Prevention of osteoporotic refractures in regional Australia

Objective: Clinical guidelines recommend that patients who sustain a minimal trauma fracture (MTF) should receive a bone mineral density (BMD) scan and bisphosphonate (or equivalent) therapy if diagnosed with osteoporosis. A pilot fracture liaison service (FLS) was implemented in regional NSW to improve adherence to the guidelines. Design: Prospective cohort study with an historical control. Setting: Primary care. Participants: Control (n = 47) and cohort (n = 93) groups comprised patients consenting to interview who presented with a MTF to the major referral hospital 4 months before and 12 months after FLS implementation respectively. Main outcome measures: Primary outcome measures were the rates of BMD scans and anti-osteoporotic medication initiation/review after MTF. Hospital admission data were also examined to determine death and refracture rates for all patients presenting during the study period with a primary diagnosis of MTF within 3 years of their initial fracture. Results: Although there was no improvement in BMD scanning rates, the reported rate of medication initiation/review after fracture was significantly higher (P \u3c 0.05) in the FLS cohort. However, once adjusted for age, this association was not significant (P = 0.086). There was a lower refracture rate during the cohort period (P = 0.013), however, there were significantly more deaths (P = 0.035) within 3 years of initial fracture. When deaths were taken into account via competing risk regression, patients in the cohort period were significantly less likely to refracture than those in the control period (Hazard ratio = 0.576, P = 0.032). Conclusions: A rurally based nurse-led FLS was associated with modest improvement after MTF. Consideration should be given to ways to strengthen the model of care to improve outcomes

Second-line antiretroviral therapy in a workplace and community-based treatment programme in South Africa: determinants of virological outcome.

: Background: As antiretroviral treatment (ART) programmes in resource-limited settings mature, more patients are experiencing virological failure. Without resistance testing, deciding who should switch to second-line ART can be difficult. The consequences for second-line outcomes are unclear. In a workplace- and community-based multi-site programme, with 6-monthly virological monitoring, we describe outcomes and predictors of viral suppression on second-line, protease inhibitor-based ART.Methods: We used prospectively collected clinic data from patients commencing first-line ART between 1/1/03 and 31/12/08 to construct a study cohort of patients switched to second-line ART in the presence of a viral load (VL) ?400 copies/ml. Predictors of VL<400 copies/ml within 15 months of switch were assessed using modified Poisson regression to estimate risk ratios.Results: 205 workplace patients (91.7% male; median age 43 yrs) and 212 community patients (38.7% male; median age 36 yrs) switched regimens. At switch compared to community patients, workplace patients had a longer duration of viraemia, higher VL, lower CD4 count, and higher reported non-adherence on first-line ART. Non-adherence was the reported reason for switching in a higher proportion of workplace patients. Following switch, 48.3% (workplace) and 72.0% (community) achieved VL<400, with non-adherence (17.9% vs. 1.4%) and virological rebound (35.6% vs. 13.2% with available measures) reported more commonly in the workplace programme. In adjusted analysis of the workplace programme, lower switch VL and younger age were associated with VL<400. In the community programme, shorter duration of viraemia, higher CD4 count and transfers into programme on ART were associated with VL<400.Conclusion: High levels of viral suppression on second-line ART can be, but are not always, achieved in multi-site treatment programmes with both individual- and programme-level factors influencing outcomes. Strategies to support both healthcare workers and patients during this switch period need to be evaluated; sub-optimal adherence, particularly in the workplace programme must be addressed

State criminal justice telecommunications (STACOM). Volume 3: Requirements analysis and design of Texas criminal Justice Telecommunications Network

For abstract, see N78-16218

Entrapment: an important mechanism to explain the shortwave 3D radiative effect of clouds

Several mechanisms have previously been proposed to explain differences between the shortwave reflectance of realistic cloud scenes computed using the 1D independent column approximation (ICA) and 3D solutions of the radiative transfer equation. When the sun is low in the sky, interception of sunlight by cloud sides tends to increase reflectance relative to ICA estimates that neglect this effect. When the sun is high, 3D radiative transfer tends to make clouds less reflective, which we argue is explained by the mechanism of “entrapment” whereby horizontal transport of radiation beneath a cloud layer increases the chances, relative to the ICA, of light being absorbed by cloud or the surface. It is especially important for multilayered cloud scenes. We describe modifications to the previously described Speedy Algorithm for Radiative Transfer through Cloud Sides (SPARTACUS) to represent different entrapment assumptions, and test their impact on 65 contrasting scenes from a cloud-resolving model. When entrapment is represented explicitly via a calculation of the mean horizontal distance traveled by reflected light, SPARTACUS predicts a mean “3D radiative effect” (the difference in top-of-atmosphere irradiances between 3D and ICA calculations) of 8.1 W m−2 for overhead sun. This is within 2% of broadband Monte Carlo calculations on the same scenes. The importance of entrapment is highlighted by the finding that the extreme assumptions in SPARTACUS of “zero entrapment” and “maximum entrapment” lead to corresponding mean 3D radiative effects of 1.7 and 19.6 W m−2, respectively

Measles to the Rescue: A Review of Oncolytic Measles Virus

Oncolytic virotherapeutic agents are likely to become serious contenders in cancer treatment. The vaccine strain of measles virus is an agent with an impressive range of oncolytic activity in pre-clinical trials with increasing evidence of safety and efficacy in early clinical trials. This paramyxovirus vaccine has a proven safety record and is amenable to careful genetic modification in the laboratory. Overexpression of the measles virus (MV) receptor CD46 in many tumour cells may direct the virus to preferentially enter transformed cells and there is increasing awareness of the importance of nectin-4 and signaling lymphocytic activation molecule (SLAM) in oncolysis. Successful attempts to retarget MV by inserting genes for tumour-specific ligands to antigens such as carcinoembryonic antigen (CEA), CD20, CD38, and by engineering the virus to express synthetic microRNA targeting sequences, and "blinding" the virus to the natural viral receptors are exciting measures to increase viral specificity and enhance the oncolytic effect. Sodium iodine symporter (NIS) can also be expressed by MV, which enables in vivo tracking of MV infection. Radiovirotherapy using MV-NIS, chemo-virotherapy to convert prodrugs to their toxic metabolites, and immune-virotherapy including incorporating antibodies against immune checkpoint inhibitors can also increase the oncolytic potential. Anti-viral host immune responses are a recognized barrier to the success of MV, and approaches such as transporting MV to the tumour sites by carrier cells, are showing promise. MV Clinical trials are producing encouraging preliminary results in ovarian cancer, myeloma and cutaneous non-Hodgkin lymphoma, and the outcome of currently open trials in glioblastoma multiforme, mesothelioma and squamous cell carcinoma are eagerly anticipated

The measurement of household socio-economic position in tuberculosis prevalence surveys: a sensitivity analysis.

OBJECTIVE: To assess the robustness of socio-economic inequalities in tuberculosis (TB) prevalence surveys. DESIGN: Data were drawn from the TB prevalence survey conducted in Lusaka Province, Zambia, in 2005-2006. We compared TB socio-economic inequalities measured through an asset-based index (Index 0) using principal component analysis (PCA) with those observed using three alternative indices: Index 1 and Index 2 accounted respectively for the biases resulting from the inclusion of urban assets and food-related variables in Index 0. Index 3 was built using regression-based analysis instead of PCA to account for the effect of using a different assets weighting strategy. RESULTS: Household socio-economic position (SEP) was significantly associated with prevalent TB, regardless of the index used; however, the magnitude of inequalities did vary across indices. A strong association was found for Index 2, suggesting that the exclusion of food-related variables did not reduce the extent of association between SEP and prevalent TB. The weakest association was found for Index 1, indicating that the exclusion of urban assets did not lead to higher extent of TB inequalities. CONCLUSION: TB socio-economic inequalities seem to be robust to the choice of SEP indicator. The epidemiological meaning of the different extent of TB inequalities is unclear. Further studies are needed to confirm our conclusions

The rise of the Louisville Slugger in the mass market

The following article is a historical case study on the obstacles confronted by Hillerich & Son and the strategies the company employed to survive in a tumultuous industry. Three key marketing strate­gies will be discussed. These key strategies, al­though historical in nature, are still effectively used by manufacturers, wholesalers, and retailers in the 1990s. Furthermore, Hillerich & Son\u27s marketing strategies defy the historical production era model. According to the production era model, production was manufacturers\u27 primary concern until 1930. Customer research was inconsequential since demand exceeded supply and competition was scarce within product markets.Hillerich & Son\u27s marketing strategies in the first decade of the 20th century exem­plify that following eras, production (1870-1930), sales (1930-1950), and-marketing (1950s), were not a sequential evolution. Competition in the baseball bat industry was indeed fierce. Consequently, manu­facturers concentrated on the customer to ascertain desired products and product attributes. This case study suggests that marketing has always been an integral part of company strategies. This proposi­tion is exemplified by Hillerich & Son\u27s three key marketing strategies, 1) the 1912 push rule, 2) the 1914 youth market decision, and 3) the 1919 na­tional advertising campaign