P-225: Effective blood-pressure control with valsartan/HCTZ combination therapy in patients with moderate to severe systolic hypertension: The valor trial

Increasing evidence shows that combination therapy with at least two antihypertensive agents is needed to achieve appropriate blood-pressure (BP) control in a large part of the hypertensive population. One of the most appealing combinations is that of adding a diuretic to an angiotensin-receptor blocker (ARB). We studied the effects on sitting systolic BP of the combinations valsartan (V; an ARB) 160 mg + HCTZ 12.5 mg and V160 mg + HCTZ 25 mg od, compared with monotherapy V160 mg od. Treatment-naive and previously treated patients (N=767) with moderate to severe systolic hypertension (SBP ≥160 mm Hg and ≤200 mmHg) and with or without co-morbidities, were randomised (after a 2-week washout if previously treated and a 2 week placebo run-in period) to either V80 od (monotherapy group) or V160 od (combination groups) for 4 weeks, with force-tration to V160 mg, V160/HCTZ 12.5 od or V160/HCTZ 25 od for an additional 4 weeks. Endpoints were change in SBP between V160 and V160/HCTZ 25 and between V160/HCTZ 12.5 and V160; changes in DBP between groups, response rates and tolerability. As shown in the Table, all treatments were highly effective and there were additional SBP and DBP reductions in the combination groups. Responder rates were above 50% in all groups and reached 75% in the V160/HCTZ 25 group. Rates of adverse events did not differ significantly between monotherapy and combination therapies. Table 1 V160 V160/HCTZ12.5 V160/HCTZ25 N 261 254 252 Male/female 130/131 141/113 140/112 Mean age 60.4 (10.6) 60.8 (11.5) 60.7 (11.6) Baseline mean SBP/DBP 167.9 (8.0)/93.2 (8.9) 167.4 (8.3)/93.4 (9.6) 167.2 (7.9)/93.7 (8.8) Mean change SBP/DBP −20.7 (15.7)/−6.6 (8.9) −27.9 (13.8) *−10.2 (7.7)* −28.3 (13.1) *−10.1 (7.8)* Response rate¥ 56.9% 74.4% * 75% * Any AE (monotherapy phase/combination phase) 37.3%/27.5% 32.1%/28.6% 32.8%/34.0% Values in brackets are ± SD. *P < 0.05 vs V160; ¥SBP < 140 or decrease in SBP ≥20 mmHg and/or DBP<90 mmHg. V160 mg od is safe and effective in patients with moderate to severe systolic hypertension. Adding HCTZ 12.5 or 25 mg provides significant additional reductions in systolic and diastolic BP and increases responder rates compared with V160 mg monotherapy, with maintained excellent tolerabilit

Human Interaction: A key to managing disruptive behavior in dementia.

The results are part of a larger multi-center, mixed-methods study investigating the effect of environmental design in managing disruptive behavior in dementia. The presentation focuses on data from fifteen (15) discussion groups conducted with families (N = 45) and staff (N= 59) from eight (8) dementia units. Participants were asked to identify the primary obstacles and facilitators for managing behaviors in long-term care facilities. Results stress the importance of human interaction and institutional flexibility. These will be discussed in the context of communication environments and supported by observational data obtained in five (5) of the units

Prospectus, March 23, 1983

ADMISSION POLICIES CHIEF CAUSE OF RESIGNATION: PARKLAND WOMEN\u27S BASKETBALL COACH RESIGNS; News Digest; Monticello wins overall; Time out; C-U Happenings; MDA needs volunteer attendants; Lobby display appreciated; Club Notes; NJCAA coverage considered \u27poor\u27; Profile: DAP instructor Lake; Finances influence spring break decisions: Question: What are you going to be doing over spring break?; Failure to register for draft: Tangle of red tape threatens financial aid process; PC financial aid is business as usual; Urban League priority: find jobs; We Saw You On Campus; Central Illinois part of Tornado Alley; Believe it or not..; Eight-state area is the tornado capital of the world; Classified; Skylines; Trivia quiz; The Ramones are true \u27rock and roll\u27; Enter Oscars contest today; Trivia quiz dies; Sport shorts; Parkland College Softball Schedule; Parkland College Baseball Schedule; Parkland College Outdoor Track Schedule; 1983 Parkland College Indoor Track All-Americanshttps://spark.parkland.edu/prospectus_1983/1021/thumbnail.jp

Lower use of carotid artery imaging at minority-serving hospitals

Objective: We determined whether site of care explains a previously identified racial disparity in carotid artery imaging. Methods: In this retrospective cohort study, data were obtained from a chart review of veterans hospitalized with ischemic stroke at 127 Veterans Administration hospitals in 2007. Extensive exclusion criteria were applied to obtain a sample who should have received carotid artery imaging. Minority-serving hospitals were defined as the top 10% of hospitals ranked by the proportion of stroke patients who were black. Population level multivariate logistic regression models with adjustment for correlation of patients in hospitals were used to calculate predictive probabilities of carotid artery imaging by race and minority-service hospital status. Bootstrapping was used to obtain 95% confidence intervals (CIs). Results: The sample consisted of 1,534 white patients and 628 black patients. Nearly 40% of all black patients were admitted to 1 of 13 minority-serving hospitals. No racial disparity in receipt of carotid artery imaging was detected within nonminority serving hospitals. However, the predicted probability of receiving carotid artery imaging for white patients at nonminority-serving hospitals (89.7%, 95% CI [87.3%, 92.1%]) was significantly higher than both white patients (78.0% [68.3%, 87.8%] and black patients (70.5% [59.3%, 81.6%]) at minority-serving hospitals. Conclusions: Underuse of carotid artery imaging occurred most often among patients hospitalized at minority-serving hospitals. Further work is required to explore why site of care is a mechanism for racial disparities in this clinically important diagnostic test

Prospectus, April 9, 1983

WELCOME SPRING!; News Digest; Job fair figures show rosy future for some; PC donors can aid Miller; Editor accused of bias; PC jazz groups perform at UI; GM seminar offers new regional training; Animals suffer for science; Judges deliberating; Readers look to the stars for favorite feature: Question: What is your favorite Prospectus feature?; Instructor prefers teaching to testing; Club Notes; C-U happenings; Signs of Spring...; Classified; Skylines; Trivia quiz; Selleck adventure surprisingly good; Sport shortshttps://spark.parkland.edu/prospectus_1983/1020/thumbnail.jp

Prospectus, February 16, 1983

PARKING PROBLEMS CONTINUE; News Digest; Opinions; C-U happenings; Many complain, few vote; Photo deadline is April 8; East hard hit by snows; Dental care routine for most at PC; Dental clinic serves all district residents; Benefits offered students; CTEP cover risk areas; Club News; Scholarships depend on SSS registration; Skylines; Easy does it!; Student gift helps program; Illinois economy due to see recovery soon; Tourney open to public; Ice Capades return to Champaign-Urbana: Medal winners combine talents to entertain; Classified; Prices under $1 now seen; Roddenberry explores creative new worlds; Trivia quiz!; Whoopsie!; Are pros too highly paid?; Intramural Results; Boardbusters earn win; Early trail leads to win; Cobras now 22-1https://spark.parkland.edu/prospectus_1983/1025/thumbnail.jp

In vitro assessment of solvent evaporation from commercial adhesive systems compared to experimental systems

Solvents should be properly evaporated after application to dental substrates. The aim of this study was to assess the evaporation of commercial, experimental and neat solvents. The tested null hypotheses were that there are no differences in solvent evaporation regardless of its formulation and over time. Evaporation from commercial adhesive systems (Scotchbond Multipurpose Primer, Scotchbond Multipurpose Adhesive, Prime & Bond NT, Multi Bond, Excite, Single Bond 2, Adhese Primer, Adhese Bond, Xeno III A and Xeno III B) and experimental primers (35% HEMA plus 65% acetone or ethanol or water v/v) were compared to neat solvents (acetone, ethanol and water). Samples (10 &#181;L) of these products were dripped into glass containers placed on a digital precision balance. Evaporation was assessed at 0, 5, 10, 15, 30, 60, 120, 300 and 600 s times to calculate mass loss. Data were analyzed statistically by ANOVA and Bonferroni's correction (a=0.05). Acetone-based products exhibited a remarkable capacity to evaporate spontaneously over time. Neat acetone evaporated significantly more than the HEMA-mixtures and the commercial formulations (p<0.05). The incorporation of monomers and other ingredients in the commercial formulations seem to reduce the evaporation capacity. Solvent evaporation was time and material-dependent.O solvente deve ser adequadamente evaporado após aplicação ao substratos dentários. O objetivo deste estudo foi avaliar a evaporação de formulações comerciais, primers experimentais e solventes puros. As hipóteses nulas testadas foram de que não há diferenças da quantidade evaporada independentemente do material e tempo. Evaporação dos sistemas adesivos comerciais (Scotchbond multipurpose primer, Scotchbond multipurpose adhesive, Prime & Bond NT, Multi Bond, Excite, Single Bond 2, Adhese Primer, Adhese Bond, Xeno III A e Xeno III B) e primers experimentais (35% HEMA associado com 65% acetona, etanol ou água v/v) foram comparadas a solventes puros (acetona, etanol e água). Amostras (10 &#181;L) de cada produto foram dispensadas em balança de precisão digital. As massas nos tempos 0, 5, 10, 15, 30, 60, 120, 300 e 600 s foram registradas. Os dados foram analisados estatisticamente por ANOVA e Bonferroni (a=0,05). Produtos a base de acetona exibiram maior capacidade de evaporação espontânea ao longo do tempo. Acetona pura evaporou significantemente mais que as misturas de HEMA e formulações comerciais (p<0,05). A incorporação de monômeros e outros ingredientes nas formulações comerciais reduzem a capacidade de evaporação. A evaporação é dependente do produto e do tempo

Prospectus, March 2, 1983

PARKLAND AT NIGHT…; News Digest; Evening job is preference; Two from PC named to board; StuGo challenged; Nominate now; UI feature: Engineering; 32nd open house planned; Behind in payments? This may be helpful; People want more than transportation; Auto mechanics must change with the times; Yesteryear: new car less than $900; Women\u27s History Week; Attending evening classes requires dedication; Parts available; \u2783-\u2784 aid forms ready; Parkland P.M.; Pick a winner; Rolling Stones as vital as ever; Reputations are staked on Oscar predictions; Classified; C-U happenings; Skylines; \u27Roughing it\u27 isn\u27t what it used to be; \u27Worst thing that\u27s happened to college football...\u27: take the money and run; Track wins 15 of 17 in regional; Sport shorts; Globetrotters: comedy and skill; Record now 25-1 for PC womenhttps://spark.parkland.edu/prospectus_1983/1023/thumbnail.jp

Changes in the inflammatory potential of diet over time and risk of colorectal cancer in postmenopausal women

We examined the associations between changes in dietary inflammatory potential and risk of colorectal cancer (CRC) in 87,042 postmenopausal women recruited from 1993-1998 into the Women\u27s Health Initiative. Food frequency questionnaire data were used to compute patterns of change in dietary inflammatory index (DII) scores and cumulative average DII scores over 3 years. Cox regression models were used to estimate hazard ratios for CRC risk. After a median 16.2 years follow-up, 1,038 CRC cases were diagnosed. DII changes were not substantially associated with overall CRC, but proximal colon cancer risk was higher in the pro-inflammatory change DII compared to the anti-inflammatory stable DII groups (hazard ratio = 1.32; 95% confidence interval: 1.01, 1.74). Among non-users of nonsteroidal anti-inflammatory drugs (NSAID) (Pinteraction = 0.055) the pro-inflammatory stable DII group was at increased risk of overall CRC and proximal colon cancer. Also among non-users of NSAID, risks of overall CRC, colon cancer, and proximal colon cancer were higher in the highest quintile compared to the lowest cumulative average DII quintile (65%, 61%, and 91% increased risk, respectively). Dietary changes towards, or a history of, pro-inflammatory diets are associated with an elevated risk of colon cancer, particularly for proximal colon cancer and among non-users of NSAID

Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging

IMPORTANCE: National guidelines do not agree on the role of carotid screening in asymptomatic patients (ie, patients who have not had a stroke or transient ischemic attack). Recently, several physician organizations participating in the Choosing Wisely campaign have identified carotid imaging in selected asymptomatic populations as being of low value. However, the majority of patients who are evaluated for carotid stenosis and subsequently revascularized are asymptomatic. OBJECTIVE: To better understand why asymptomatic patients who undergo revascularization receive initial carotid imaging. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 4127 Veterans Health Administration patients 65 years and older undergoing carotid revascularization for asymptomatic carotid stenosis between 2005 and 2009. MAIN OUTCOMES AND MEASURES: Indications for carotid ultrasounds were extracted using trained abstractors. Frequency of indications and appropriateness of initial carotid ultrasound imaging for patients within each rating category after the intervention were reported. RESULTS: The mean (SD) age of this cohort of 4127 patients was 73.6 (5.9) years; 4014 (98.8%) were male. Overall, there were 5226 indications for 4063 carotid ultrasounds. The most common indications listed were carotid bruit (1578 [30.2% of indications]) and follow-up for carotid disease (stenosis/history of carotid disease) in patients who had previously documented carotid stenosis (1087 [20.8% of indications]). Multiple vascular risk factors were the next most common indication listed. Rates of appropriate, uncertain, and inappropriate imaging were 5.4% (227 indications), 83.4% (3387 indications), and 11.3% (458 indications), respectively. Among the most common inappropriate indications were dizziness/vertigo and syncope. Among the 4063 patients, 3373 (83.0%) received a carotid endarterectomy. Overall, 663 procedures were performed in patients 80 years and older. CONCLUSIONS AND RELEVANCE: Carotid bruit and follow-up for carotid disease accounted for approximately half of all indications provided by physicians for carotid testing. Strong consideration should be given to improving the evidence base around carotid testing, especially around monitoring stenosis over long periods and evaluating carotid bruits. Targeting carotid ultrasound ordering with decision support tools may also be an important step in reducing use of low-value imaging