Comparison of osteoporosis pharmacotherapy fracture rates: Analysis of a marketScan® claims database cohort

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications. Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database. Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. Logistic regression was used to account for and quantify the contribution of risk factors, and to make direct comparisons between different osteoporosis medications. Results: A total of 51649 patients were included in the cohort, with an average age of 56 years. The overall incidence rate of fracture was 1.55 per 100 person - years of treatment. Orally administered medications had the lowest fracture rates, led by raloxifene and alendronate (1.24 and 1.54 respectively), while parenterally administered medications including teriparatide and zolerdonic acid had the highest rates (3.90 and 1.98 respectively). No statistically significant differences found between oral or parenterally administered bisphosphonate medications. Conclusions: While patients taking orally administered drugs including bisphosphonates had less frequent incident fracture no statistically significant differences were found between most drugs in head - to - head comparisons, even considering the route of administration of bisphosphonates. These findings support previous evidence that minimal differences in efficacy exist between different osteoporosis medications. This is the first study using a large database to compare all currently available osteoporosis treatments and will hopefully be augmented by further study to provide more evidence to make clinical decisions on osteoporosis medication use. © 2017 American Association of Neuropathologists, Inc

Pressure-Regulated Volume Control vs Volume Control Ventilation in Infants After Surgery for Congenital Heart Disease

The objective of this investigation was to compare how two modes of positive pressure ventilation affect cardiac output, airway pressures, oxygenation, and carbon dioxide removal in children with congenital heart disease in the immediate postoperative period. The investigation used a one group pretest–post-test study design and was performed in the pediatric cardiac intensive care unit in a university-affiliated children's hospital. Nine infants were enrolled immediately after repair of tetralogy of Fallot (2) or atrioventricular septal defects (7) with mean weight = 5.5 kg (4.2–7.3 kg). Children were admitted to the pediatric cardiothoracic intensive care unit after complete surgical repair of their cardiac defect and stabilized on a Siemen's Servo 300 ventilator in volume control mode (VCV1) (volume-targeted ventilation with a square flow wave pattern). Tidal volume was set at 15 cc/kg (total). Hemodynamic parameters, airway pressures and ventilator settings, and an arterial blood gas were measured. Patients were then changed to pressure-regulated volume control mode (PRVC) (volume-targeted ventilation with decelerating flow wave pattern) with the tidal volume set as before. Measurements were repeated after 30 minutes. Patients were then returned to volume control mode (VCV2) and final measurements made after 30 minutes. The measurements and results are as follows:Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42385/1/246-22-3-233_10220233.pd

STUDY OF DUAL-SERVICE OFFICER RETENTION IN THE U.S. NAVY AND U.S. MARINE CORPS

Since the all-volunteer force began, the number of dual-service marriages has risen. Retention of diverse, skilled personnel is critical to national security. This study examines retention rates of Navy and Marine Corps officers by focusing on marital status and identifies themes in dual-service experiences to explain retention behavior. Quantitative multivariate data analysis of 27,126 officers commissioned from 1998 to 2003 is used to identify factors such as marital status, gender, race, and commissioning source to explain retention outcomes. Regression analyses indicate that dual-service officers have higher retention rates than their single counterparts across time. However, compared with officers married to civilians, dual-service officers tend to retain at similar rates early in their careers but at lower rates after 10 years of service. Focus group discussions reveal that navigating a rigid career path while maintaining a family in a system with varying support and flexibility can strongly influence a dual-service officer’s decision to remain in military service. Policy changes addressing concerns regarding colocation and more flexible career paths are an ongoing approach to retaining dual-service officers. Future research should be expanded to include a larger population representing all occupational fields, ranks, education, and parental status.http://archive.org/details/studyofdualservi1094561206Lieutenant Commander, United States NavyMajor, United States Marine CorpsApproved for public release; distribution is unlimited

A model for evaluating dispersed outdoor recreation use estimation

Section: Visitor flow modelling and data managemen

Designing a sampling system for concurrently measuring outdoor recreation visitation and describing visitor characteristics

Section: Visitor monitoring method

Characteristics and use patterns of visitors to dispersed areas of urban national forests

Section: Visitor information and visitor managemen