present over production. However the people in the industry, taking the medium- and long-term view, are not despondent

  7. Long-term corrosion studies

    International Nuclear Information System (INIS)

    Gdowski, G.

    1998-01-01

    The scope of this activity is to assess the long-term corrosion properties of metallic materials under consideration for fabricating waste package containers. Three classes of metals are to be assessed: corrosion resistant, intermediate corrosion resistant, and corrosion allowance. Corrosion properties to be evaluated are general, pitting and crevice corrosion, stress-corrosion cracking, and galvanic corrosion. The performance of these materials will be investigated under conditions that are considered relevant to the potential emplacement site. Testing in four aqueous solutions, and vapor phases above them, and at two temperatures are planned for this activity. (The environmental conditions, test metals, and matrix are described in detail in Section 3.0.) The purpose and objective of this activity is to obtain the kinetic and mechanistic information on degradation of metallic alloys currently being considered for waste package containers. This information will be used to provide assistance to (1) waste package design (metal barrier selection) (E-20-90 to E-20-92), (2) waste package performance assessment activities (SIP-PA-2), (3) model development (E-20-75 to E-20-89). and (4) repository license application

  8. A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial.

    Science.gov (United States)

    Cardoso, Graça; Papoila, Ana; Tomé, Gina; Killaspy, Helen; King, Michael; Caldas-de-Almeida, José Miguel

    2017-11-01

    This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.

  9. Adverse event reporting in Czech long-term care facilities.

    Science.gov (United States)

    Hěib, Zdenřk; Vychytil, Pavel; Marx, David

    2013-04-01

    To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

  10. Long-term effects of weight loss with a very-low carbohydrate, low saturated fat diet on flow mediated dilatation in patients with type 2 diabetes: A randomised controlled trial.

    Science.gov (United States)

    Wycherley, Thomas P; Thompson, Campbell H; Buckley, Jonathan D; Luscombe-Marsh, Natalie D; Noakes, Manny; Wittert, Gary A; Brinkworth, Grant D

    2016-09-01

    Very-low carbohydrate diets can improve glycaemic control in patients with type 2 diabetes (T2DM). However, compared to traditional higher carbohydrate, low fat (HighCHO) diets, they have been associated with impaired endothelial function (measured by flow mediated dilatation [FMD]) that is possibly related to saturated fat. This study aimed to examine the effects of a 12-month hypocaloric very-low carbohydrate, low saturated fat (LowCHO) diet compared to an isocaloric HighCHO diet. One hundred and fifteen obese patients with T2DM (age:58.4 ± 0.7 [SEM] yr, BMI:34.6 ± 0.4 kg/m(2), HbA1c:7.33 [56.3 mmol/mol] ± 0.10%) were randomised to consume an energy restricted LowCHO diet (Carb:Pro:Fat:Sat-Fat 14:28:58: < 10% energy; n = 58) or isocaloric HighCHO diet (53:17:30: < 10%; n = 57) whilst undertaking exercise (60 min, 3/wk). Bodyweight, HbA1c and FMD were assessed. Seventy eight participants completed the intervention (LowCHO = 41, HighCHO = 37). Both groups experienced similar reductions in weight and HbA1c (-10.6 ± 0.7 kg, -1.05 ± 0.10%; p < 0.001 time, p ≥ 0.48 time × diet). FMD did not change (p = 0.11 time, p = 0.20 time × diet). In patients with obesity and T2DM, HighCHO diet and LowCHO diet have similar effects on endothelial function. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial.

    Science.gov (United States)

    Malmberg, Milijana; Lunner, Thomas; Kähäri, Kim; Andersson, Gerhard

    2017-06-06

    Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population. The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention. We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37). Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants. This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention. This trial is registered at ClinicalTrals.gov, NCT01837550; results. © Article author

  12. A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores.

    Science.gov (United States)

    Yamamoto, Masaaki; Serizawa, Toru; Higuchi, Yoshinori; Sato, Yasunori; Kawagishi, Jun; Yamanaka, Kazuhiro; Shuto, Takashi; Akabane, Atsuya; Jokura, Hidefumi; Yomo, Shoji; Nagano, Osamu; Aoyama, Hidefumi

    2017-09-01

    The JLGK0901 study showed the noninferiority of stereotactic radiosurgery (SRS) alone as initial treatment of 5 to 10 brain metastases (BMs) compared with 2 to 4 BMs in terms of overall survival and most secondary endpoints (Lancet Oncol 2014;15:387-95). However, observation periods were not long enough to allow confirmation of the long-term safety of SRS alone in patients with 5 to 10 BMs. This was a prospective observational study of Gamma Knife SRS-treated patients with 1 to 10 newly diagnosed BMs enrolled at 23 facilities between March 1, 2009, and February 15, 2012. The 1194 eligible patients were categorized into the following groups: group A, 1 tumor (n=455); group B, 2 to 4 tumors (n=531); and group C, 5 to 10 tumors (n=208). Cumulative rates of Mini-Mental State Examination (MMSE) score maintenance (MMSE score decrease <3 from baseline) determined with a competing risk analysis of groups A, B, and C were 93%, 91%, and 92%, respectively, at the 12th month after SRS; 91%, 89%, and 91%, respectively, at the 24th month; 89%, 88%, and 89%, respectively, at the 36th month; and 87%, 86%, and 89%, respectively, at the 48th month (hazard ratio [HR] of group A vs group B, 0.719; 95% confidence interval [CI], 0.437-1.172; P=.18; HR of group B vs group C, 1.280; 95% CI, 0.696-2.508; P=.43). During observations ranging from 0.3 to 67.5 months (median, 12.0 months; interquartile range, 5.8-26.5 months), as of December 2014, 145 patients (12.1%) had SRS-induced complications. Cumulative complication incidences by competing risk analysis for groups A, B, and C were 7%, 8%, and 6%, respectively, at the 12th month after SRS; 10%, 11%, and 11%, respectively, at the 24th month; 11%, 11%, and 12%, respectively, at the 36th month; and 12%, 12%, and 13%, respectively, at the 48th month (HR of group A vs group B, 0.850; 95% CI, 0.592-1.220; P=.38; HR of group B vs group C, 1.052; 95% CI, 0.666-1.662, P=.83). Leukoencephalopathy occurred in 12 of the 1074 patients (1.1%) with

  13. Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: A prospective randomised study

    International Nuclear Information System (INIS)

    Valek, Vlastimil; Kysela, Petr; Kala, Zdenek; Kiss, Igor; Tomasek, Jiri; Petera, Jiri

    2007-01-01

    Purpose: To evaluate the effect of radiation therapy including intraluminal brachyterapy with iridium-192 on survival of patients with malignant biliary strictures (cholangiocarcinoma, histologically improved) treated with metallic stent in a prospective randomised study. Method and materials: In the prospective randomised study, 21 patients with cholangiocarcinoma were treated with implantation of percutaneous stents followed with intraluminal Ir-192 brachytherapy (mean dose 30 Gy) and external radiotherapy (mean dose 50 Gy) and 21 patients were treated only with stents insertion. We did not find any statistically significant differences in age and tumor localization between these two groups of patients. Results: All the patients died. In the group of patients treated with brachytherapy and with stent implantation, the mean survival time was 387.9 days. In the group of patients treated only with stent insertion the mean survival was 298 days. In effort to eliminate possible effect of external radiotherapy we treated the control group of eight patients with cholangiocarcinoma by stent insertion and brachyterapy only. Conclusion: Our results show that combined radiation therapy could extend the survival in the patients with cholangiocarcinoma obstruction

  14. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study.

    Science.gov (United States)

    Mithoefer, Michael C; Wagner, Mark T; Mithoefer, Ann T; Jerome, Lisa; Martin, Scott F; Yazar-Klosinski, Berra; Michel, Yvonne; Brewerton, Timothy D; Doblin, Rick

    2013-01-01

    We report follow-up data evaluating the long-term outcomes for the first completed trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for chronic, treatment-resistant post-traumatic stress disorder (PTSD) (Mithoefer et al., 2011). All of the 19 subjects who received MDMA-assisted treatment in the original trial participated in the long-term follow-up (LTFU), with 16 out of 19 completing all of the long-term outcome measures, which were administered from 17 to 74 months after the original study's final MDMA session (mean = 45.4; SD = 17.3). Our primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS). Secondary outcome measures were the Impact of Events Scale-Revised (IES-R) and the Neuroticism Extroversion Oppenness Personality Inventory-Revised (NEO PI-R) Personality Inventory. We also collected a long-term follow-up questionnaire. Results for the 16 CAPS completers showed there were no statistical differences between mean CAPS score at LTFU (mean = 23.7; SD = 22.8) (t (matched) = 0.1; df = 15, p = 0.91) and the mean CAPS score previously obtained at Study Exit (mean = 24.6, SD = 18.6). On average, subjects maintained statistically and clinically-significant gains in symptom relief, although two of these subjects did relapse. It was promising that we found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time, with no subjects reporting harm from participation in the study.

  15. Haloperidol for long-term aggression in psychosis.

    Science.gov (United States)

    Khushu, Abha; Powney, Melanie J

    2016-11-27

    Psychotic disorders can lead some people to become agitated. Characterised by restlessness, excitability and irritability, this can result in verbal and physically aggressive behaviour - and both can be prolonged. Aggression within the psychiatric setting imposes a significant challenge to clinicians and risk to service users; it is a frequent cause for admission to inpatient facilities. If people continue to be aggressive it can lengthen hospitalisation. Haloperidol is used to treat people with long-term aggression. To examine whether haloperidol alone, administered orally, intramuscularly or intravenously, is an effective treatment for long-term/persistent aggression in psychosis. We searched the Cochrane Schizophrenia Group Trials Register (July 2011 and April 2015). We included randomised controlled trials (RCT) or double blind trials (implying randomisation) with useable data comparing haloperidol with another drug or placebo for people with psychosis and long-term/persistent aggression. One review author (AK) extracted data. For dichotomous data, one review author (AK) calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed-effect model. One review author (AK) assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. We have no good-quality evidence of the absolute effectiveness of haloperidol for people with long-term aggression. One study randomising 110 chronically aggressive people to three different antipsychotic drugs met the inclusion criteria. When haloperidol was compared with olanzapine or clozapine, skewed data (n=83) at high risk of bias suggested some advantage in terms of scale scores of unclear clinical meaning for olanzapine/clozapine for 'total aggression'. Data were available for only one other outcome, leaving the study early. When compared with other antipsychotic drugs, people allocated to haloperidol were no more likely to leave the study

  16. Financing long term liabilities (Germany)

    International Nuclear Information System (INIS)

    2003-01-01

    charges and fees levied from the waste producers. Altogether, financial resources for decommissioning are needed for the following steps: the post-operational phase in which the facility is prepared for dismantling after its final shut-down, dismantling of the radioactive part of the facility, management, storage and disposal of the radioactive waste, restoration of the site, licensing and regulatory supervision of all these steps. Additional means are necessary for the management, storage and disposal of the spent fuel. The way in which the availability of financial resources is secured differs between public owned installations and installations of the private power utilities. In Germany, past practices has resulted in singular contaminated sites of limited extent, mainly during the first half of the 20. century. Those contaminated sites have been or are being cleaned up and redeveloped. In large areas of Saxony and Thuringia, the geological formations permitted the surface and underground mining of Uranium ore. Facilities of the former Soviet-German WISMUT Ltd. where ore was mined and processed from 1946 until the early 1990's can be found at numerous sites. In the course of the re-unification of Germany, the soviet shares of the WISMUT were taken over by the Federal Republic of Germany and the closure of the WISMUT facilities was initiated. In that phase the extent of the damages to the environment and of the necessary remediation work became clear. All mining and milling sites are now closed and are under decommissioning. A comprehensive remediation concept covers all WISMUT sites. Heaps and mill-tailing ponds are transferred into a long-term stable condition. The area of the facilities to be remediated amounts to more than 30 km 2 . Heaps cover a total area of ca. 15,5 km 2 , tailing ponds in which the tailings resulting from the Uranium production are stored as sludges cover 6,3 km 2 ). In total, the remediation issues are very complex and without precedent. The

  17. A Long-term Plan for Kalk

    DEFF Research Database (Denmark)

    2017-01-01

    In this case, the author demonstrates together with the owner-manager of KALK A/S, Mr Rasmus Jorgensen, how to use the Family Business Map to frame a constructive discussion about long-term planning. The Family Business Map is a tool for long-term planning in family firms developed by Professor...

  18. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  19. Results of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure

    NARCIS (Netherlands)

    Roolker, W.; Kraaneveld, E.; Been, H. D.; Marti, R. K.

    2002-01-01

    A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47

  20. Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block.

    Science.gov (United States)

    Cánovas Martínez, L; Orduña Valls, J; Paramés Mosquera, E; Lamelas Rodríguez, L; Rojas Gil, S; Domínguez García, M

    2016-05-01

    To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS]>6) that lasted more than 3 months. Patients were randomised into three groups (n=20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency "palisade". Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1cm. Group C: modified bipolar radiofrequency "palisade" (needle distance >1cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. One month after the treatment, pain reduction was >50% in the three groups PDolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study.

    LENUS (Irish Health Repository)

    Mahdy, Saad

    2009-06-01

    Anemia is a common problem in the ICU population. Most patients are anemic at admission, their hemoglobin concentrations declining further thereafter. The aim of the present study was to evaluate the effect of a combination strategy, involving closed arterial blood gas sampling and the use of pediatric vials for phlebotomy (Group A), on the sampling-induced blood loss and the rate of decline in hemoglobin in adult ICU patients. Combination (Group A) was compared to the current standard technique of arterial line sampling and adult vial phlebotomy (Group B) in a prospective, randomised, ethically-approved trial for the first 72 hours of their ICU stay. Peri-operative, oncology, coagulopathic and uremic patients were excluded. All other ICU patients with arterial cannulae and predicted to stay beyond 3 days, were enrolled.

  2. A Long-Term Mathematical Model for Mining Industries

    OpenAIRE

    Achdou , Yves; Giraud , Pierre-Noel; Lasry , Jean-Michel; Lions , Pierre-Louis

    2016-01-01

    International audience; A parcimonious long term model is proposed for a mining industry. Knowing the dynamics of the global reserve, the strategy of each production unit consists of an optimal control problem with two controls, first the flux invested into prospection and the building of new extraction facilities, second the production rate. In turn, the dynamics of the global reserve depends on the individual strategies of the producers, so the models leads to an equilibrium, which is descr...

  3. Long-term Outcome of Arterial Stroke in Children

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2015-05-01

    Full Text Available Investigators at University Children’s Hospital, Inselspital, and Universities of Bern, Geneva, Basel, and Zurich, Switzerland compared long-term outcome of children (1 month-16 years and young adults (16.1-45 years with arterial ischemic stroke (AIS using prospective data from the Swiss Neuropediatric Stroke Registry and the Adult Bernese stroke registry, between Jan 2000 and Dec 2008.

  4. Long-term efficacy and tolerability of quetiapine in patients with schizophrenia who switched from other antipsychotics because of inadequate therapeutic response-a prospective open-label study.

    Science.gov (United States)

    Hashimoto, Naoki; Toyomaki, Atsuhito; Honda, Minoru; Miyano, Satoru; Nitta, Nobuyuki; Sawayama, Hiroyuki; Sugawara, Yasufumi; Uemura, Keiichi; Tsukamoto, Noriko; Koyama, Tsukasa; Kusumi, Ichiro

    2015-01-01

    While the frequency and importance of antipsychotic switching in patients with schizophrenia, there is insufficient evidence with regard to switching strategy. Quetiapine is one of the drugs of choice for switch because of its unique receptor profile. However, there were no data on the long-term clinical and neurocognitive effect of quetiapine in patients who had responded inadequately to prior antipsychotics. The purpose of this study is to examine the long-term efficacy and tolerability of quetiapine in patients with schizophrenia who switched from other antipsychotics because of inadequate therapeutic response. We hypothesized that quetiapine would show long-term effectiveness in broad symptom dimensions including negative and neurocognitive symptoms while having good tolerability. Twenty-nine subjects with schizophrenia who did not respond to their current monotherapy of antipsychotic or who could not tolerate the treatment were switched to quetiapine and assessed at baseline and at 3, 6, and 12 months. The outcome measures included the brief assessment of cognition in schizophrenia (BACS), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions Scale (CGI), the Schizophrenia Quality of Life Scale Japanese version (JSQLS), the Athens Insomnia Scale (AIS), and the Drug Attitude Inventory with 30 items (DAI-30). The Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), HbA1c, prolactin (PRL), and body weight were also evaluated. Statistically significant improvements were observed in all subscores of the PANSS, the GAF, and the symptoms and side effects subscale of the JSQLS, the DIEPSS, the AIS, and the PRL level, and nearly significant improvements were observed in the DAI-30. Quetiapine monotherapy was associated with significant improvement in the verbal memory test, even after controlling for the practice effect. Although quetiapine was well tolerated, three subjects dropped out because of the worsening of the psychotic symptoms and

  5. Perinatal respiratory infections and long term consequences

    Directory of Open Access Journals (Sweden)

    Luciana Indinnimeo

    2015-10-01

    Full Text Available Respiratory syncytial virus (RSV is the most important pathogen in the etiology of respiratory infections in early life. 50% of children are affected by RSV within the first year of age, and almost all children become infected within two years. Numerous retrospective and prospective studies linking RSV and chronic respiratory morbidity show that RSV bronchiolitis in infancy is followed by recurrent wheezing after the acute episod. According to some authors a greater risk of wheezing in children with a history of RSV bronchiolitis would be limited to childhood, while according to others this risk would be extended into adolescence and adulthood. To explain the relationship between RSV infection and the development of bronchial asthma or the clinical pathogenetic patterns related to a state of bronchial hyperreactivity, it has been suggested that RSV may cause alterations in the response of the immune system (immunogenic hypothesis, activating directly mast cells and basophils and changing the pattern of differentiation of immune cells present in the bronchial tree as receptors and inflammatory cytokines. It was also suggested that RSV infection can cause bronchial hyperreactivity altering nervous airway modulation, acting on nerve fibers present in the airways (neurogenic hypothesis.The benefits of passive immunoprophylaxis with palivizumab, which seems to represent an effective approach in reducing the sequelae of RSV infection in the short- and long-term period, strengthen the implementation of prevention programs with this drug, as recommended by the national guidelines of the Italian Society of Neonatology. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the

  6. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

    Science.gov (United States)

    Sydnor, Malcolm; Mavropoulos, John; Slobodnik, Natalia; Wolfe, Luke; Strife, Brian; Komorowski, Daniel

    2017-07-01

    Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

  7. Cumulative impact of axial, structural, and repolarization ECG findings on long-term cardiovascular mortality among healthy individuals in Japan: National Integrated Project for Prospective Observation of Non-Communicable Disease and its Trends in the Aged, 1980 and 1990.

    Science.gov (United States)

    Inohara, Taku; Kohsaka, Shun; Okamura, Tomonori; Watanabe, Makoto; Nakamura, Yasuyuki; Higashiyama, Aya; Kadota, Aya; Okuda, Nagako; Murakami, Yoshitaka; Ohkubo, Takayoshi; Miura, Katsuyuki; Okayama, Akira; Ueshima, Hirotsugu

    2014-12-01

    Various cohort studies have shown a close association between long-term cardiovascular disease (CVD) outcomes and individual electrocardiographic (ECG) abnormalities such as axial, structural, and repolarization changes. The combined effect of these ECG abnormalities, each assumed to be benign, has not been thoroughly investigated. Community-dwelling Japanese residents from the National Integrated Project for Perspective Observation of Non-Communicable Disease and its Trends in the Aged, 1980-2004 and 1990-2005 (NIPPON DATA80 and 90), were included in this study. Baseline ECG findings were classified using the Minnesota Code and categorized into axial (left axis deviation, clockwise rotation), structural (left ventricular hypertrophy, atrial enlargement), and repolarization (minor and major ST-T changes) abnormalities. The hazard ratios of the cumulative impacts of ECG findings on long-term CVD death were estimated by stratified Cox proportional hazard models, including adjustments for cohort strata. In all, 16,816 participants were evaluated. The average age was 51.2 ± 13.5 years; 42.7% participants were male. The duration of follow up was 300,924 person-years (mean 17.9 ± 5.8 years); there were 1218 CVD deaths during that time. Overall, 4203 participants (25.0%) had one or more categorical ECG abnormalities: 3648 (21.7%) had a single abnormality, and 555 (3.3%) had two or more. The risk of CVD mortality increased as the number of abnormalities accumulated (single abnormality HR 1.29, 95% CI 1.13-1.48; ≥2 abnormalities HR 2.10, 95% CI 1.73-2.53). Individual ECG abnormalities had an additive effect in predicting CVD outcome risk in our large-scale cohort study. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Long-term risk of recurrent vascular events after young stroke: The FUTURE study

    NARCIS (Netherlands)

    Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Vlugt, M.J. van der; Dijk, E.J. van; Leeuw, F.E. de

    2013-01-01

    OBJECTIVE: Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke. METHODS: We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA),

  9. Long term wet spent nuclear fuel storage

    International Nuclear Information System (INIS)

    1987-04-01

    The meeting showed that there is continuing confidence in the use of wet storage for spent nuclear fuel and that long-term wet storage of fuel clad in zirconium alloys can be readily achieved. The importance of maintaining good water chemistry has been identified. The long-term wet storage behaviour of sensitized stainless steel clad fuel involves, as yet, some uncertainties. However, great reliance will be placed on long-term wet storage of spent fuel into the future. The following topics were treated to some extent: Oxidation of the external surface of fuel clad, rod consolidation, radiation protection, optimum methods of treating spent fuel storage water, physical radiation effects, and the behaviour of spent fuel assemblies of long-term wet storage conditions. A number of papers on national experience are included

  10. Industrial Foundations as Long-Term Owners

    DEFF Research Database (Denmark)

    Thomsen, Steen; Poulsen, Thomas; Børsting, Christa Winther

    Short-termism has become a serious concern for corporate governance, and this has inspired a search for institutional arrangements to promote long-term decision-making. In this paper, we call attention to long-term ownership by industrial foundations, which is common in Northern Europe but little...... known in the rest of the world. We use a unique Danish data set to document that industrial foundations are long-term owners that practice long-term governance. We show that foundation ownership is highly stable compared to other ownership structures. Foundation-owned companies replace managers less...... frequently. They have conservative capital structures with low financial leverage. They score higher on an index of long-termism in finance, investment, and employment. They survive longer. Overall, our paper supports the hypothesis that corporate time horizons are influenced by ownership structures...

  11. Coping with PH over the Long Term

    Science.gov (United States)

    ... a job, a volunteer commitment, or even a hobby can take a toll on long-term survivors ... people find solace in meditation, faith, humor, writing, hobbies and more. Find an outlet that you enjoy ...

  12. Long term effects of radiation in man

    International Nuclear Information System (INIS)

    Tso Chih Ping; Idris Besar

    1984-01-01

    An overview of the long term effects of radiation in man is presented, categorizing into somatic effects, genetic effects and teratogenic effects, and including an indication of the problems that arise in their determination. (author)

  13. Long term liquidity analysis of the firm

    Directory of Open Access Journals (Sweden)

    Jaroslav Gonos

    2009-09-01

    Full Text Available Liquidity control is a very difficult and important function. If the business is not liquid in the long term, it is under threatof bankruptcy, and on the other hand surplus of the cash in hand threaten its future efficiency, because the cash in hand is a sourceof only limited profitability. Long term liquidity is related to the ability of the short term and long term liabilities payment. Articleis trying to point out to the monitoring and analyzing of the long term liquidity in the concrete business, in this case the printing industrycompany. Hereby at the end of the article mentioned monitored and analyzed liquidity is evaluated in the five years time period.

  14. Long Term Care Minimum Data Set (MDS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  15. Sleep facilitates long-term face adaptation

    OpenAIRE

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-01-01

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted imag...

  16. Long term plan of atomic energy development and utilization

    International Nuclear Information System (INIS)

    1982-01-01

    The atomic energy utilization and development in Japan have progressed remarkably, and already nuclear power generation has borne an important part in electric power supply, while radiation has been utilized in the fields of industry, agriculture, medicine and so on. Now, atomic energy is indispensable for national life and industrial activity. The former long term plan was decided in September, 1978, and the new long term plan should be established since the situation has changed largely. The energy substituting for petroleum has been demanded, and the expectation to nuclear power generation has heightened because it enables stable and economical power supply. The independently developed technology related to atomic energy must be put in practical use. The peaceful utilization of atomic energy must be promoted, while contributing to the nuclear non-proliferation policy. The Atomic Energy Commission of Japan decided the new long term plan to clearly show the outline of the important measures related to atomic energy development and utilization in 10 years hereafter, and the method of its promotion. The basic concept of atomic energy development and utilization, the long term prospect and the concept on the promotion, the method of promoting the development and utilization, and the problems of funds, engineers and location are described. (kako, I.)

  17. Associations of rs3918242 and rs2285053 MMP-9 and MMP-2 polymorphisms with the risk, severity, and short- and long-term complications of degenerative mitral valve diseases: a 4.8-year prospective cohort study.

    Science.gov (United States)

    Balistreri, Carmela Rita; Allegra, Alberto; Crapanzano, Floriana; Pisano, Calogera; Triolo, Oreste Fabio; Argano, Vincenzo; Candore, Giuseppina; Lio, Domenico; Ruvolo, Giovanni

    2016-01-01

    Degenerative forms of mitral valve diseases (MVDs) are very complex pathologies. Thus, it is difficult to make generalizations about the disease pathways or genetic risk factors contributing to these diseases. However, a key role of metalloproteinases (MMPs) in their pathophysiology is emerging. Thus, we performed for the first time a perspective study to assess eventual associations of some functional single nucleotide polymorphisms (SNPs) in MMP-2 and MMP-9 genes with the MVD risk, symptom severity, and short- and long-term (4.8 years) complications. For this purpose, 90 patients and two control groups were genotyped for rs3918242, rs243865, and rs2285053 MMP-2 and MMP-9 gene SNPs, and systemic levels of pro-atrial natriuretic peptide (pro-ANP) and two enzymes were quantified and correlated to genotypes of MMP-2 and MMP-9 SNPs studied. In addition, associations between these SNPs and symptom severity and short- and long-term (4.8 years) complications were evaluated. Interestingly, rs3918242 MMP-9 and rs2285053 MMP-2 SNPs were significantly represented in cases than two control groups and were associated with a higher MVD risk, as demonstrated using dominant/recessive models. Cases stratified for NYHA symptoms and particularly those NYHA III+IV with rs3918242 CT+TT MMP-9 and rs2285053CT+TT genotypes also showed higher severity related to significant higher systemic levels of MMP enzymes and pro-ANP at enrolment and 4.8 follow-up times. In addition, cases with these genotypes and particularly those NYHA III+IV had a very significant percentage of complications, particularly at the 4.8 follow-up. Surprisingly, 20% of patient controls developed MVD at 4.8-year follow-up and were carriers of these genotypes. Thus, the associations observed seem to suggest that the two SNPs might represent useful biomarkers and targets for preventing and monitoring MVDs and developing personalized treatments, consenting a more appropriate management and outcome. Copyright © 2016

  18. Long-term effects of a home-visiting intervention for depressed mothers and their infants

    NARCIS (Netherlands)

    Kersten-Alvarez, L.E.; Hosman, C.M.H.; Riksen-Walraven, J.M.A.; Doesum, K.T.M. van; Hoefnagels, C.C.J.

    2010-01-01

    Background - Whereas preventive interventions for depressed mothers and their infants have yielded positive short-term outcomes, few studies have examined their long-term effectiveness. The present follow-up of a randomised controlled trial (RCT) is one of the first to examine the longer-term

  19. Long-term impact of interferon beta-1b in patients with CIS

    DEFF Research Database (Denmark)

    Edan, G; Kappos, L; Montalbán, X

    2014-01-01

    OBJECTIVE: To examine the long-term impact of early treatment initiation of interferon beta-1b (IFNB1b, Betaferon/Betaseron) in patients with a first event suggestive of multiple sclerosis (MS). METHODS: In the original placebo-controlled phase of BENEFIT, patients were randomised to IFNB1b 250 μg...

  20. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD

    NARCIS (Netherlands)

    Hoogendoorn, Martine; Feenstra, Talitha L.; Hoogenveen, Rudolf T.; Rutten-van Molken, Maureen P. M. H.

    Background The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). Methods A systematic review was performed of randomised controlled trials on smoking cessation interventions in

  1. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); T.L. Feenstra (Talitha); R.T. Hoogenveen (Rudolf); M.P.M.H. Rutten-van Mölken (Maureen)

    2010-01-01

    textabstractBackground: The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). Methods: A systematic review was performed of randomised controlled trials on smoking cessation

  2. Premature Discontinuation of Prospective Clinical Studies Approved by a Research Ethics Committee - A Comparison of Randomised and Non-Randomised Studies.

    Directory of Open Access Journals (Sweden)

    Anette Blümle

    Full Text Available Premature discontinuation of clinical studies affects about 25% of randomised controlled trials (RCTs which raises concerns about waste of scarce resources for research. The risk of discontinuation of non-randomised prospective studies (NPSs is yet unclear.To compare the proportion of discontinued studies between NPSs and RCTs that received ethical approval.We systematically surveyed prospective longitudinal clinical studies that were approved by a single REC in Freiburg, Germany between 2000 and 2002. We collected study characteristics, identified subsequent publications, and surveyed investigators to elucidate whether a study was discontinued and, if so, why.Of 917 approved studies, 547 were prospective longitudinal studies (306 RCTs and 241 NPSs. NPSs were on average smaller than RCTs, more frequently single centre and pilot studies, and less frequently funded by industry. NPSs were less frequently discontinued than RCTs: 32/221 (14% versus 78/288 (27%, p<0.001, missing data excluded. Poor recruitment was the most frequent reason for discontinuation in both NPSs (36% and RCTs (37%.Compared to RCTs, NPSs were at lower risk for discontinuation. Measures to reliably predict, sustain, and stimulate recruitment could prevent discontinuation of many RCTs but also of some NPSs.

  3. Intrathoracic Anastomotic Leakage after Gastroesophageal Cancer Resection Is Associated with Reduced Long-term Survival

    DEFF Research Database (Denmark)

    Kofoed, Steen Christian; Calatayud, Dan; Jensen, Lone Susanne

    2014-01-01

    BACKGROUND: Most likely because of low statistical power, no previous studies have shown any significant association between long-term survival and anastomotic leakage in patients who have undergone gastroesophageal cancer resection. MATERIAL AND METHODS: The present study included, prospectively...

  4. Very long-term sequelae of craniopharyngioma.

    Science.gov (United States)

    Wijnen, Mark; van den Heuvel-Eibrink, Marry M; Janssen, Joseph A M J L; Catsman-Berrevoets, Coriene E; Michiels, Erna M C; van Veelen-Vincent, Marie-Lise C; Dallenga, Alof H G; van den Berge, J Herbert; van Rij, Carolien M; van der Lely, Aart-Jan; Neggers, Sebastian J C M M

    2017-06-01

    Studies investigating long-term health conditions in patients with craniopharyngioma are limited by short follow-up durations and generally do not compare long-term health effects according to initial craniopharyngioma treatment approach. In addition, studies comparing long-term health conditions between patients with childhood- and adult-onset craniopharyngioma report conflicting results. The objective of this study was to analyse a full spectrum of long-term health effects in patients with craniopharyngioma according to initial treatment approach and age group at craniopharyngioma presentation. Cross-sectional study based on retrospective data. We studied a single-centre cohort of 128 patients with craniopharyngioma treated from 1980 onwards (63 patients with childhood-onset disease). Median follow-up since craniopharyngioma presentation was 13 years (interquartile range: 5-23 years). Initial craniopharyngioma treatment approaches included gross total resection ( n  = 25), subtotal resection without radiotherapy ( n  = 44), subtotal resection with radiotherapy ( n  = 25), cyst aspiration without radiotherapy ( n  = 8), and 90 Yttrium brachytherapy ( n  = 21). Pituitary hormone deficiencies (98%), visual disturbances (75%) and obesity (56%) were the most common long-term health conditions observed. Different initial craniopharyngioma treatment approaches resulted in similar long-term health effects. Patients with childhood-onset craniopharyngioma experienced significantly more growth hormone deficiency, diabetes insipidus, panhypopituitarism, morbid obesity, epilepsy and psychiatric conditions compared with patients with adult-onset disease. Recurrence-/progression-free survival was significantly lower after initial craniopharyngioma treatment with cyst aspiration compared with other therapeutic approaches. Survival was similar between patients with childhood- and adult-onset craniopharyngioma. Long-term health conditions were comparable after

  5. Detection of occult paroxysmal atrial fibrilation by implantable long-term electrocardiographic monitoring in cryptogenic stroke and transient ischemic attack population: a study protocol for prospective matched cohort study.

    Science.gov (United States)

    Petrovičová, Andrea; Kurča, Egon; Brozman, Miroslav; Hasilla, Jozef; Vahala, Pavel; Blaško, Peter; Andrášová, Andrea; Hatala, Robert; Urban, Luboš; Sivák, Štefan

    2015-12-03

    Cardio-embolic etiology is the most frequently predicted cause of cryptogenic stroke/TIA. Detection of occult paroxysmal atrial fibrillation is crucial for selection of appropriate medication. Enrolment of eligible cryptogenic stroke and TIA patients began in 2014 and will continue until 2018. The patients undergo long-term (12 months) ECG monitoring (implantable loop recorder) and testing for PITX2 (chromosome 4q25) and ZFHX3 (chromosome 16q22) gene mutations. There will be an appropriate control group of age- and sex-matched healthy volunteers. To analyse the results descriptive statistics, statistical tests for group differences, and correlation analyses will be used. In our study we are focusing on a possible correlation between detection of atrial fibrillation by an implantable ECG recorder, and PITX2 and/or ZFHX3 gene mutations in cryptogenic stroke/TIA patients. A correlation could lead to implementation of this genomic approach to cryptogenic stroke/TIA diagnostics and management. The results will be published in 2018. ClinicalTrials.gov: NCT02216370 .

  6. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study

    NARCIS (Netherlands)

    van der Eerden, M. M.; Vlaspolder, F.; de Graaff, C. S.; Groot, T.; Bronsveld, W.; Jansen, H. M.; Boersma, W. G.

    2005-01-01

    Background: There is much controversy about the ideal approach to the management of community acquired pneumonia ( CAP). Recommendations differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics. Methods: In a prospective randomised open study performed

  7. Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial

    Science.gov (United States)

    2014-01-01

    Background Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness. Methods/Design This study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated. Discussion We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease. Trial registration ClinicalTrials.gov identifier: NCT01547611

  8. Intravenous iron vs blood for acute post-partum anaemia (IIBAPPA): a prospective randomised trial.

    Science.gov (United States)

    Chua, Seng; Gupta, Sarika; Curnow, Jennifer; Gidaszewski, Beata; Khajehei, Marjan; Diplock, Hayley

    2017-12-19

    Acute post-partum anaemia can be associated with significant morbidity including a predisposition for postnatal depression. Lack of clear practice guidelines means a number of women are treated with multiple blood transfusions. Intravenous iron has the potential to limit the need for multiple blood transfusions but its role in the post-partum setting is unclear. IIBAPPA is a multi-centre randomised non-inferiority trial. Women with a primary post-partum haemorrhage (PPH) >1000 mL and resultant haemoglobin (Hb) 5.5-8.0 g/dL after resuscitation with ongoing symptomatic anaemia who are otherwise stable (no active bleeding) are eligible to participate. Patients with sepsis or conditions necessitating rapid Hb restoration are excluded. Eligible participants are randomised to receive a blood transfusion or a single dose of intravenous iron polymaltose calculated using the Ganzoni formula. Primary outcome measures include Hb, Ferritin and C-Reactive Protein levels on Day 7. Secondary outcomes evaluate (i) Hb, Ferritin and CRP levels on Day 14, 28, (ii) anaemia symptoms on Day 0, 7, 14 and 28 using structured health related quality of life questionnaires, (iii) treatment safety by assessing adverse reactions and infection endpoints and (iv) the quantitative impact of anaemia on breast feeding quality using a hospital designed questionnaire. If equivalence in Hb and ferritin levels, symptom scores and safety endpoints is demonstrated, intravenous iron may become the preferred treatment for women with acute post-partum anaemia to minimise transfusion reactions and costs. Australian and New Zealand Clinical Trials Registry: ACTRN12615001370594 on 16th December, 2015 (prospective approval).

  9. Intracameral bevacizumab as an adjunct to trabeculectomy: a 1-year prospective, randomised study.

    Science.gov (United States)

    Vandewalle, Evelien; Abegão Pinto, Luís; Van Bergen, Tine; Spielberg, Leigh; Fieuws, Steffen; Moons, Lieve; Spileers, Werner; Zeyen, Thierry; Stalmans, Ingeborg

    2014-01-01

    To investigate the efficacy and safety of a single intracameral bevacizumab injection to improve the outcome of trabeculectomy. A 12-month, prospective, randomised, double-masked, placebo-controlled trial. Patients with medically uncontrolled open-angle glaucoma scheduled for a primary trabeculectomy were recruited and randomised to receive 50 µL of either bevacizumab (1.25 mg) or placebo (balanced salt solution) peroperatively. Absolute success was defined as intraocular pressure (IOP) ≤18 mm Hg and >5 mm Hg with at least 30% reduction from baseline and no loss of light perception. Success through the use of additional medical and/or surgical IOP-lowering treatments was defined as qualified success. 138 patients completed a 12-month follow-up, 69 of whom were in the bevacizumab treated group. IOP at 1 year postoperatively was significantly lower than baseline (placebo: 25.6±9.9 mm Hg vs 11.5±3.9 mm Hg, p<0.01; bevacizumab: 24.8±8.1 mm Hg vs 11.9±3.8 mm Hg, p<0.01), with no difference between treatment groups (p=0.69). However, absolute success was higher in the bevacizumab group (71% vs 51%, p=0.02), with the need for IOP-lowering interventions (needlings) being lower in this group (12% vs 33%, p=0.003). Complication rates were low and comparable between groups. Peroperative administration of intracameral bevacizumab significantly reduces the need for additional interventions during the follow-up of patients undergoing trabeculectomy.

  10. Long-term prisoner in prison isolation

    Directory of Open Access Journals (Sweden)

    Karolina Grudzińska

    2013-06-01

    Full Text Available Long-term prisoner belongs to a particular category of people who are imprisoned in prisons. On the one hand in this group are often heavily demoralized people who committed the most serious crimes, on the other hand it is a group of prisoners, who should be well thought out and programmed the impact of rehabilitation. The situation of man trapped for years poses in a complicated situation not only the prisoners, but also the entire prison staff. They have to take care of the fact that the prison isolation did not cause the state in which convicts form itself in learned helplessness and lack of skills for self-planning and decision-making. In addition, planning the rehabilitation impact of long-term prisoners should not be forgotten that these prisoners in the short or the long term will return to the libertarian environment therefore, should prevent any negative effects of long-term imprisonment. This article presents the main issues related to the execution of imprisonment against long-term prisoners. It is an attempt to systematize the knowledge of this category of people living in prison isolation.

  11. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    Science.gov (United States)

    2012-08-31

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

  12. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park

    2010-04-01

    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  13. DRIVERS OF LONG-TERM CONVERGENCE. FOCUS ON ROMANIA

    Directory of Open Access Journals (Sweden)

    MANUELA UNGURU

    2014-11-01

    Full Text Available With initial low levels of income per capita, a declining population and relatively modest economic growth rates, there are little prospects of diminishing the gap between Romania and the EU countries. Nevertheless, in the long term, convergence is expected. The question then arises, “What are the drivers and their likely potential to boost economic growth and the catching-up process?”. This paper presents shortly the theoretical background of economic convergence and then focuses on the assessment of possible paths of Romania’s convergence towards the EU. Based on the existing long-term macroeconomic projections and the assessment of the possible future developments of the drivers of economic growth, we have built three scenarios of economic convergence, highlighting the possible timespan of convergence. We have employed growth accounting methods to decompose output growth rate into production factors’ contributions (capital and labour and total factor productivity.

  14. Long-Term Prognosis of Plantar Fasciitis

    DEFF Research Database (Denmark)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell

    2018-01-01

    , exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study....... The risk was significantly greater for women (P heel...... regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us...

  15. Long-term dependence in exchange rates

    Directory of Open Access Journals (Sweden)

    A. Karytinos

    2000-01-01

    Full Text Available The extent to which exchange rates of four major currencies against the Greek Drachma exhibit long-term dependence is investigated using a R/S analysis testing framework. We show that both classic R/S analysis and the modified R/S statistic if enhanced by bootstrapping techniques can be proven very reliable tools to this end. Our findings support persistence and long-term dependence with non-periodic cycles for the Deutsche Mark and the French Franc series. In addition a noisy chaos explanation is favored over fractional Brownian motion. On the contrary, the US Dollar and British Pound were found to exhibit a much more random behavior and lack of any long-term structure.

  16. Long term planning for wind energy development

    International Nuclear Information System (INIS)

    Trinick, M.

    1995-01-01

    In a planning system intended to be governed primarily by policies in statutory plans a reasonable horizon for long term planning is 10 years or longer. Because of statutory requirements, developers have no option but to pay due regard to, and take a full part in, long term planning. The paper examines the type of policies which have emerged in the last few years to cater for wind energy development. It canvasses the merits of different types of policies. Finally, it discusses the policy framework which may emerge to cater for development outside NFFO. (Author)

  17. Long-term characteristics of nuclear emulsion

    International Nuclear Information System (INIS)

    Naganawa, N; Kuwabara, K

    2010-01-01

    Long-term characteristics of the nuclear emulsion so called 'OPERA film' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  18. Long-term characteristics of nuclear emulsion

    Science.gov (United States)

    Naganawa, N.; Kuwabara, K.

    2010-02-01

    Long-term characteristics of the nuclear emulsion so called ``OPERA film'' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  19. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  20. Long term storage techniques for 85Kr

    International Nuclear Information System (INIS)

    Foster, B.A.; Pence, D.T.; Staples, B.A.

    1975-01-01

    As new nuclear fuel reprocessing plants go on stream, the collection of fission product 85 Kr will be required to avoid potential local release problems and long-term atmospheric buildup. Storage of the collected 85 Kr for a period of at least 100 years will be necessary to allow approximately 99.9 percent decay before it is released. A program designed to develop and evaluate proposed methods for long-term storage of 85 Kr is discussed, and the results of a preliminary evaluation of three methods, high pressure steel cylinders, zeolite encapsulation, and clathrate inclusion are presented. (U.S.)

  1. No Evidence for the Benefit of Gonadotropin-Releasing Hormone Agonist in Preserving Ovarian Function and Fertility in Lymphoma Survivors Treated With Chemotherapy: Final Long-Term Report of a Prospective Randomized Trial.

    Science.gov (United States)

    Demeestere, Isabelle; Brice, Pauline; Peccatori, Fedro A; Kentos, Alain; Dupuis, Jehan; Zachee, Pierre; Casasnovas, Olivier; Van Den Neste, Eric; Dechene, Julie; De Maertelaer, Viviane; Bron, Dominique; Englert, Yvon

    2016-08-01

    We have reported previously that after 1-year follow up, gonadotropin-releasing hormone agonist (GnRHa) did not prevent chemotherapy-induced premature ovarian failure (POF) in patients with lymphoma, but may provide protection of the ovarian reserve. Here, we report the final analysis of the cohort after 5 years of follow up. A total of 129 patients with lymphoma were randomly assigned to receive either triptorelin plus norethisterone (GnRHa group) or norethisterone alone (control group) during chemotherapy. Ovarian function and fertility were reported after 2, 3, 4, and 5 to 7 years of follow up. The primary end point was POF, defined as at least one follicle-stimulating hormone value of > 40 IU/L after 2 years of follow up. Sixty-seven patients 26.21 ± 0.64 years of age had available data after a median follow-up time of 5.33 years in the GnRHa group and 5.58 years in the control group (P = .452). Multivariate logistic regression analysis showed a significantly increased risk of POF in patients according to age (P = .047), the conditioning regimen for hematopoietic stem cell transplant (P = .002), and the cumulative dose of cyclophosphamide > 5 g/m(2) (P = .019), but not to the coadministration of GnRHa during chemotherapy (odds ratio, 0.702; P = .651). The ovarian reserve, evaluated using anti-Müllerian hormone and follicle-stimulating hormone levels, was similar in both groups. Fifty-three percent and 43% achieved pregnancy in the GnRHa and control groups, respectively (P = .467). To the best of our knowledge, this is the first long-term analysis confirming that GnRHa is not efficient in preventing chemotherapy-induced POF in young patients with lymphoma and did not influence future pregnancy rate. These results reopen the debate about the drug's benefit in that it should not be recommended as standard for fertility preservation in patients with lymphoma. © 2016 by American Society of Clinical Oncology.

  2. Prospective observational study protocol to investigate long-term adverse effects of methylphenidate in children and adolescents with ADHD: the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study.

    Science.gov (United States)

    Inglis, S K; Carucci, S; Garas, P; Häge, A; Banaschewski, T; Buitelaar, J K; Dittmann, R W; Falissard, B; Hollis, C; Kovshoff, H; Liddle, E; McCarthy, S; Nagy, P; Neubert, A; Rosenthal, E; Sonuga-Barke, E; Wong, I; Zuddas, A; Coghill, D C

    2016-04-26

    Methylphenidate is the most frequently used medication for the treatment of attention-deficit/hyperactivity disorder (ADHD) in Europe. Following concerns about its safety, the European Commission called for research into the long-term effects of methylphenidate on children and adolescents with ADHD. The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) research programme was designed to address this call. At the heart of this programme is a 2-year longitudinal naturalistic pharmacovigilance study being conducted in 27 European sites. 3 cohorts of children and adolescents (aged 6-17) living in the UK, Germany, Italy and Hungary are being recruited:Group 1 (Medicated ADHD): 800 ADHD medication-naive children and adolescents with a clinical diagnosis of ADHD about to start methylphenidate treatment for the first time.Group 2 (Unmedicated ADHD): 400 children and adolescents with a clinical diagnosis of ADHD who have never been treated with ADHD medication and have no intention of beginning medication.Group 3 (Non-ADHD): 400 children and adolescents without ADHD who are siblings of individuals in either group 1 or 2.All participants will be assessed 5 times during their 2-year follow-up period for growth and development, psychiatric, neurological and cardiovascular health. The primary outcome measure will be the height velocity SD score. Ethical approval for the study has been granted by the East of Scotland Research Ethics Service. Following this approval, patient information leaflets and consent forms were translated as necessary and submissions made by lead sites in each of the other 3 countries to their own ethics committees. Following ethical approval in each country, local ethical permissions at each site were sought and obtained as needed. The study's website (http://www.adhd-adduce.org/page/view/2/Home) provides information for researchers, participants and the general public. NCT01470261. Published by the BMJ Publishing Group Limited

  3. Experiences of long-term tranquillizer use

    DEFF Research Database (Denmark)

    Skinhoj, K T; Larsson, S; Helweg-Joergensen, S

    2001-01-01

    , the psychodynamic perspective is integrated within a multi-dimensional model that considers biological, cognitive, identity, gender and social learning factors. The analysis reveals the possibility of achieving a detailed understanding of the dynamic processes involved in the development of long-term tranquillizer...

  4. Long-Term Orientation in Trade

    NARCIS (Netherlands)

    Hofstede, G.J.; Jonker, C.M.; Verwaart, D.

    2008-01-01

    Trust does not work in the same way across cultures. This paper presents an agent model of behavior in trade across Hofstedes cultural dimension of long-term vs. short-term orientation. The situation is based on a gaming simulation, the Trust and Tracing game. The paper investigates the

  5. Safety of long-term PPI therapy

    DEFF Research Database (Denmark)

    Reimer, Christina

    2013-01-01

    Proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. Long-term use is becoming increasingly common, in some cases without a proper indication. A large number of mainly observational studies on a very wide range of possible associations have been publishe...... to a careful evaluation of the indication for PPI treatment....

  6. Long term consequences of early childhood malnutrition

    NARCIS (Netherlands)

    Kinsey, B.H.; Hoddinott, J; Alderman, H.

    2006-01-01

    This paper examines the impact of pre-school malnutrition on subsequent human capital formation in rural Zimbabwe using a maternal fixed effects - instrumental variables (MFE-IV) estimator with a long term panel data set. Representations of civil war and drought shocks are used to identify

  7. Financial Incentives in Long-Term Care

    NARCIS (Netherlands)

    P.L.H. Bakx (Pieter)

    2015-01-01

    markdownabstract__Abstract__ Long-term care (ltc) aims to help individuals to cope with their impairments. In my thesis, I describe ltc financing alternatives and their consequences for the allocation of ltc. This thesis consists of two parts. In the first part, I investigate how alternative ways

  8. Long-term outcomes of patellofemoral arthroplasty.

    NARCIS (Netherlands)

    Jonbergen, J.P.W. van; Werkman, D.M.; Barnaart, L.F.; Kampen, A. van

    2010-01-01

    The purpose of this study was to correlate the long-term survival of patellofemoral arthroplasty with primary diagnosis, age, sex, and body mass index. One hundred eighty-five consecutive Richards type II patellofemoral arthroplasties were performed in 161 patients with isolated patellofemoral

  9. Long-Term Memory and Learning

    Science.gov (United States)

    Crossland, John

    2011-01-01

    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  10. The 2013 Long-Term Budget Outlook

    Science.gov (United States)

    2013-09-01

    number of years, leading to substantial additional federal spending. For example, the nation could experience a massive earthquake, a nuclear meltdown...budget surpluses remaining after paying down publicly held debt available for redemption . a. For comparison with the current long-term projections, CBO

  11. Long-term effects of ionizing radiation

    International Nuclear Information System (INIS)

    Kaul, Alexander; Burkart, Werner; Grosche, Bernd; Jung, Thomas; Martignoni, Klaus; Stephan, Guenther

    1997-01-01

    This paper approaches the long-term effects of ionizing radiation considering the common thought that killing of cells is the basis for deterministic effects and that the subtle changes in genetic information are important in the development of radiation-induced cancer, or genetic effects if these changes are induced in germ cells

  12. Pituitary diseases : long-term psychological consequences

    NARCIS (Netherlands)

    Tiemensma, Jitske

    2012-01-01

    Nowadays, pituitary adenomas can be appropriately treated, but patients continue to report impaired quality of life (QoL) despite long-term remission or cure. In patients with Cushing’s disease, Cushing’s syndrome or acromegaly, doctors should be aware of subtle cognitive impairments and the

  13. The long term stability of lidar calibrations

    DEFF Research Database (Denmark)

    Courtney, Michael; Gayle Nygaard, Nicolai

    Wind lidars are now used extensively for wind resource measurements. One of the requirements for the data to be accepted in support of project financing (so-called ‘banka-bility’) is to demonstrate the long-term stability of lidar cali-brations. Calibration results for six Leosphere WindCube li...

  14. Rebalancing for Long-Term Investors

    NARCIS (Netherlands)

    Driessen, Joost; Kuiper, Ivo

    2017-01-01

    In this study we show that the rebalance frequency of a multi-asset portfolio has only limited impact on the utility of a long-term passive investor. Although continuous rebalancing is optimal, the loss of a suboptimal strategy corresponds to up to only 30 basis points of the initial wealth of the

  15. Long-term uranium supply-demand analyses

    International Nuclear Information System (INIS)

    1986-12-01

    It is the intention of this study to investigate the long-term uranium supply demand situation using a number of supply and demand related assumptions. For supply, these assumptions as used in the Resources and Production Projection (RAPP) model include country economic development status, and consequent lead times for exploration and development, uranium development status, country infrastructure, and uranium resources including the Reasonably Assured (RAR), Estimated Additional, Categories I and II, (EAR-I and II) and Speculative Resource categories. The demand assumptions were based on the ''pure'' reactor strategies developed by the NEA Working Party on Nuclear Fuel Cycle Requirements for the 1986 OECD (NEA)/IAEA reports ''Nuclear Energy and its Fuel Cycle: Prospects to 2025''. In addition for this study, a mixed strategy case was computed using the averages of the Plutonium (Pu) burning LWR high, and the improved LWR low cases. It is understandable that such a long-term analysis cannot present hard facts, but it can show which variables may in fact influence the long-term supply-demand situation. It is hoped that results of this study will provide valuable information for planners in the uranium supply and demand fields. Periodical re-analyses with updated data bases will be needed from time to time

  16. Long-term health outcomes of youth sports injuries.

    Science.gov (United States)

    Maffulli, N; Longo, U G; Gougoulias, N; Loppini, M; Denaro, V

    2010-01-01

    Injuries can counter the beneficial effects of sports participation at a young age if a child or adolescent is unable to continue to participate because of residual effects of injury. This paper reviews current knowledge in the field of long-term health outcomes of youth sports injuries to evaluate the evidence regarding children dropping out of sport due to injury, physeal injuries and growth disturbance, studies of injuries affecting the spine and knee of young and former athletes and surgical outcome of anterior cruciate ligament (ACL) reconstruction in children. Studies of dropping out of sport due to injury are limited primarily to gymnasts and implicate such injuries as ACL rupture and osteochondritis dissecans of the elbow joint in the early retirement of young athletes. Although most physeal injuries resolve with treatment and rest, there is evidence of disturbed physeal growth as a result of injury. Radiological findings implicate the effects of intense physical loading and injury in the development of spinal pathology and back pain during the growth of youth athletes; however, long-term effects are unclear. Follow-up studies of young athletes and adults indicate a high risk of osteoarthritis after meniscus or ACL injury. Prospective cohort studies with a follow-up into adulthood are needed to clarify the long-term health outcomes of youth sports injuries. Important to this research is meticulous documentation of injuries on injury report forms that include age-appropriate designations of the type of injury and accurate determination of exposure-based injury rates.

  17. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    OBJECTIVE: A prospective study of 207 laymen and professionals answered a questionnaire regarding the expectations of the long-term outcome 6 months after a unilateral tibial shaft fracture. The aim was (1) to disclose the expected outcome after unilateral tibial shaft fracture, and (2) to compare...... these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...

  18. Long-term deconditioning of gas-filled surge arresters

    Science.gov (United States)

    Stanković, Koviljka; Brajović, Dragan; Alimpijević, Mališa; Lončar, Boris

    2016-07-01

    The aim of this paper is to identify parameters that influence the long-term deconditioning effect of gas-filled surge arrester (GFSA) and to provide practical recommendations for mitigating this effect. Namely, after some period of time, on order of hours or days, during which there is no activation due to overvoltage, the deconditioning of GFSA occurs. This effect was observed experimentally within the paper. The observed parameters that could influence the long-term deconditioning effect were the following: shape of voltage load, gas type, gas pressure, interelectrode distance, electrode material, electrode surface topography as well as GFSA design such as two- or three-electrode configuration. According to the results obtained, it has been shown that the occurrence of long-term deconditioning in an insulating system, insulated by a noble gas at a subpressure and with small interelectrode distances, is a phenomenon that always occurs when the insulating system is at rest for about an hour. It has been found that the type of noble gas does not influence the long-term deconditioning. Analysis of such insulating systems' parameters, with a prospect of being used as GFSAs, has demonstrated that this phenomenon is less pronounced at higher pressures (for the same value of the pressure (p) and interelectrode distance (d) product) and for electrodes with microscopically embossed surfaces. According to the results that were obtained by noble gases and their mixtures, as well as the results that were obtained by mixtures of SF6 gas with noble gasses, it can be claimed with confidence that the effect of the long-term deconditioning is an electrode effect. It has also been established that the deconditioning effect does not depend on the electrode material except in the case of electrodes made out of noble metals, which reduce the effect. Based on these results, it can be recommended that the working point of GFSAs be set (according to the DC breakdown voltage value) at a

  19. Fourteen-Year Long-Term Results after Gastric Banding

    Directory of Open Access Journals (Sweden)

    Christine Stroh

    2011-01-01

    Full Text Available Background. Gastric banding (GB is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up. Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome. Results. The mean postoperative follow up time was 94.4 months (range 2–144. The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up. Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

  20. Long-term outcomes of unilateral transtibial amputations.

    Science.gov (United States)

    Ebrahimzadeh, Mohamad H; Hariri, Sanaz

    2009-06-01

    the long-term outcomes of wartime transtibial amputations have not been well documented. The purpose of this case series is to present the long-term functional, social, and psychological outcomes of modern-day military unilateral transtibial amputees. the Iranian Veterans Administration of the Khorasan province invited their Iranian military amputees from the Iran-Iraq War (1980-1988) to its medical center for evaluation. The patients filled out a detailed questionnaire and were interviewed and examined by each team member. two hundred (77%) of the 260 invited amputees were willing and able to come back for follow-up. Ninety-six of these patients (48%) were unilateral transtibial amputation. The average follow-up was 17.4 years (range 15-22 years). Land mines were the leading cause of war injury necessitating a transtibial amputation (68%). The most common symptoms about their amputated limbs were phantom sensations (54%), phantom pain (17%), and stump pain (42%). Lower back pain, contralateral (nonamputated limb) knee pain, and ipsilateral (amputated limb) knee pain were reported by 44%, 38%, and 13% of subjects, respectively. Sixty-five percent of patients were employed or had been employed for multiple years after their war injury. All patients were married, and 97% had children. Fifty-four percent of amputees reported psychological problems; 26% were currently utilizing psychological support services. at long-term follow-up, most military transtibial amputees experienced phantom sensation or some type of stump pain. More than half had persistent psychiatric problems, but only about half of these patients were receiving psychological treatment. Although this case series reports the status of these amputees, the next step would be to prospectively follow modern wartime amputees using standardized, validated outcome measures. With the goal of optimizing long-term amputee outcomes, researchers should correlate outcomes with demographics, injury characteristics, and

  1. Moderate risk-adapted dose escalation with 3D-conformal radiotherapy for prostate cancer from 70 to 74 Gy : long-term morbidity and survival from a prospective phase II trial

    International Nuclear Information System (INIS)

    Bombosch, V. B.

    2015-01-01

    Abstract English Background and Purpose: Evaluation of late side-effects and survival more than 60 months after 3-dimensional conformal radiotherapy with moderate, risk adapted dose escalation from 70 to 74 Gy in patients with localized prostate cancer within a prospective Austrian-German phase II multicenter trial. Material and Methods: Between 03/1999 and 07/2002 486 patients were registered in the prospective Austrian-German multicenter phase II trial. 441 (90.7%) patients were evaluated. Patients in the low and intermediate risk group were treated with 70Gy, patients in the high risk group received 74Gy. Additional hormonal-therapy was recommended for intermediate- and high-risk group patients. Gastrointestinal (GI) and genitourinary (GU) late toxicity according to EORTC/RTOG criteria, initial appearance, prevalence and duration of grade >=2 side-effects were investigated. Furthermore bNED (Phoenix/Nadir + 2), overall and disease specific survival were prospectively assessed. Results: Median follow-up was 90 (2-158) months in all 441 patients and 99 (18-158) months in living patients. 154 patients (35%) had a follow-up of longer or equal 120 months. Distribution among risk groups was 26% (low), 51% (intermediate) and 23% (high). HT was administered in 86% of patients prior to RT. Late gastrointestinal side-effects at 5- and 10 years were 29%/32% (70/74Gy) and 30%/35% (70/74Gy) as actuarial rates; p=0.67. Late genitourinary side-effects at 5- and 10 years were 17%/26% (70/74Gy) and 27%/34% (70/74Gy); p=0.12. No more than 15% (GI) and 15% (GU) of patients suffered from side-effects >=2 at any time after the end of therapy (prevalence). The proportion of patients suffering from severe toxicity was low (Grade 3 GI: 2%, GU: 10%). 10 year actuarial bNED rate was 65%, 70% and 58% in the low-, intermediate- and high risk group according to Phoenix (Nadir +2) criteria. Overall and disease specific survival were 67% and 91% in all patients. Conclusion: Dose escalation

  2. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

    Science.gov (United States)

    2013-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  3. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR)

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  4. Factors During Pregnancy, Delivery and Birth Affecting Global Quality of Life of the Adult Child at Long-term Follow-up. Results from the Prospective Copenhagen Perinatal Birth Cohort 1959-61

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available This paper presents a prospective cohort study, where we explore associations between pregnancy, delivery and the global quality of life (QOL of the adult child 31-33 years later. The data is from the Copenhagen Perinatal Birth Cohort 1959-61 using two sets of questionnaires send to 7,222 persons: one filled out by physicians during pregnancy and delivery, while the follow-up questionnaire was completed by the adult children 31-33 years later. The main outcome measures were objective factors describing pregnancy and delivery along with global quality of life, including: Well-being, life satisfaction, happiness, fulfilment of needs, experience of life's temporal and spatial domains, expression of life's potentials and objective measures. Results showed two main factors in pregnancy that seemed to be associated with a reduced quality of life for the child 31-33 years later: the mother's smoking habits and the mother's medication–especially painkillers and different psychopharmacological drugs with the association being most prevalent early in pregnancy. Considering what can and do go wrong during the various stages of labour and delivery and considering how few connections we found between the factors examined and the later global QOL, it seems that the child is remarkably resilient to external influences during pregnancy and delivery concerned with global QOL, as an adult.

  5. Long-term selenium status in humans

    International Nuclear Information System (INIS)

    Baskett, C.K.; Spate, V.L.; Mason, M.M.; Nichols, T.A.; Williams, A.; Dubman, I.M.; Gudino, A.; Denison, J.; Morris, J.S.

    2001-01-01

    The association of sub-optimal selenium status with increased risk factors for some cancers has been reported in two recent epidemiological studies. In both studies the same threshold in selenium status was observed, below which, cancer incidence increased. To assess the use of nails as a biologic monitor to measure the long-term selenium status, an eight-year longitudinal study was undertaken with a group of 11 adult subjects, 5 women and 6 men. Selenium has been measured by instrumental neutron activation analysis. Differences between fingernails and toenails with be discussed. In addition, the results will be discussed in the context of the long-term stability of the nail monitor to measure selenium status during those periods when selenium determinants are static; and the changes that occur as a result of selenium supplementation. (author)

  6. Influenza in long-term care facilities.

    Science.gov (United States)

    Lansbury, Louise E; Brown, Caroline S; Nguyen-Van-Tam, Jonathan S

    2017-09-01

    Long-term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services. As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long-term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence. © 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

  7. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas

    2016-01-01

    in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long......-term in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...... the hypothesis that time horizons are influenced by ownership structures and particularly that industrial foundations promote longtermism. Policymakers which are interested in promoting longtermism should allow and perhaps even encourage the creation of industrial foundations. More generally they should consider...

  8. Analysis of long-term energy scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Lemming, J.; Morthorst, P.E.

    1998-09-01

    When addressing the role of fusion energy in the 21. century, the evaluation of possible future structures in the electricity market and the energy sector as a whole, can be a useful tool. Because fusion energy still needs demonstration, commercialized fusion energy is not likely to be a reality within the next few decades. Therefore long-term scenarios are needed describing the energy markets, which fusion energy eventually will be part of. This report performs an analysis of two of the most detailed existing long-term scenarios describing possible futures of the energy system. The aim is to clarify the frames in which the future development of the global energy demand, as well as the structure of the energy system can be expected to develop towards the year 2100. (au) 19 refs.

  9. Long-term effects of radiation

    International Nuclear Information System (INIS)

    Smith, J.; Smith, T.

    1981-01-01

    It is pointed out that sources of long-term damage from radiation are two-fold. People who have been exposed to doses of radiation from initial early fallout but have recovered from the acute effects may still suffer long-term damage from their exposure. Those who have not been exposed to early fallout may be exposed to delayed fallout, the hazards from which are almost exclusively from ingesting strontium, caesium and carbon isotopes present in food; the damage caused is relatively unimportant compared with that caused by the brief doses from initial radiation and early fallout. A brief discussion is presented of the distribution of delayed long-lived isotope fallout, and an outline is sketched of late biological effects, such as malignant disease, cataracts, retarded development, infertility and genetic effects. (U.K.)

  10. Long term economic relationships from cointegration maps

    Science.gov (United States)

    Vicente, Renato; Pereira, Carlos de B.; Leite, Vitor B. P.; Caticha, Nestor

    2007-07-01

    We employ the Bayesian framework to define a cointegration measure aimed to represent long term relationships between time series. For visualization of these relationships we introduce a dissimilarity matrix and a map based on the sorting points into neighborhoods (SPIN) technique, which has been previously used to analyze large data sets from DNA arrays. We exemplify the technique in three data sets: US interest rates (USIR), monthly inflation rates and gross domestic product (GDP) growth rates.

  11. Murine model of long term obstructive jaundice

    Science.gov (United States)

    Aoki, Hiroaki; Aoki, Masayo; Yang, Jing; Katsuta, Eriko; Mukhopadhyay, Partha; Ramanathan, Rajesh; Woelfel, Ingrid A.; Wang, Xuan; Spiegel, Sarah; Zhou, Huiping; Takabe, Kazuaki

    2016-01-01

    Background With the recent emergence of conjugated bile acids as signaling molecules in cancer, a murine model of obstructive jaundice by cholestasis with long-term survival is in need. Here, we investigated the characteristics of 3 murine models of obstructive jaundice. Methods C57BL/6J mice were used for total ligation of the common bile duct (tCL), partial common bile duct ligation (pCL), and ligation of left and median hepatic bile duct with gallbladder removal (LMHL) models. Survival was assessed by Kaplan-Meier method. Fibrotic change was determined by Masson-Trichrome staining and Collagen expression. Results 70% (7/10) of tCL mice died by Day 7, whereas majority 67% (10/15) of pCL mice survived with loss of jaundice. 19% (3/16) of LMHL mice died; however, jaundice continued beyond Day 14, with survival of more than a month. Compensatory enlargement of the right lobe was observed in both pCL and LMHL models. The pCL model demonstrated acute inflammation due to obstructive jaundice 3 days after ligation but jaundice rapidly decreased by Day 7. The LHML group developed portal hypertension as well as severe fibrosis by Day 14 in addition to prolonged jaundice. Conclusion The standard tCL model is too unstable with high mortality for long-term studies. pCL may be an appropriate model for acute inflammation with obstructive jaundice but long term survivors are no longer jaundiced. The LHML model was identified to be the most feasible model to study the effect of long-term obstructive jaundice. PMID:27916350

  12. Long-term course of opioid addiction.

    Science.gov (United States)

    Hser, Yih-Ing; Evans, Elizabeth; Grella, Christine; Ling, Walter; Anglin, Douglas

    2015-01-01

    Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

  13. Long-term data storage in diamond

    OpenAIRE

    Dhomkar, Siddharth; Henshaw, Jacob; Jayakumar, Harishankar; Meriles, Carlos A.

    2016-01-01

    The negatively charged nitrogen vacancy (NV?) center in diamond is the focus of widespread attention for applications ranging from quantum information processing to nanoscale metrology. Although most work so far has focused on the NV? optical and spin properties, control of the charge state promises complementary opportunities. One intriguing possibility is the long-term storage of information, a notion we hereby introduce using NV-rich, type 1b diamond. As a proof of principle, we use multic...

  14. French Approach for Long Term Storage Safety

    International Nuclear Information System (INIS)

    Marciano, Jacob; Carreton, Jean-Pierre; Lizot, Marie Therese; Lhomme, Veronique

    2014-01-01

    IRSN presents its statement regarding long-term storage facilities; in France, the regulatory documents do not define the long term duration. The storage facility lifetime can only be appreciated according to the needs and materials stored therein. However, the magnitude of the long-term can be estimated at a few hundred years compared to a few decades for current storage. Usually, in France, construction of storage facilities is driven from the necessity various necessities, linked to the management of radioactive material (eg spent fuel) and to the management of radioactive waste. Because of the variety of 'stored materials and objects' (fission product solutions, plutonium oxide powders, activated solids, drums containing technological waste, spent fuel...), a great number of storage facility design solutions have been developed (surface, subsurface areas, dry or wet conditions...) in the World. After describing the main functions of a storage facility, IRSN displays the safety principles and the associated design principles. The specific design principles applied to particular storage (dry or wet spent fuel storage, depleted uranium or reprocessed uranium storage, plutonium storage, waste containing tritium storage, HLW and ILLW storage...) are also presented. Finally, the concerns due to the long-term duration storage and related safety assessment are developed. After discussing these issues, IRSN displays its statement. The authorization procedures governing the facility lifetime are similar to those of any basic nuclear installation, the continuation of the facility operation remaining subject to periodic safety reviews (in France, every 10 years). The applicant safety cases have to show, that the safety requirements are always met; this requires, at minimum, to take into account at the design stage, comfortable design margins. (author)

  15. Accounting of Long-Term Biological Assets

    OpenAIRE

    Valeriy Mossakovskyy; Vasyl Korytnyy

    2015-01-01

    The article is devoted to generalization of experience in valuation of long-term biological assets of plant-growing and animal-breeding, and preparation of suggestions concerning improvement of accounting in this field. Recommendations concerning accounting of such assets are given based on the study of accounting practice at specific agricultural company during long period of time. Authors believe that fair value is applicable only if price level for agricultural products is fixed by the gov...

  16. Optimal long-term contracting with learning

    OpenAIRE

    He, Zhiguo; Wei, Bin; Yu, Jianfeng; Gao, Feng

    2016-01-01

    We introduce uncertainty into Holmstrom and Milgrom (1987) to study optimal long-term contracting with learning. In a dynamic relationship, the agent's shirking not only reduces current performance but also increases the agent's information rent due to the persistent belief manipulation effect. We characterize the optimal contract using the dynamic programming technique in which information rent is the unique state variable. In the optimal contract, the optimal effort is front-loaded and decr...

  17. Timber joints under long-term loading

    DEFF Research Database (Denmark)

    Feldborg, T.; Johansen, M.

    This report describes tests and results from stiffness and strength testing of splice joints under long-term loading. During two years of loading the spicimens were exposed to cyclically changing relative humidity. After the loading period the specimens were short-term tested. The connectors were...... integral nail-plates and nailed steel and plywood gussets. The report is intended for designers and researchers in timber engineering....

  18. Inflation Hedging for Long-Term Investors

    OpenAIRE

    Shaun K. Roache; Alexander P. Attie

    2009-01-01

    Long-term investors face a common problem-how to maintain the purchasing power of their assets over time and achieve a level of real returns consistent with their investment objectives. While inflation-linked bonds and derivatives have been developed to hedge the effects of inflation, their limited supply and liquidity lead many investors to continue to rely on the indirect hedging properties of traditional asset classes. In this paper, we assess these properties over different time horizons,...

  19. Long term evolution 4G and beyond

    CERN Document Server

    Yacoub, Michel; Figueiredo, Fabrício; Tronco, Tania

    2016-01-01

    This book focus on Long Term Evolution (LTE) and beyond. The chapters describe different aspects of research and development in LTE, LTE-Advanced (4G systems) and LTE-450 MHz such as telecommunications regulatory framework, voice over LTE, link adaptation, power control, interference mitigation mechanisms, performance evaluation for different types of antennas, cognitive mesh network, integration of LTE network and satellite, test environment, power amplifiers and so on. It is useful for researchers in the field of mobile communications.

  20. Long-Term Care Services for Veterans

    Science.gov (United States)

    2017-02-14

    includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

  1. Long term adequacy of uranium resources

    International Nuclear Information System (INIS)

    Steyn, J.

    1990-01-01

    This paper examines the adequacy of world economic uranium resources to meet requirements in the very long term, that is until at least 2025 and beyond. It does so by analysing current requirements forecasts, existing and potential production centre supply capability schedules and national resource estimates. It takes into account lead times from resource discovery to production and production rate limitations. The institutional and political issues surrounding the question of adequacy are reviewed. (author)

  2. No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study.

    Science.gov (United States)

    Luginbühl, Rolf; Brunner, Florian; Schneeberger, Alberto G

    2008-01-01

    The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used.

  3. J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results.

    Science.gov (United States)

    Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, Mustafa

    2017-11-01

    To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: a prospective cohort study.

    Science.gov (United States)

    Kuroda, Yujiro; Iwasa, Hajime; Goto, Aya; Yoshida, Kazuki; Matsuda, Kumiko; Iwamitsu, Yumi; Yasumura, Seiji

    2017-09-03

    This study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake. This was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis. Of the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation. Renters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. The long-term outcomes of epilepsy surgery

    Science.gov (United States)

    Keller, Simon; Nicolson, Andrew; Biswas, Shubhabrata; Smith, David; Osman Farah, Jibril; Eldridge, Paul; Wieshmann, Udo

    2018-01-01

    Objective Despite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K. Methods This a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom. Results We included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1–27). Kaplan-Meier estimates showed that 47% (95% CI 40–58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31–45) at 10 years after surgery. 74% (95% CI 69–80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64–77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years. Conclusion The vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with

  6. Long-term outcomes of vertebroplasty for osteoporotic compression fractures

    International Nuclear Information System (INIS)

    Thillainadesan, G.; Schlaphoff, G.; Gibson, K.A.; Hassett, G.M.; McNeil, H.P.

    2010-01-01

    This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.

  7. Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma. A prospective randomised study

    International Nuclear Information System (INIS)

    Rudzianskiene, Milda; Inciura, Arturas; Gerbutavicius, Rolandas; Rudzianskas, Viktoras; Dambrauskiene, Ruta; Juozaityte, Elona; Macas, Andrius; Simoliuniene, Renata; Kiavialaitis, Greta Emilia

    2017-01-01

    To compare the impact of a single fraction (8 Gy x 1 fraction) and multifraction (3 Gy x 10 fractions) radiotherapy regimens on pain relief, recalcification and the quality of life (QoL) in patients with bone destructions due to multiple myeloma (MM). In all, 101 patients were included in a randomised prospective clinical trial: 58 patients were included in the control arm (3 Gy x 10 fractions) and 43 patients into the experimental arm (8 Gy x 1 fraction). The response rate was defined according to the International Consensus on Palliative Radiotherapy criteria. Recalcification was evaluated with radiographs. QoL questionnaires were completed before and 4 weeks after treatment. Pain relief was obtained in 81/101 patients (80.2%): complete response in 56 (69%) and partial in 25 patients (30.9%). No significant differences were observed in analgesic response between the groups. Significant factors for pain relief were female gender, age under 65, IgG MM type, presence of recalcification at the irradiated site. Recalcification was found in 32/101 patients (33.7%): complete in 17 (53.2%) and partial in 15 (46.2%). No significant differences were observed in recalcification between the groups. Significant factors for recalcification were Karnofsky index ≥ 60%, haemoglobin level ≤ 80 g/dl, MM stage II and analgesic response at the irradiated site. The QoL after radiotherapy was improved in the control group. The same analgesic and recalcification response was observed using two different radiotherapy regimens. Higher doses should be used to achieve a better QoL. (orig.) [de

  8. A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.

    Science.gov (United States)

    Cristaudo, Adam; Nayak, Arun; Martin, Sarah; Adib, Reza; Martin, Ian

    2015-05-01

    The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. Gonadotropin Releasing Hormone Agonists or Antagonists for Preimplantation Genetic Diagnosis (PGD)? A Prospective Randomised Trial.

    Science.gov (United States)

    Verpoest, Willem; De Vos, Anick; De Rycke, Martine; Parikh, Shruti; Staessen, Catherine; Tournaye, Herman; De Vos, Michel; Vloeberghs, Veerle; Blockeel, Christophe

    2017-11-10

    The use of GnRH analogue medication is essential in reproductive medicine to avoid premature ovulation by pituitary suppression for the duration of ovarian stimulation by gonadotrophins. The type of pituitary suppression by either GnRH agonist analogues versus GnRH antagonist analogues may result in different embryological hence clinical results. Preimplantation genetic diagnosis is a subtype of IVF in which embryos are created for genetic diagnosis of hereditary disorders in order to avoid genetically affected children. Embryological quality hence ovarian stimulation in preimplantation genetic diagnosis is crucial as genetic selection will reduce the number of available embryos to a fraction of the total. The aim of this study was to assess the efficiency of GnRH antagonist versus GnRH agonist treatment for pituitary suppression in ovarian stimulation for PGD, by proxy of number and quality of embryos at cleavage stage available for biopsy. We conducted a prospective randomised controlled trial comparing pituitary suppression by GnRH antagonist versus GnRH agonist in ovarian stimulation for PGD. The primary outcome measure was the number of embryos of sufficient quality for biopsy at cleavage stage. Secondary outcome parameters were the number of blastocysts available of top quality, and clinical pregnancy rate. There was no difference in number of oocytes retrieved, embryos at cleavage stage available for biopsy or embryo quality. The clinical pregnancy rate was higher in the GnRH agonist group; however the sample size was insufficient to allow conclusions. The use of GnRH agonist versus antagonist treatment does not result in differences in a number of oocytes, embryos or embryo quality in ovarian stimulation for preimplantation genetic diagnosis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  10. An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial.

    Science.gov (United States)

    Hyland, Ela J; D'Cruz, Rachel; Harvey, John G; Moir, Jordyn; Parkinson, Christina; Holland, Andrew J A

    2015-12-01

    Burns remain extremely painful and distressing in young children. The consequences of poorly managed pain and anxiety can be life-long. Whilst Child Life Therapy (CLT) has been shown to be effective in many situations, few studies have looked at the effectiveness of CLT in regard to reducing pain and anxiety in children undergoing burn dressing changes. A prospective, randomised controlled trial was conducted, comparing CLT versus standard care in relation to pain and anxiety scores of children undergoing their initial burn dressing change. Pain and anxiety were assessed by an independent observer and questionnaires completed by the child, parent/caregiver and nursing staff. 50 subjects were recruited in each treatment group; median age 2.3 years (CLT) and 2.2 years (standard care). The median total body surface area (TBSA) burnt was 0.8% (CLT) and 0.5% (standard care). The majority were partial thickness dermal burns (88% CLT, 94% standard care). Rates of parent anxiety and pre-procedural child pain and anxiety were similar. Combined and scaled pain and anxiety scores in the CLT group were significantly less than in the standard treatment group (p=0.03). Whilst pain was significantly better in the CLT group (p=0.02), fear scores, wound outcomes and the need for skin grafting were not statistically different in either group. The presence of a Child Life Therapist, with their ability to adapt to the environment, the child and their family, significantly reduced the experience of pain during paediatric burn dressings. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  11. Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study.

    LENUS (Irish Health Repository)

    Mahdy, Saad

    2012-02-01

    OBJECTIVE AND METHODS: Anemia is a common problem in the ICU population. Most patients are anemic at admission, their hemoglobin concentrations declining further thereafter. The aim of the present study was to evaluate the effect of a combination strategy, involving closed arterial blood gas sampling and the use of pediatric vials for phlebotomy (Group A), on the sampling-induced blood loss and the rate of decline in hemoglobin in adult ICU patients. Combination (Group A) was compared to the current standard technique of arterial line sampling and adult vial phlebotomy (Group B) in a prospective, randomised, ethically-approved trial for the first 72 hours of their ICU stay. Peri-operative, oncology, coagulopathic and uremic patients were excluded. All other ICU patients with arterial cannulae and predicted to stay beyond 3 days, were enrolled. RESULTS: 39 patients entered the study, 20 in Group A, and 19 in Group B. Data collection was complete for all. There was a statistically significant difference in sampling-induced blood loss between the groups over the first 72 hours of treatment (mean +\\/- standard deviation: 15.16 +\\/- 5.3 ml Group A vs 45.11 +\\/- 14 ml Group B, p<0.001). There was a smaller decline in mean hemoglobin level, which was not statistically significant (0.79 +\\/- 0.6 g\\/dL vs 1.30 +\\/- 1.13, p = 0.09). CONCLUSIONS: Overall, this strategy reduced measurable blood losses from phlebotomy. In larger trials it might also preserve hemoglobin levels.

  12. Abdominoplasty and seroma: a prospective randomised study comparing scalpel and handheld electrocautery dissection.

    Science.gov (United States)

    Marsh, Dan J; Fox, Andreas; Grobbelaar, Adriaan O; Chana, Jagdeep S

    2015-02-01

    Seroma formation remains a significant problem in abdominoplasty procedures--the cause of which remains to be elucidated. It has been suggested that one of the causative factors for seroma formation is the use of handheld electrocautery as opposed to scalpel for abdominal flap dissection. Prospective trial in 102 consecutive abdominoplasty patients randomised to have abdominal flap dissection with either handheld electrocautery device on 'coagulation setting' or sharp dissection with scalpel and monopolar electrocautery forceps for haemostasis. In all other aspects the surgical technique was identical between the two groups. All drains were removed at 48 h, irrespective of drain volume. Primary outcome measure is postoperative seroma formation on clinical examination, secondary outcome measures are drain volume, weight of tissue removed, effect of liposuction and patient BMI. Both study groups were similar in demographics with no significant difference in weight of tissue excised, BMI, drain output or post operative complictions. There was no significant difference in seroma formation rates between the handheld electrocautery group (17.2%) and the sharp dissection group (20.1%). Overall, the seroma rate was 18.6%. Liposuction to the flanks at the time of abdominoplasty was found to significantly increase the incidence of seroma, compared to patients having abdominoplasty alone. Use of handheld electrocautery rather than scalpel for tissue dissection does not lead to increased seroma formation in abdominoplasty patients. Concomitant liposuction at the time of abdominoplasty increases the risk of seroma formation compared to patients having abdominoplasty alone. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Meningite bacteriana neonatal: estudo prospectivo da evolução a longo prazo de 55 crianças Neonatal bacterial meningitis: prospective study of the long term outcome of 55 children

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Jornada Krebs

    1996-03-01

    Full Text Available Foram estudadas prospectivamente 55 crianças que apresentaram meningite bacteriana no período neonatal, com o objetivo da analisar a frequência e o tipo de sequelas neurológicas. Todas as crianças nasceram a termo, sendo 38 do sexo masculino e 17 do feminino; a idade de início da doença variou de 3 a 28 dias. Os principais agentes etiológicos foram as enterobactérias. O tempo médio de seguimento foi 5 anos. A frequência de sequelas neurológicas foi 67,3%, representadas principalmente pelo atraso do desenvolvimento neuropsicomotor (58,2%, hidrocefalia (45,5% e convulsões (34,5%. As alterações motoras graves ocorreram em 23,6% dos pacientes (tetraplegia, diplegia, hemiparesia e ataxia. As convulsões na fase aguda da doença e a cultura positiva do líquido cefalorraqueano estiveram associadas significativamente com a presença de sequelas. Na avaliação do desempenho escolar, realizada em 25 crianças, observaram-se dificuldades na aprendizagem em 48% dos casos, associadas significativamente à deficiência mental.Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns.There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%, hydrocephaly (45.5% and convulsions (34.5%. Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia. Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

  14. Long-term outcomes of nasopharyngectomy using partial maxillectomy approach.

    Science.gov (United States)

    Ng, Li Shia; Lim, Chwee Ming; Loh, Kwok Seng

    2016-05-01

    To determine the long-term outcomes of a prospective cohort of 20 patients who had nasopharyngectomy using an open partial-maxillectomy approach. A prospective cohort study of the surgical outcomes of patients with recurrent T1 (rT1) and rT2 nasopharyngeal carcinoma recurrence. There were 14 male and six female patients. The mean age was 49 years. The mean duration of follow-up was 60.4 months. All of the surgical margins were free of malignancy. Ten patients (50%) developed recurrences. The 5-year local control rate, disease-free, disease-specific, and overall survivals were 70%, 48.9%, 70.2%, and 66.7%, respectively. There were no major intraoperative complications. The most common morbidity was pain. The median length of hospitalization was 4 days. Early local recurrence of nasopharyngeal carcinoma can be treated surgically using a partial maxillectomy approach. The long-term outcomes are similar to nasopharyngectomy performed using the more common approaches. 4. Laryngoscope, 126:1103-1107, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Long-term care financing: lessons from France.

    Science.gov (United States)

    Doty, Pamela; Nadash, Pamela; Racco, Nathalie

    2015-06-01

    adjusted and amounts are low. Nevertheless, expenditures have exceeded projections, burdening local governments. Private supplemental insurance covers 11% of French, mostly middle-income adults (versus 3% of Americans 18 and older). Whether policyholders will maintain employer-sponsored coverage after retirement is not known. The government's interest in pursuing an explicit public/private partnership has waned under President François Hollande, a centrist socialist, in contrast to the previous center-right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy. American private insurers are showing increasing interest in long-term care financing approaches that combine public and private elements. The French example shows how a simple, cheap, cash-based product can gain traction among middle-income individuals when offered by employers and combined with a steeply income-adjusted universal public program. The adequacy of such coverage, however, is a concern. © 2015 Milbank Memorial Fund.

  16. Sexuality and Physical Intimacy in Long Term Care: Sexuality, long term care, capacity assessment

    OpenAIRE

    Lichtenberg, Peter A.

    2014-01-01

    Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long term care settings. Because older adults in medical rehabilitation and long term care beds present with significant frailties, and often significant neurocognitive disorders it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literatur...

  17. Multilevel analysis of workplace and individual risk factors for long-term sickness absence

    DEFF Research Database (Denmark)

    Labriola, Merete; Christensen, Karl B; Lund, Thomas

    2006-01-01

    OBJECTIVE: The objective of this study was to examine if psychosocial and physical work-environment factors predict long-term sickness absence (>8 weeks) at both the individual and the workplace level. MATERIAL AND METHODS: Data were collected in a prospective study in 52 Danish workplaces....... Psychosocial factors were aggregated as workplace means. We used multilevel logistic regression models with psychosocial factors as predictors of long-term sickness absence over 5 years based on data from a national absence register. RESULTS: Long-term sickness absence was predicted by physical work...

  18. LONG-TERM OUTCOME IN PEDIATRIC TRICHOTILLOMANIA.

    Science.gov (United States)

    Schumer, Maya C; Panza, Kaitlyn E; Mulqueen, Jilian M; Jakubovski, Ewgeni; Bloch, Michael H

    2015-10-01

    To examine long-term outcome in children with trichotillomania. We conducted follow-up clinical assessments an average of 2.8 ± 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General Hospital Hairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. © 2015 Wiley Periodicals, Inc.

  19. Long-term EEG in children.

    Science.gov (United States)

    Montavont, A; Kaminska, A; Soufflet, C; Taussig, D

    2015-03-01

    Long-term video-EEG corresponds to a recording ranging from 1 to 24 h or even longer. It is indicated in the following situations: diagnosis of epileptic syndromes or unclassified epilepsy, pre-surgical evaluation for drug-resistant epilepsy, follow-up of epilepsy or in cases of paroxysmal symptoms whose etiology remains uncertain. There are some specificities related to paediatric care: a dedicated pediatric unit; continuous monitoring covering at least a full 24-hour period, especially in the context of pre-surgical evaluation; the requirement of presence by the parents, technician or nurse; and stronger attachment of electrodes (cup electrodes), the number of which is adapted to the age of the child. The chosen duration of the monitoring also depends on the frequency of seizures or paroxysmal events. The polygraphy must be adapted to the type and topography of movements. It is essential to have at least an electrocardiography (ECG) channel, respiratory sensor and electromyography (EMG) on both deltoids. There is no age limit for performing long-term video-EEG even in newborns and infants; nevertheless because of scalp fragility, strict surveillance of the baby's skin condition is required. In the specific context of pre-surgical evaluation, long-term video-EEG must record all types of seizures observed in the child. This monitoring is essential in order to develop hypotheses regarding the seizure onset zone, based on electroclinical correlations, which should be adapted to the child's age and the psychomotor development. Copyright © 2015. Published by Elsevier SAS.

  20. Long-term governance for sustainability

    International Nuclear Information System (INIS)

    Martell, M.

    2007-01-01

    Meritxell Martell spoke of the long-term aspects of radioactive waste management. She pointed out that decision-making processes need to be framed within the context of sustainability, which means that a balance should be sought between scientific considerations, economic aspects and structural conditions. Focusing on structural aspects, Working Group 3 of COWAM-Spain came to the conclusion that the activity of the regulator is a key factor of long-term management. Another finding is that from a sustainability perspective multi-level governance is more effective for coping with the challenges of radioactive waste management than one tier of government-making decisions. The working group also felt that the current Local Information Committees need to evolve towards more institutionalized and legitimized mechanisms for long-term involvement. Ms. Martell introduced a study comparing the efficiency of economic instruments to advance sustainable development in nuclear communities vs. municipalities in mining areas. The study found that funds transferred to nuclear zones had become a means to facilitate local acceptance of nuclear facilities rather than a means to promote socio-economic development. Another finding is that economic instruments are not sufficient guarantees of sustainable development by themselves; additional preconditions include leadership, vision and entrepreneur-ship on the part of community leaders, private or public investments, among others. Finally, Ms. Martell summarised the challenges faced by the Spanish radioactive waste management programme, which include the need for strategic thinking, designing the future in a participatory fashion, and working with local and regional governments and citizens to devise mechanisms for social learning, economic development and environmental protection. (author)

  1. Long term aspects of uranium tailings management

    International Nuclear Information System (INIS)

    Bragg, K.

    1980-05-01

    This paper sets out the background issues which lead to the development of interim close-out criteria for uranium mill tailings. It places the current state-of-the-art for tailings management into both a national and international perspective and shows why such interim criteria are needed now. There are seven specific criteria proposed dealing with the need to have: passive barriers, limits on surface water recharge, durable systems, long term performance guarantees, limits to access, controls on water and airborne releases and finally to have a knowledge of exposure pathways. This paper is intended to serve as a focus for subsequent discussions with all concerned parties. (auth)

  2. Human Behaviour in Long-Term Missions

    Science.gov (United States)

    1997-01-01

    In this session, Session WP1, the discussion focuses on the following topics: Psychological Support for International Space Station Mission; Psycho-social Training for Man in Space; Study of the Physiological Adaptation of the Crew During A 135-Day Space Simulation; Interpersonal Relationships in Space Simulation, The Long-Term Bed Rest in Head-Down Tilt Position; Psychological Adaptation in Groups of Varying Sizes and Environments; Deviance Among Expeditioners, Defining the Off-Nominal Act in Space and Polar Field Analogs; Getting Effective Sleep in the Space-Station Environment; Human Sleep and Circadian Rhythms are Altered During Spaceflight; and Methodological Approach to Study of Cosmonauts Errors and Its Instrumental Support.

  3. Optimal Long-Term Financial Contracting

    OpenAIRE

    Peter M. DeMarzo; Michael J. Fishman

    2007-01-01

    We develop an agency model of financial contracting. We derive long-term debt, a line of credit, and equity as optimal securities, capturing the debt coupon and maturity; the interest rate and limits on the credit line; inside versus outside equity; dividend policy; and capital structure dynamics. The optimal debt-equity ratio is history dependent, but debt and credit line terms are independent of the amount financed and, in some cases, the severity of the agency problem. In our model, the ag...

  4. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Science.gov (United States)

    2010-10-01

    ... standardized amount— (i) Is adjusted for the applicable hospital inpatient prospective payment system DRG... applicable hospital inpatient prospective payment system DRG weighting factors; (ii) Is adjusted by the... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

  5. Long term treatment with metformin in patients with type 2 diabetes and vitamin B 12

    Directory of Open Access Journals (Sweden)

    Yu V Pankratova

    2012-12-01

    Full Text Available Реферат по статье: De Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ. 2010 May 20;340:c2181.

  6. Long-term environmental behaviour of radionuclides

    International Nuclear Information System (INIS)

    Brechignac, F.; Moberg, L.; Suomela, M.

    2000-04-01

    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: i) redistribution in the soil-plant system, ii) modelling, iii) countermeasures, iv) runoff v) spatial variations, and vi) dose assessment. The long term behaviour of the radionuclides 137 Cs, 90 Sr and 239-240 Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  7. Craniopharyngioma in Children: Long-term Outcomes

    Science.gov (United States)

    STEINBOK, Paul

    2015-01-01

    The survival rate for childhood craniopharyngioma has been improving, with more long-term survivors. Unfortunately it is rare for the patient to be normal, either from the disease itself or from the effects of treatment. Long-term survivors of childhood craniopharyngioma suffer a number of impairments, which include visual loss, endocrinopathy, hypothalamic dysfunction, cerebrovascular problems, neurologic and neurocognitive dysfunction. Pituitary insufficiency is present in almost 100%. Visual and hypothalamic dysfunction is common. There is a high risk of metabolic syndrome and increased risk of cerebrovascular disease, including stroke and Moyamoya syndrome. Cognitive, psychosocial, and emotional problems are prevalent. Finally, there is a higher risk of premature death among survivors of craniopharyngioma, and often this is not from tumor recurrence. It is important to consider craniopharyngioma as a chronic disease. There is no perfect treatment. The treatment has to be tailored to the individual patient to minimize dysfunction caused by tumor and treatments. So “cure” of the tumor does not mean a normal patient. The management of the patient and family needs multidisciplinary evaluation and should involve ophthalmology, endocrinology, neurosurgery, oncology, and psychology. Furthermore, it is also important to address emotional issues and social integration. PMID:26345668

  8. Institutionalization and Organizational Long-term Success

    Directory of Open Access Journals (Sweden)

    Denise L. Fleck

    2007-05-01

    Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

  9. Long term testing of PSI-membranes

    Energy Technology Data Exchange (ETDEWEB)

    Huslage, J; Brack, H P; Geiger, F; Buechi, F N; Tsukada, A; Scherer, G G [Paul Scherrer Inst. (PSI), Villigen (Switzerland)

    1999-08-01

    Long term tests of PSI membranes based on radiation-grafted FEP and ETFE films were carried out and FEP-based membranes were evaluated by monitoring the in-situ membrane area resistance measured by a current pulse method. By modifying our irradiation procedure and using the double crosslinking concept we obtain reproducible membrane cell lifetimes (in term of in-situ membrane resistance) of greater than 5000 hours at 60-65{sup o}C. Preliminary tests at 80-85{sup o}C with lifetimes of greater than 2500 demonstrate the potential long term stability of PSI proton exchange membranes based on FEP over the whole operating temperature range of low-temperature polymer electrolyte fuel cells. Radiation grafted PSI membranes based on ETFE have better mechanical properties than those of the FEP membranes. Mechanical properties are particularly important in large area cells and fuel cell stacks. ETFE membranes have been tested successfully for approximately 1000 h in a 2-cell stack (100 cm{sup 2} active area each cell). (author) 4 figs., 4 refs.

  10. Neo bladder long term follow-up

    International Nuclear Information System (INIS)

    Fakhr, I.; Mohamed, A. M.; Moustafa, A.; Al-Sherbiny, M.; Salama, M.

    2013-01-01

    One of the commonest forms of orthotopic bladder substitution for bladder cancer surivors, used in our institute, is the use of ileocecal segment. Sometimes, the need for Indiana pouch heterotropic continent diversion arises. Aim: To compare the long-term effect of orthotopic ileocecal bladder and heterotropic Indiana pouch following radical cystectomy in bladder cancer patients. Patients and methods: Between January 2008 and December 2011, 91 patients underwent radical cystectomy/anterior pelvic exentration and ortho topic ileocecal bladder reconstruction (61 patients) and Indiana pouch (30 patients), when orthotopic diversion could not be technically or oncologically feasible. Results: Convalescence was uneventful in most patients. All minor and major urinary leakage cases, in both diversions groups, where successfully conservatively treated. Only one patient in the ileocecal group with major urinary leak required re-exploration with successful revision of uretro-colonic anastomosis. Only one patient in the Indiana pouch group had accidentally discovered sub-centimetric stone, which was simply expelled. The overall survival proportion of ileocecal group was 100% compared to 80% in the Indiana pouch group (p < 0.001). The disease free survival proportion of ileocecal group was 90.8% compared to 80% in the Indiana pouch group (p = 0.076). Effective comparative daytime and nighttime urinary continence as well as renal function deterioration were not statistically significant between both reconstruction types. Conclusion: Both ileocecal bladder and Indiana pouch are safe procedures in regard to long-term effects over kidney function following radical cystectomy

  11. Toward a comprehensive long term nicotine policy.

    Science.gov (United States)

    Gray, N; Henningfield, J E; Benowitz, N L; Connolly, G N; Dresler, C; Fagerstrom, K; Jarvis, M J; Boyle, P

    2005-06-01

    Global tobacco deaths are high and rising. Tobacco use is primarily driven by nicotine addiction. Overall tobacco control policy is relatively well agreed upon but a long term nicotine policy has been less well considered and requires further debate. Reaching consensus is important because a nicotine policy is integral to the target of reducing tobacco caused disease, and the contentious issues need to be resolved before the necessary political changes can be sought. A long term and comprehensive nicotine policy is proposed here. It envisages both reducing the attractiveness and addictiveness of existing tobacco based nicotine delivery systems as well as providing alternative sources of acceptable clean nicotine as competition for tobacco. Clean nicotine is defined as nicotine free enough of tobacco toxicants to pass regulatory approval. A three phase policy is proposed. The initial phase requires regulatory capture of cigarette and smoke constituents liberalising the market for clean nicotine; regulating all nicotine sources from the same agency; and research into nicotine absorption and the role of tobacco additives in this process. The second phase anticipates clean nicotine overtaking tobacco as the primary source of the drug (facilitated by use of regulatory and taxation measures); simplification of tobacco products by limitation of additives which make tobacco attractive and easier to smoke (but tobacco would still be able to provide a satisfying dose of nicotine). The third phase includes a progressive reduction in the nicotine content of cigarettes, with clean nicotine freely available to take the place of tobacco as society's main nicotine source.

  12. Long term ground movement of TRISTAN synchrotron

    International Nuclear Information System (INIS)

    Endo, K.; Ohsawa, Y.; Miyahara, M.

    1989-01-01

    The long term ground movement is estimated through the geological survey before a big accelerator is planned. For the case of TRISTAN-MR (main ring), its site was surveyed to reflect the underground information to the building prior to the construction. The movement of the synchrotron magnet mainly results from the structure of the tunnel. If an individual movement of the magnet exceeds a certain threshold limit, it gives a significant effect on the particle behavior in a synchrotron. Height of the quadrupole magnets were observed periodically during past two years at the TRISTAN-MR and their height differences along the 3 km circumference of the accelerator ring were decomposed into the Fourier components depicting the causes of the movements. Results shows the movement of the tunnel foundation which was also observed by the simultaneous measurement of both magnets and fiducial marks on the tunnel wall. The long term movement of the magnets is summarized with the geological survey prior to construction. 1 ref., 6 figs., 1 tab

  13. Long-term environmental behaviour of radionuclides

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F.; Moberg, L.; Suomela, M

    2000-04-01

    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: (i) redistribution in the soil-plant system, (ii) modelling, (iii) countermeasures, (iv) runoff (v) spatial variations, and (vi) dose assessment. The long term behaviour of the radionuclides {sup 137}Cs, {sup 90}Sr and {sup 239-240}Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  14. Long-term preservation of anammox bacteria.

    Science.gov (United States)

    Rothrock, Michael J; Vanotti, Matias B; Szögi, Ariel A; Gonzalez, Maria Cruz Garcia; Fujii, Takao

    2011-10-01

    Deposit of useful microorganisms in culture collections requires long-term preservation and successful reactivation techniques. The goal of this study was to develop a simple preservation protocol for the long-term storage and reactivation of the anammox biomass. To achieve this, anammox biomass was frozen or lyophilized at two different freezing temperatures (-60°C and in liquid nitrogen (-200°C)) in skim milk media (with and without glycerol), and the reactivation of anammox activity was monitored after a 4-month storage period. Of the different preservation treatments tested, only anammox biomass preserved via freezing in liquid nitrogen followed by lyophilization in skim milk media without glycerol achieved stoichiometric ratios for the anammox reaction similar to the biomass in both the parent bioreactor and in the freshly harvested control treatment. A freezing temperature of -60°C alone, or in conjunction with lyophilization, resulted in the partial recovery of the anammox bacteria, with an equal mixture of anammox and nitrifying bacteria in the reactivated biomass. To our knowledge, this is the first report of the successful reactivation of anammox biomass preserved via sub-zero freezing and/or lyophilization. The simple preservation protocol developed from this study could be beneficial to accelerate the integration of anammox-based processes into current treatment systems through a highly efficient starting anammox biomass.

  15. Andra long term memory project - 59277

    International Nuclear Information System (INIS)

    Charton, Patrick; Boissier, Fabrice; Martin, Guillaume

    2012-01-01

    Document available in abstract form only. Full text of publication follows: Long term memory of repositories is required by safety, reversibility and social expectations. Thus Andra has implemented since 2010 a long-term memory project to reinforce and diversify its current arrangements in this field, as well as to explore opportunities to extend memory keeping over thousands years. The project includes opportunity studies of dedicated facilities. The 'Ecotheque' and 'Geotheque' projects contribute to memory respectively through environmental and geological samples preservation. The options of creating (i) an archive centre for Andra's interim and permanent archives, (ii) an artist center to study the contribution of arts to memory preservation, (iii) a museum of radioactive waste disposal history and technology (radium industry..., sea disposal, current solutions...) are considered. Other studies provided by the project examine our heritage. This includes the continuity of languages and symbolic systems, the continuity of writing and engraving methods, the archaeology of landscapes (memory of the earths evolution, multi-century memory of industrial and agricultural landscapes), the archaeology practices (how might a future archaeologist be interested in our current activity?), the preservation of historical sites and industrial memory, the continuity of institutional organizations, the memory and history of science evolution as well as broad history

  16. Long term creep behavior of concrete

    International Nuclear Information System (INIS)

    Kennedy, T.W.

    1975-01-01

    This report presents the findings of an experimental investigation to evaluate the long term creep behavior of concrete subjected to sustained uniaxial loads for an extended period of time at 75 0 F. The factors investigated were (1) curing time (90, 183, and 365 days); (2) curing history (as-cast and air-dried); and (3) uniaxial stress (600 and 2400 psi). The experimental investigation applied uniaxial compressive loads to cylindrical concrete specimens and measured strains with vibrating wire strain gages that were cast in the concrete specimen along the axial and radial axes. Specimens cured for 90 days prior to loading were subjected to a sustained load for a period of one year, at which time the loads were removed; the specimens which were cured for 183 or 365 days, however, were not unloaded and have been under load for 5 and 4.5 years, respectively. The effect of each of the above factors on the instantaneous and creep behavior is discussed and the long term creep behavior of the specimens cured for 183 or 365 days is evaluated. The findings of these evaluations are summarized. (17 figures, 10 tables) (U.S.)

  17. Sleep facilitates long-term face adaptation.

    Science.gov (United States)

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-10-22

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as 'storage'. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation--which are usually not considered to play a relevant role in mnemonic processes--with learning and memory, and at the same time reveal a new function of sleep in cognition.

  18. The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality.

    Science.gov (United States)

    Barili, Fabio; Pacini, Davide; D'Ovidio, Mariangela; Dang, Nicholas C; Alamanni, Francesco; Di Bartolomeo, Roberto; Grossi, Claudio; Davoli, Marina; Fusco, Danilo; Parolari, Alessandro

    2016-10-01

    The European System for Cardiac Operation Risk Evaluation (EuroSCORE) II has not been tested yet for predicting long-term mortality. This study was undertaken to evaluate the relationship between EuroSCORE II and long-term mortality and to develop a new algorithm based on EuroSCORE II factors to predict long-term survival after cardiac surgery. Complete data on 10,033 patients who underwent major cardiac surgery during a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Mortality at follow-up was analyzed with time-to-event analysis. The Kaplan-Meier estimates of survival at 1 and 5 were, respectively, 95.0% ± 0.2% and 84.7% ± 0.4%. Both discrimination and calibration of EuroSCORE II decreased in the prediction of 1-year and 5-year mortality. Nonetheless, EuroSCORE II was confirmed to be an independent predictor of long-term mortality with a nonlinear trend. Several EuroSCORE II variables were independent risk factors for long-term mortality in a regression model, most of all very low ejection fraction (less than 20%), salvage operation, and dialysis. In the final model, isolated mitral valve surgery and isolated coronary artery bypass graft surgery were associated with improved long-term survival. The EuroSCORE II cannot be considered a direct estimator of long-term risk of death, as its performance fades for mortality at follow-up longer than 30 days. Nonetheless, it is nonlinearly associated with long-term mortality, and most of its variables are risk factors for long-term mortality. Hence, they can be used in a different algorithm to stratify the risk of long-term mortality after surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Long-term funding and faithfulness to the original goal

    International Nuclear Information System (INIS)

    Sjoegren, G.

    1999-02-01

    The study describes long-term funding in terms of faithfulness to the original goals of the foundations. After having examined 20 different Swedish foundations three main categories of problems have appeared. The main threats to the original goals of the foundations are juridical problems, economic problems and a changing society. Fraud and embezzlement are covered by the Act (1994:1220) Concerning Foundations, but the law does not prevent unfaithfulness to the original goal of the foundation in terms of permutation. If the foundation is a private-established foundation the board has to apply for a change of the original goal to the Swedish Judicial Board for Public Lands and Funds. If the State, a municipality or a community establishes the foundation the Government can change the goal without permission of any other authority. Economic problems often strike smaller funds established by private persons, but State-established funds can also be hit by economical problems. The economic problems presented in the text are high tax levels, bad investments and problems getting donations. Both small private and large State-established foundations sometimes have to change their original goals as a result of a changing society. The goal of the foundation can be out-of-date, be against the ideology of the government party or the demography might have changed. Examples from each category are given in the text. The study is made to facilitate a description in general terms of the prospects for the Swedish nuclear funds if a final decision can not be made in the time span of 100 or 200 years. Looking back on the changes in the judicial, economical and political arenas during the last 200 years, one realizes the impossibility to foresee the changes that will occur within the next 200 years. The author's conclusion, after examined 20 foundation, is that it is impossible to establish a perfect long-term fund as we can not foresee the long-term future

  20. The long-term health of vegetarians and vegans.

    Science.gov (United States)

    Appleby, Paul N; Key, Timothy J

    2016-08-01

    Vegetarians, who do not eat any meat, poultry or fish, constitute a significant minority of the world's population. Lacto-ovo-vegetarians consume dairy products and/or eggs, whereas vegans do not eat any foods derived wholly or partly from animals. Concerns over the health, environmental and economic consequences of a diet rich in meat and other animal products have focussed attention on those who exclude some or all of these foods from their diet. There has been extensive research into the nutritional adequacy of vegetarian diets, but less is known about the long-term health of vegetarians and vegans. We summarise the main findings from large cross-sectional and prospective cohort studies in western countries with a high proportion of vegetarian participants. Vegetarians have a lower prevalence of overweight and obesity and a lower risk of IHD compared with non-vegetarians from a similar background, whereas the data are equivocal for stroke. For cancer, there is some evidence that the risk for all cancer sites combined is slightly lower in vegetarians than in non-vegetarians, but findings for individual cancer sites are inconclusive. Vegetarians have also been found to have lower risks for diabetes, diverticular disease and eye cataract. Overall mortality is similar for vegetarians and comparable non-vegetarians, but vegetarian groups compare favourably with the general population. The long-term health of vegetarians appears to be generally good, and for some diseases and medical conditions it may be better than that of comparable omnivores. Much more research is needed, particularly on the long-term health of vegans.

  1. Long-term funding and faithfulness to the original goal

    Energy Technology Data Exchange (ETDEWEB)

    Sjoegren, G

    1999-02-01

    The study describes long-term funding in terms of faithfulness to the original goals of the foundations. After having examined 20 different Swedish foundations three main categories of problems have appeared. The main threats to the original goals of the foundations are juridical problems, economic problems and a changing society. Fraud and embezzlement are covered by the Act (1994:1220) Concerning Foundations, but the law does not prevent unfaithfulness to the original goal of the foundation in terms of permutation. If the foundation is a private-established foundation the board has to apply for a change of the original goal to the Swedish Judicial Board for Public Lands and Funds. If the State, a municipality or a community establishes the foundation the Government can change the goal without permission of any other authority. Economic problems often strike smaller funds established by private persons, but State-established funds can also be hit by economical problems. The economic problems presented in the text are high tax levels, bad investments and problems getting donations. Both small private and large State-established foundations sometimes have to change their original goals as a result of a changing society. The goal of the foundation can be out-of-date, be against the ideology of the government party or the demography might have changed. Examples from each category are given in the text. The study is made to facilitate a description in general terms of the prospects for the Swedish nuclear funds if a final decision can not be made in the time span of 100 or 200 years. Looking back on the changes in the judicial, economical and political arenas during the last 200 years, one realizes the impossibility to foresee the changes that will occur within the next 200 years. The author`s conclusion, after examined 20 foundation, is that it is impossible to establish a perfect long-term fund as we can not foresee the long-term future

  2. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial.

    Science.gov (United States)

    Nakamura, Haruo; Arakawa, Kikuo; Itakura, Hiroshige; Kitabatake, Akira; Goto, Yoshio; Toyota, Takayoshi; Nakaya, Noriaki; Nishimoto, Shoji; Muranaka, Masaharu; Yamamoto, Akira; Mizuno, Kyoichi; Ohashi, Yasuo

    2006-09-30

    Evidence-based treatment for hypercholesterolaemia in Japan has been hindered by the lack of direct evidence in this population. Our aim was to assess whether evidence for treatment with statins derived from western populations can be extrapolated to the Japanese population. In this prospective, randomised, open-labelled, blinded study, patients with hypercholesterolaemia (total cholesterol 5.69-6.98 mmol/L) and no history of coronary heart disease or stroke were randomly assigned diet or diet plus 10-20 mg pravastatin daily. The primary endpoint was the first occurrence of coronary heart disease. Statistical analyses were done by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00211705. 3966 patients were randomly assigned to the diet group and 3866 to the diet plus pravastatin group. Mean follow-up was 5.3 years. At the end of study, 471 and 522 patients had withdrawn, died, or been lost to follow-up in the diet and diet plus pravastatin groups, respectively. Mean total cholesterol was reduced by 2.1% (from 6.27 mmol/L to 6.13 mmol/L) and 11.5% (from 6.27 mmol/L to 5.55 mmol/L) and mean LDL cholesterol by 3.2% (from 4.05 mmol/L to 3.90 mmol/L) and 18.0% (from 4.05 mmol/L to 3.31 mmol/L) in the diet and the diet plus pravastatin groups, respectively. Coronary heart disease was significantly lower in the diet plus pravastatin group than in the diet alone group (66 events vs 101 events; HR 0.67, 95% CI 0.49-0.91; p=0.01). There was no difference in the incidence of malignant neoplasms or other serious adverse events between the two groups. Treatment with a low dose of pravastatin reduces the risk of coronary heart disease in Japan by much the same amount as higher doses have shown in Europe and the USA.

  3. SUPRAPATELLAR VERSUS INFRAPATELLAR TIBIAL NAIL INSERTION- A PROSPECTIVE, RANDOMISED CONTROL PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Sreekumar K

    2017-06-01

    Full Text Available BACKGROUND The standard for treating tibial shaft fractures are by intramedullary nails currently. After the procedure, one of the most frequent complication is knee pain, after consolidation even more chronically. Chronic knee pain can affect more than 50% of the cases, which was said by most authors. Alternative routes of inserting the nail is used, which includes by means of lateral patellar paratendon, medial patellar paratendon or transtendon to avoid the symptom. The aim of the study is to study the clinical and functional outcomes of suprapatellar versus infrapatellar tibial nail insertion. MATERIALS AND METHODS This is a prospective study, which was done from January 2014 to February 2015 and 50 patients who were skeletally mature were selected and randomised into IP and SP nail insertion groups. They were also given informed consent and only after they agreed, they were taken into the study. The technique of nail insertion was revealed to both the surgeon and the patient at that time. Exclusion Criteria- Pregnant women, patients with intra-articular involvement, periprosthetic fractures, nonunions, ipsilateral injuries, previous knee injuries, history of gout, rheumatoid, osteoarthritis, spinal injury and incarceration. SP insertion was performed percutaneously with the help of a special cannula system. RESULTS A total of 50 patients were selected in this study. 31 SP and 19 IP. 10 SP and 2 IP did not show up for follow up examinations, so only 38 patients were present for 12 months. At last, there were 21 SP and 17 IP patients. The time from when the index procedure was done to follow up was 14.6 months, i.e. it ranged from 12-28 months. 12 were males and 9 were females with suprapatellar, 9 were males and 8 were females in infrapatellar. Average age of suprapatellar was 42 and that of infrapatellar was 44. Open fractures were 5 and closed fractures were 33. VAS score was 0.78 in suprapatellar and 1.87 in infrapatellar. Data analysis

  4. Long-term dietary intervention trials: critical issues and challenges

    Directory of Open Access Journals (Sweden)

    Crichton Georgina E

    2012-07-01

    Full Text Available Abstract Background There are many challenges involved in running randomised controlled dietary intervention trials that investigate health outcomes. The aim of this paper was to evaluate the recruitment process, retention of participants and challenges faced in our dairy intervention trial, and to provide strategies to combat the difficulties of running long-term dietary intervention trials. Methods A 12-month, randomised, two-way crossover study was conducted in overweight adults with habitually low dairy food consumption to assess the effects of a high dairy intake (4 servings of reduced-fat dairy per day compared with a low dairy intake (1 serving of reduced-fat dairy per day on measures of cardiometabolic and cognitive health. On completion of the high dairy intake phase, each participant was interviewed about their experience in the trial and responses were used to evaluate the key issues for study participants. Results Although the recruitment target was achieved, high rates of attrition (49.3% and difficulties maintaining participant compliance (reported by 37.8% of participants were major threats to the viability of the study. Factors that contributed to the high attrition included inability to comply with the dietary requirements of the study protocol (27.0%, health problems or medication changes (24.3% and time commitment (10.8%. Conclusion Attrition and adherence to study requirements present challenges to trials requiring longer-term dietary change. Including a run-in period to further assess the motivation, commitment and availability of participants, maintaining regular contact with participants during control phases, minimising time commitment, providing flexibility with dietary requirements, facilitating positive experiences, and stringent monitoring of diet are some key recommendations for future dietary intervention trials. Trial registration Australia and New Zealand Clinical Trials Registry (ACTRN 12608000538347

  5. Long-term prospects for the gas-cooled reactor

    International Nuclear Information System (INIS)

    Tan, W.P.S.

    1982-01-01

    Towards the second half of a fifty-year time span the market for gas-cooled reactors as sources of high temperature process heat and as highly fuel efficient electricity producers should be reasonably bright, given a fair degree of technological maturity and consequent realisation of inherent economic advantages. Declining fossil resources and increasing prices, initially in oil and gas later in open-cast coal, provide the economic impetus towards substitution of nuclear for coal heat, not only in the generally accepted processes of coal conversion and steel-making but also for oil shale pyrolysis and electrothermal aluminium smelting. Around 2010, if not sooner, the need for uranium conservation should allow the market penetration of breeders and thorium-cycle reactors for which gas cooling has a potential techno-economic edge. (author)

  6. Long-term prospects for the gas-cooled reactor

    International Nuclear Information System (INIS)

    Tan, W.P.S.

    1983-01-01

    Towards the second half of a 50-year time span the market for gas-cooled reactors as sources of high-temperature process heat and as highly fuel-efficient electricity producers should be reasonably bright, given a fair degree of technological maturity and consequent realization of inherent economic advantages. Declining fossil resources and increasing prices, initially in oil and gas, later in open-cast coal, provide the economic impetus towards substitution of nuclear for coal heat, not only in the generally accepted processes of coal conversion and steel making but also for oil shale pyrolysis and electrothermal aluminium smelting. Around 2010, if not sooner, the need for uranium conservation should allow the market penetration of breeders and thorium-cycle reactors for which gas cooling has a potential techno-economic edge. (author)

  7. Considerations on long-term energy prospects in Italy

    Energy Technology Data Exchange (ETDEWEB)

    Campos Venuti, G; Frullani, S; Tabet, E; Vecchia, P

    1977-11-07

    The different implications of alternative energy sources (nuclear, fusion, and solar) for Italy are discussed from the environmental, economic, and political viewpoint. Natural limits to the increase of energy production and some energy conservation measures are also considered.

  8. The long-term global prospects for energy

    International Nuclear Information System (INIS)

    Ion, D.C.

    1985-01-01

    The subject is covered in sections, entitled: coal (accessible coal in significant coalfields in the 10 major producing countries, 1983; major coal production and exports, 1980 and estimates 1990 and 2000); crude oil (proved reserves and production, 1950 to present); resources for the future; possible future availability; economic growth, energy and oil demand; competition between coal and oil; stability of oil supplies; oil prices; natural gas (proved reserves; production); hydroelectricity; nuclear power; the renewable or inexhaustible energy sources; conclusions. (U.K.)

  9. Long-term prospects for oil market stability

    Energy Technology Data Exchange (ETDEWEB)

    Subroto, Dr [OPEC, Vienna (AT)

    1989-10-01

    OPEC recognize that energy consumption has its social costs and benefits, and that some energy sources impose fewer costs on society. We must consider the environmental implications of oil extraction. Our policies today should enable future generations to secure their energy needs, and OPEC is well-positioned to supply them. An inward-looking OPEC, distracted by internal wranglings and inconsistencies, cannot expect to be a stabilizing force in the oil markets. We have sought, therefore, to put our own house in order. Aside from the debate on depletion policy, a major strain on OPEC stability is the growing tendency towards regionalization in the world oil market. And the absence of universally acceptable quota allocation criteria means that OPEC may have to live with instability for some time to come, but this will be manageable in the short run. In the medium term, however, the call on OPEC oil in the 1990s is predicted to rise to a level commensurate with the sustainable capacities of member states. Producers and consumers have a common interest and should share a similar perspective on the inter-dependence between energy, the environment and economic development. (author).

  10. LOng-term follow-up after liVE kidney donation (LOVE) study: A longitudinal comparison study protocol

    NARCIS (Netherlands)

    S. Janki (Shiromani); K.W.J. Klop (Karel); H.J.A.N. Kimenai (Hendrikus); J. van de Wetering (Jacqueline); W. Weimar (Willem); E.K. Massey (Emma); A. Dehghan (Abbas); D. Rizopoulos (Dimitris); H. Völzke (Henry); A. Hofman (Albert); J.N.M. IJzermans (Jan)

    2016-01-01

    textabstractBackground: The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods: The "LOng-term follow-up after liVE kidney donation"

  11. Mortality and life expectancy in relation to long-term cigarette, cigar and pipe smoking: The Zutphen Study

    NARCIS (Netherlands)

    Streppel, M.T.; Boshuizen, H.C.; Ocké, M.C.; Kok, F.J.; Kromhout, D.

    2007-01-01

    Study objective: To study the effect of long-term smoking on all-cause and cause-specific mortality, and to estimate the effects of cigarette and cigar or pipe smoking on life expectancy. Design: A long-term prospective cohort study. Setting: Zutphen, The Netherlands. Participants: 1373 men from the

  12. PROspective MEmory Training to improve HEart failUre Self-care (PROMETHEUS): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Cameron, Jan; Rendell, Peter G; Ski, Chantal F; Kure, Christina E; McLennan, Skye N; Rose, Nathan S; Prior, David L; Thompson, David R

    2015-04-29

    Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients' health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients' engagement in HF self-care and health outcomes, carer strain and quality of life. The proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients' baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients' HF symptoms, and ratings of the patients' level of engagement in HF self-care behaviours. If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs. Australian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False .

  13. One-year outcomes of a bilateral randomised prospective clinical trial comparing PRK with mitomycin C and LASIK.

    Science.gov (United States)

    Wallau, A D; Campos, M

    2009-12-01

    To compare 1-year follow-up results of photorefractive keratectomy (PRK) with mitomycin C (MMC) and laser in situ keratomileusis (LASIK) for custom correction of myopia. Eighty-eight eyes of 44 patients with moderate myopia were randomised to PRK with 0.002% MMC for 1 min in one eye and LASIK in the fellow eye. The 1-year follow-up was evaluated. There were no differences between LASIK and MMC-PRK eyes preoperatively. Forty-two patients completed the 1-year follow-up. MMC-PRK eyes achieved better uncorrected visual acuity (p = 0.03) and better best-spectacle-corrected visual acuity (pPRK eyes postoperatively. Excellent vision was reported in 64% of LASIK and 74% of MMC-PRK eyes 1 year after surgery. The corneal resistance factor and corneal hysteresis (ORA, Reichert) were higher in LASIK than in MMC-PRK eyes (pPRK with 0.002% MMC was more effective than wavefront-guided LASIK for correction of moderate myopia. Further research is necessary to determine the optimal concentration, exposure time and long-term corneal side effect of MMC.

  14. [Long-term effectiveness of psychodynamic outpatient treatment of addiction].

    Science.gov (United States)

    Steffen, D V; Werle, L; Steffen, R; Steffen, M; Steffen, S

    2012-07-01

    The aim of this study is to make an evaluation of the effectiveness of long-term outpatient treatment for addiction on the basis of abstinence, cognitive functions, and changes in personality structure. This is a prospective cohort study of 259 patients with registration of the German core data set "addiction", a 12-month follow-up and neuropsychological testing (personality inventory, intelligence and cognitive functions). One year after the end of the long-term treatment we see an abstinence rate (DGSS4) of 57.5 %. The most substantial factors in abstinence are the participation in a self-help-group (β = 0.734, p addiction seem to show its high effectiveness in terms of abstinence and processing of drug structures. The cognitive functions could increase. This could be determinate of a condition for the conservation and restoration of working capacity. Further studies should differentiate the effect of insight into the dependency structure from the abstinence as an specific or unspecific effect. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Cohort Measures of Internal Migration: Understanding Long-Term Trends.

    Science.gov (United States)

    Bernard, Aude

    2017-12-01

    Internal migration intensities fluctuate over time, but both migration levels and trends show great diversity. The dynamics underpinning these trends remain poorly understood because they are analyzed almost exclusively by applying period measures to cross-sectional data. This article proposes 10 cohort measures that can be applied to both prospective and retrospective data to systematically examine long-term trends. To demonstrate their benefits, the proposed measures are applied to retrospective survey data for England that provide residential histories from birth to age 50 for cohorts born between 1918 and 1957. The analysis reveals stable lifetime migration for men but increased lifetime migration for women associated with earlier ages at moving in adulthood and a compression of intervals between consecutive moves. The proposed cohort measures provide a more comprehensive picture of migration behavior and should be used to complement period measures in exploring long-term trends. Increasing availability of retrospective and longitudinal survey data means that researchers can now apply the proposed measures to a wide range of countries.

  16. Long-term stability of salivary cortisol

    DEFF Research Database (Denmark)

    Garde, A H; Hansen, Åse Marie

    2005-01-01

    either stored in small vials or spiked to polyester Salivette tampons before analysis for cortisol using Spectria RIA kits. The effects of storage were evaluated by a linear regression model (mixed procedure) on a logarithmic scale. No effects on cortisol concentrations were found after storage of saliva......The measurement of salivary cortisol provides a simple, non-invasive, and stress-free measure frequently used in studies of the hypothalamic-pituitary-adrenal axis activity. In research projects, samples are often required to be stored for longer periods of time either because of the protocol...... of the project or because of lack of funding for analysis. The aim of the present study was to explore the effects of long-term storage of samples on the amounts of measurable cortisol. Ten pools of saliva were collected on polyester Salivette tampons from five subjects. After centrifugation the samples were...

  17. Long-term cryogenic space storage system

    Science.gov (United States)

    Hopkins, R. A.; Chronic, W. L.

    1973-01-01

    Discussion of the design, fabrication and testing of a 225-cu ft spherical cryogenic storage system for long-term subcritical applications under zero-g conditions in storing subcritical cryogens for space vehicle propulsion systems. The insulation system design, the analytical methods used, and the correlation between the performance test results and analytical predictions are described. The best available multilayer insulation materials and state-of-the-art thermal protection concepts were applied in the design, providing a boiloff rate of 0.152 lb/hr, or 0.032% per day, and an overall heat flux of 0.066 Btu/sq ft hr based on a 200 sq ft surface area. A six to eighteen month cryogenic storage is provided by this system for space applications.

  18. Long-term control of root growth

    Science.gov (United States)

    Burton, Frederick G.; Cataldo, Dominic A.; Cline, John F.; Skiens, W. Eugene

    1992-05-26

    A method and system for long-term control of root growth without killing the plants bearing those roots involves incorporating a 2,6-dinitroaniline in a polymer and disposing the polymer in an area in which root control is desired. This results in controlled release of the substituted aniline herbicide over a period of many years. Herbicides of this class have the property of preventing root elongation without translocating into other parts of the plant. The herbicide may be encapsulated in the polymer or mixed with it. The polymer-herbicide mixture may be formed into pellets, sheets, pipe gaskets, pipes for carrying water, or various other forms. The invention may be applied to other protection of buried hazardous wastes, protection of underground pipes, prevention of root intrusion beneath slabs, the dwarfing of trees or shrubs and other applications. The preferred herbicide is 4-difluoromethyl-N,N-dipropyl-2,6-dinitro-aniline, commonly known as trifluralin.

  19. Long term performance of radon mitigation systems

    International Nuclear Information System (INIS)

    Prill, R.; Fisk, W.J.

    2002-01-01

    Researchers installed radon mitigation systems in 12 houses in Spokane, Washington and Coeur d'Alene, Idaho during the heating season 1985--1986 and continued to monitor indoor radon quarterly and annually for ten years. The mitigation systems included active sub-slab ventilation, basement over-pressurization, and crawlspace isolation and ventilation. The occupants reported various operational problems with these early mitigation systems. The long-term radon measurements were essential to track the effectiveness of the mitigation systems over time. All 12 homes were visited during the second year of the study, while a second set 5 homes was visited during the fifth year to determine the cause(s) of increased radon in the homes. During these visits, the mitigation systems were inspected and measurements of system performance were made. Maintenance and modifications were performed to improve system performance in these homes

  20. Rising Long-term Interest Rates

    DEFF Research Database (Denmark)

    Hallett, Andrew Hughes

    Rather than chronicle recent developments in European long-term interest rates as such, this paper assesses the impact of increases in those interest rates on economic performance and inflation. That puts us in a position to evaluate the economic pressures for further rises in those rates......, the first question posed in this assignment, and the scope for overshooting (the second question), and then make some illustrative predictions of future interest rates in the euro area. We find a wide range of effects from rising interest rates, mostly small and mostly negative, focused on investment...... till the emerging European recovery is on a firmer basis and capable of overcoming increases in the cost of borrowing and shrinking fiscal space. There is also an implication that worries about rising/overshooting interest rates often reflect the fact that inflation risks are unequally distributed...

  1. Prediction of long-term creep curves

    International Nuclear Information System (INIS)

    Oikawa, Hiroshi; Maruyama, Kouichi

    1992-01-01

    This paper aims at discussing how to predict long-term irradiation enhanced creep properties from short-term tests. The predictive method based on the θ concept was examined by using creep data of ferritic steels. The method was successful in predicting creep curves including the tertiary creep stage as well as rupture lifetimes. Some material constants involved in the method are insensitive to the irradiation environment, and their values obtained in thermal creep are applicable to irradiation enhanced creep. The creep mechanisms of most engineering materials definitely change at the athermal yield stress in the non-creep regime. One should be aware that short-term tests must be carried out at stresses lower than the athermal yield stress in order to predict the creep behavior of structural components correctly. (orig.)

  2. Hanford grout: predicting long-term performance

    International Nuclear Information System (INIS)

    Sewart, G.H.; Mitchell, D.H.; Treat, R.L.; McMakin, A.H.

    1987-01-01

    Grouted disposal is being planned for the low-level portion of liquid radioactive wastes at the Hanford site in Washington state. The performance of the disposal system must be such that it will protect people and the environment for thousands of years after disposal. To predict whether a specific grout disposal system will comply with existing and foreseen regulations, a performance assessment (PA) is performed. Long-term PAs are conducted for a range of performance conditions. Performance assessment is an inexact science. Quantifying projected impacts is especially difficult when only scant data exist on the behavior of certain components of the disposal system over thousands of years. To develop defensible results, we are honing the models and obtaining experimental data. The combination of engineered features and PA refinements is being used to ensure that Hanford grout will meet its principal goal: to protect people and the environment in the future

  3. The discovery of long-term potentiation.

    Science.gov (United States)

    Lømo, Terje

    2003-04-29

    This paper describes circumstances around the discovery of long-term potentiation (LTP). In 1966, I had just begun independent work for the degree of Dr medicinae (PhD) in Per Andersen's laboratory in Oslo after an eighteen-month apprenticeship with him. Studying the effects of activating the perforant path to dentate granule cells in the hippocampus of anaesthetized rabbits, I observed that brief trains of stimuli resulted in increased efficiency of transmission at the perforant path-granule cell synapses that could last for hours. In 1968, Tim Bliss came to Per Andersen's laboratory to learn about the hippocampus and field potential recording for studies of possible memory mechanisms. The two of us then followed up my preliminary results from 1966 and did the experiments that resulted in a paper that is now properly considered to be the basic reference for the discovery of LTP.

  4. Long-term opioid therapy in Denmark

    DEFF Research Database (Denmark)

    Birke, H; Ekholm, Ola; Sjøgren, P

    2017-01-01

    significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all......,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were...... individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS: Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE: Long...

  5. Long Term Planning at IQ Metal

    DEFF Research Database (Denmark)

    2017-01-01

    This is a Danish version. This case about long term planning at the owner-managed manufacturing firm IQ Metal shows how the future management and ownership may be organized to utilize owner assets and minimize roadblocks. Initially, the owner-manager Bo Fischer Larsen explains how he acquired...... a stake in 2007 in the company which at that time was named Braendstrup Maskinfabrik. He furthermore expalins how he has developed the company based on a strategic plan focusing on professionalization and outsourcing. Next, the video shows how to type Bo Fischer Larsen's replies to the questions...... in The Owner Strategy Map into the questionnaire available on www.ejerstrategi-kortet.dk. Lastly, the Owner Strategy Map's recommendation of how to organize the future management and ownership of IQ Metal is explained....

  6. Long-term Consequences of Early Parenthood

    DEFF Research