Patient-Reported Satisfaction and Study Drug Discontinuation: Post-Hoc Analysis of Findings from ROCKET AF.

IntroductionPatient-reported outcomes (PROs) and satisfaction endpoints are increasingly important in clinical trials and may be associated with treatment adherence. In this post hoc substudy from ROCKET AF, we examined whether patient-reported satisfaction was associated with study drug discontinuation.MethodsROCKET AF (n = 14,264) compared rivaroxaban with warfarin for prevention of stroke and systemic embolism in patients with atrial fibrillation. We analyzed treatment satisfaction scores: the Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM II). We compared satisfaction with study drug between the two treatment arms, and examined the association between satisfaction and patient-driven study drug discontinuation (stopping study drug due to withdrawal of consent, noncompliance, or loss to follow-up).ResultsA total of 1577 (11%) patients participated in the Patient Satisfaction substudy; 1181 (8.3%) completed both the ACTS and TSQM II 4 weeks after starting study drug. Patients receiving rivaroxaban did not experience significant differences in satisfaction compared with those receiving warfarin. During a median follow-up of 1.6 years, 448 premature study drug discontinuations occurred (213 rivaroxaban group; 235 warfarin group), of which 116 (26%) were patient-driven (52 [24%] rivaroxaban group; 64 [27%] warfarin group). No significant differences were observed between satisfaction level and rates of patient-driven study drug discontinuation.ConclusionsStudy drug satisfaction did not predict rate of study drug discontinuation. No significant difference was observed between satisfaction with warfarin and rivaroxaban, as expected given the double-blind trial design. Although these results are negative, the importance of PRO data will only increase, and these analyses may inform future studies that explore the relationship between drug-satisfaction PROs, adherence, and clinical outcomes. CLINICALTRIALS.GOV: NCT00403767.FundingThe ROCKET AF trial was funded by Johnson & Johnson and Bayer

Singularity in the boundary resistance between superfluid 4^4He and a solid surface

We report new measurements in four cells of the thermal boundary resistance $R$ between copper and $^4$He below but near the superfluid-transition temperature $T_\lambda$. For $10^{-7} \leq t \equiv 1 - T/T_\lambda \leq 10^{-4}$ fits of $R = R_0 t^{x_b} + B_0$ to the data yielded $x_b \simeq 0.18$, whereas a fit to theoretical values based on the renormalization-group theory yielded $x_b = 0.23$. Alternatively, a good fit of the theory to the data could be obtained if the {\it amplitude} of the prediction was reduced by a factor close to two. The results raise the question whether the boundary conditions used in the theory should be modified.Comment: 4 pages, 4 figures, revte

Translational Symmetry Breaking in the Superconducting State of the Cuprates: Analysis of the Quasiparticle Density of States

Motivated by the recent STM experiments of J.E. Hoffman et.al. and C. Howald et.al., we study the effects of weak translational symmetry breaking on the quasiparticle spectrum of a d-wave superconductor. We develop a general formalism to discuss periodic charge order, as well as quasiparticle scattering off localized defects. We argue that the STM experiments in $Bi_2Sr_2CaCu_2O_{8+\delta}$ cannot be explained using a simple charge density wave order parameter, but are consistent with the presence of a periodic modulation in the electron hopping or pairing amplitude. We review the effects of randomness and pinning of the charge order and compare it to the impurity scattering of quasiparticles. We also discuss implications of weak translational symmetry breaking for ARPES experiments.Comment: 12 pages, 9 figs; (v2) minor corrections to formalism, discussions of dispersion, structure factors and sum rules added; (v3) discussion of space-dependent normalization added. To be published in PR

Uganda's HIV Prevention Success: The Role of Sexual Behavior Change and the National Response

There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of “zero grazing” (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women’s, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over “what happened in Uganda” continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality

On the Electromagnetic Response of Charged Bosons Coupled to a Chern-Simons Gauge Field: A Path Integral Approach

We analyze the electromagnetic response of a system of charged bosons coupled to a Chern-Simons gauge field. Path integral techniques are used to obtain an effective action for the particle density of the system dressed with quantum fluctuations of the CS gauge field. From the action thus obtained we compute the U(1) current of the theory for an arbitrary electromagnetic external field. For the particular case of a homogeneous external magnetic field, we show that the quantization of the transverse conductivity is exact, even in the presence of an arbitrary impurity distribution. The relevance of edge states in this context is analyzed. The propagator of density fluctuations is computed, and an effective action for the matter density in the presence of a vortex excitation is suggested.Comment: LaTex file, 27 pages, no figure

1994-95 Advisory Council On Social Security Technical Panel on Trends and Issues in Retirement Saving Final Report

The charge of the Technical Panel on Trends and Issues in Retirement Savings (TIRS) was to assist the 1994-95 [Social Security] Advisory Council with respect to its charge to analyze the relative roles of the public and private sectors in the provision of retirement income, particularly how underlying policies of public and private programs, including relevant tax laws, affect retirement decisions and the economic status of the elderly

The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

Hospitalizations in patients with atrial fibrillation:an analysis from ROCKET AF

AIMS: The high costs associated with treatment for atrial fibrillation (AF) are primarily due to hospital care, but there are limited data to understand the reasons for and predictors of hospitalization in patients with AF. METHODS AND RESULTS: The ROCKET AF trial compared rivaroxaban with warfarin for stroke prophylaxis in AF. We described the frequency of and reasons for hospitalization during study follow-up and utilized Cox proportional hazards models to assess for baseline characteristics associated with all-cause hospitalization. Of 14 171 patients, 14% were hospitalized at least once. Of 2614 total hospitalizations, 41% were cardiovascular including 4% for AF; of the remaining, 12% were for bleeding. Compared with patients not hospitalized, hospitalized patients were older (74 vs. 72 years), and more frequently had diabetes (46 vs. 39%), prior MI (23 vs. 16%), and paroxysmal AF (19 vs. 17%), but less frequently had prior transient ischaemic attack/stroke (49 vs. 56%). After multivariable adjustment, lung disease [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.29–1.66], diabetes [1.22, (1.11–1.34)], prior MI [1.27, (1.13–1.42)], and renal dysfunction [HR 1.07 per 5 unit GFR < 65 mL/min, (1.04–1.10)] were associated with increased hospitalization risk. Treatment assignment was not associated with differential rates of hospitalization. CONCLUSION: Nearly 1 in 7 of the moderate-to-high-risk patients with AF enrolled in this trial was hospitalized within 2 years, and both AF and bleeding were rare causes of hospitalization. Further research is needed to determine whether care pathways directed at comorbid conditions among AF patients could reduce the need for and costs associated with hospitalization

Collective Particle Flow through Random Media

A simple model for the nonlinear collective transport of interacting particles in a random medium with strong disorder is introduced and analyzed. A finite threshold for the driving force divides the behavior into two regimes characterized by the presence or absence of a steady-state particle current. Below this threshold, transient motion is found in response to an increase in the force, while above threshold the flow approaches a steady state with motion only on a network of channels which is sparse near threshold. Some of the critical behavior near threshold is analyzed via mean field theory, and analytic results on the statistics of the moving phase are derived. Many of the results should apply, at least qualitatively, to the motion of magnetic bubble arrays and to the driven motion of vortices in thin film superconductors when the randomness is strong enough to destroy the tendencies to lattice order even on short length scales. Various history dependent phenomena are also discussed.Comment: 63 preprint pages plus 6 figures. Submitted to Phys Rev

A Surprising Prevention Success: Why Did the HIV Epidemic Decline in Zimbabwe?

Daniel Halperin and colleagues examine reasons for the remarkable decline in HIV in Zimbabwe, in the context of severe social, political, and economic disruption