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

Modeling Potential Energy of the Gaussian Gun

The Gaussian gun is an arrangement of magnets and ball bearings (pictured in Fig. 1) such that—when the leftmost ball is released—the rightmost ball is ejected at high speeds. The device has been described in several articles on energy education. The sudden appearance of kinetic energy offers a productive context for considering a range of challenging ideas: the often-counterintuitive relationship between force and potential energy, the escape velocity for attractive forces, why energy is required to break bonds, and why energy is released when bonds form. Beyond these ideas, it is also useful for motivating the representation of a potential well and bound states for both quantum mechanics and chemistry

Reducing care-resistant behaviors during oral hygiene in persons with dementia

Abstract Background Nursing home residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. The intervention, called Managing Oral Hygiene Using Threat Reduction, combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate care-resistant behaviors. Methods/Design Using a randomized repeated measures design, 80 elders with dementia from 5 different nursing homes will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and care-resistant behavior measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing care-resistant behaviors in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the proposed intervention. Discussion At the conclusion of this study, the research team anticipates having a proven intervention that prevents and reduces care-resistant within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to nursing home staff, which may radically change the manner in which care is provided to persons with dementia. Trial Registration ClinicalTrials.gov: NCT01363258http://deepblue.lib.umich.edu/bitstream/2027.42/112778/1/12903_2011_Article_198.pd

The Ransom and Sarah Williams Farmstead: Post-Emancipation Transitions of an African American Family in Central Texas Vol. 1

In conjunction with the proposed construction of the southwest segment of State Highway 45 in southern Travis County, the Texas Department of Transportation sponsored archeological testing and data recovery efforts at the Ransom Williams farmstead. Prewitt and Associates, Inc., conducted an interdisciplinary community-based historic archeological study of the farmstead from 2005 through 2011. Extensive archival research reveals that the 45-acre farm was owned and occupied by Ransom Williams and his wife Sarah, both former slaves, from about 1871 to ca. 1905. The Williams family lived in the predominantly white rural community of Bear Creek, but they had connections to the nearby freedmen communities of Antioch Colony in northern Hays County and Manchaca in southern Travis County. The stories of the Ransom Williams family and their connections to these communities are enhanced by extensive oral history research, with over 46 hours of taped and transcribed interviews with 27 descendant community members. Data recovery investigations focused on a landscape archeological study to define the layout and design of the entire farmstead, including a stock pond and a network of dry-laid rock walls that facilitated water drainage, demarcated property boundaries, and formed livestock pens. Intensive hand excavations were used to examine features associated with the Williams house, outbuildings and activity areas, and a large trash midden. This work recovered more than 26,000 artifacts. They constitute an impressive material culture assemblage that is associated, with few exceptions, with the Williams family tenure on the land. The combined archival data, oral history interviews, and archeological evidence tell the fascinating story of how one African American farm family lived and thrived in central Texas during Reconstruction and into the Jim Crow era

Neuroactive Steroid 3α-Hydroxy-5α-Pregnan-20-One Modulates Electrophysiological and Behavioral Actions of Ethanol

Neuroactive steroids are synthesize

A Mobile App For Delirium Screening

Objective: The objective of this study is to describe the algorithm and technical implementation of a mobile app that uses adaptive testing to assess an efficient mobile app for the diagnosis of delirium. Materials and Methods: The app was used as part of a NIH-funded project to assess the feasibility, effectiveness, administration time, and costs of the 2-step delirium identification protocol when performed by physicians and nurses, and certified nursing assistants (CNA). The cohort included 535 hospitalized patients aged 79.7 (SD¼6.6) years enrolled at 2 different sites. Each patient was assessed on 2 consecutive days by the research associate who performed the reference delirium assessment. Thereafter, physicians, nurses, and CNAs performed adaptive delirium assessments using the app. Qualitative data to assess the experience of administering the 2-step protocol, and the app usability were also collected and analyzed from 50 physicians, 189 nurses, and 83 CNAs. We used extensible hypertext markup language (XHTML) and JavaScript to develop the app for the iOS–based iPad. The App was linked to Research Electronic Data Capture (REDCap), a relational database system, via a REDCap application programming interface (API) that sent and received data from/to the app. The data from REDCap were sent to the Statistical Analysis System for statistical analysis. Results: The app graphical interface was successfully implemented by XHTML and JavaScript. The API facilitated the instant updating and retrieval of delirium status data between REDCap and the app. Clinicians performed 881 delirium assessments using the app for 535 patients. The transmission of data between the app and the REDCap system showed no errors. Qualitative data indicated that the users were enthusiastic about using the app with no negative comments, 82% positive comments, and 18% suggestions of improvement. Delirium administration time for the 2-step protocol showed similar total time between nurses and physicians (103.9 vs 106.5 seconds). Weekly enrollment reports of the app data were generated for study tracking purposes, and the data are being used for statistical analyses for publications. Discussion: The app developed using iOS could be easily converted to other operating systems such as Android and could be linked to other relational databases beside REDCap, such as electronic health records to facilitate better data retrieval and updating of patient’s delirium status