Using Healthcare Data in Embedded Pragmatic Clinical Trials among People Living with Dementia and Their Caregivers: State of the Art

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/156003/1/jgs16617_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/156003/2/jgs16617.pd

Safety and efficacy of botox injection in alleviating post-operative pain and improving quality of life in lower extremity limb lengthening and deformity correction

<p>Abstract</p> <p>Background</p> <p>Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A), which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis.</p> <p>Methods/Design</p> <p>The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5–21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont). Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group) intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada.</p> <p>Discussion</p> <p>BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX-A is being used under the context of limb lengthening and deformity correction.</p> <p>Trial Registration</p> <p>NCT00412035</p

Diagnosed prevalence of Alzheimer’s disease and related dementias in Medicare Advantage plans

IntroductionOne- third of Medicare beneficiaries are enrolled in Medicare Advantage (MA). Yet, little is known about MA beneficiaries diagnosed with Alzheimer’s disease (AD) and AD- related dementias (AD/ADRD).MethodsWe calculated the prevalence of AD/ADRD diagnoses in 2014 and 2016 in three MA plans. We determined the demographic characteristics of beneficiaries diagnosed with AD/ADRD, and whether they disenrolled from the MA plan for any reason within 364 days from the index date.ResultsIn 2014 and 2016, the overall prevalence of AD/ADRD diagnoses was 5.6% and 6.5%, respectively. In 2016, AD/ADRD beneficiaries were on average 82.4 (SD = 7.4) years of age, 61.8% female, and had multiple comorbidities. By 364 days post- index date, 32% of beneficiaries with AD/ADRD had disenrolled from their plan. The demographic characteristics of 2014 beneficiaries with diagnosed AD/ADRD were similar to their 2016 counterparts.DiscussionThe prevalence of AD/ADRD diagnosis in MA is lower than rates reported in Medicare fee- for- service.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156169/2/dad212048.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156169/1/dad212048_am.pd

The Lantern Vol. 61, No. 1, December 1993

• In Order to Succeed • Essay • Power of Human Self-Interest: Man vs. Car • In Setterich • Wandering Wanda • Maybe Kitchens • Saltiness • Homecoming • Perfect • Sincerely, Jen • A Midterm and a Paper • Prophet Junkie • Soundless Memo • After Ireland, Part 1https://digitalcommons.ursinus.edu/lantern/1142/thumbnail.jp

Photochemical reactivity of ancient marine dissolved organic carbon

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 39 (2012): L18602, doi:10.1029/2012GL052974.Marine dissolved organic carbon (DOC) is the largest reservoir of reduced carbon in seawater and persists up to 4,000–6,000 conventional radiocarbon (14C) years on average. Photochemical degradation has been suggested as a geochemical sink for these long-lived molecules, yet there have been no studies relating photochemical lability to the 14C-ages of surface DOC. We observed apparent second order (2°) kinetics with respect to DOC and a strong trend from Δ14C-enriched to depleted values during exhaustive photomineralization of surface marine DOC with high energy UV light. Geochemically, these results suggest that surface DOC is an isotopically-heterogeneous mixture of molecules for which photochemical lability and 14C ages are correlated. Photochemical mineralization may therefore be an important control on the persistence of 14C-depleted DOC in the ocean.This study was supported under NSF grant OCE-0961980 to E. R. M. Druffel.2013-03-2

Cut-off scores for mild and moderate dementia on the Addenbrooke's Cognitive Examination-III and the Mini-Addenbrooke's Cognitive Examination compared with the Mini-Mental State Examination

Aims and method We aimed to establish cut-off scores to stage dementia on the Addenbrooke's Cognitive Examination-III (ACE-III) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) compared with scores traditionally used with the Mini-Mental State Examination (MMSE). Our cross-sectional study recruited 80 patients and carers from secondary care services in the UK. Results A score ≤76 on the ACE-III and ≤19 on the M-ACE correlated well with MMSE cut-offs for mild dementia, with a good fit on the receiver operating characteristic analysis for both the ACE-III and M-ACE. The cut-off for moderate dementia had lower sensitivity and specificity. There were low to moderate correlations between the cognitive scales and scales for everyday functioning and behaviour. Clinical implications Our findings allow an objective interpretation of scores on the ACE-III and the M-ACE relative to the MMSE, which may be helpful for clinical services and research trials

Cut-off scores for mild and moderate dementia on the Addenbrooke's Cognitive Examination-III and the Mini-Addenbrooke's Cognitive Examination compared with the Mini-Mental State Examination

Aims and method: We aimed to establish cut-off scores to stage dementia on the Addenbrooke's Cognitive Examination-III (ACE-III) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) compared with scores traditionally used with the Mini-Mental State Examination (MMSE). Our cross-sectional study recruited 80 patients and carers from secondary care services in the UK. Results: A score ≤76 on the ACE-III and ≤19 on the M-ACE correlated well with MMSE cut-offs for mild dementia, with a good fit on the receiver operating characteristic analysis for both the ACE-III and M-ACE. The cut-off for moderate dementia had lower sensitivity and specificity. There were low to moderate correlations between the cognitive scales and scales for everyday functioning and behaviour. Clinical implications: Our findings allow an objective interpretation of scores on the ACE-III and the M-ACE relative to the MMSE, which may be helpful for clinical services and research trials

Security: Collective good or commodity?

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2008 Sage.The state monopoly on the legitimate use of violence in Europe and North America has been central to the development of security as a collective good. Not only has it institutionalized the state as the prime national and international security provider, it has helped to reduce the threat from other actors by either prohibiting or limiting their use of violence. The recent growth of the private security industry appears to undermine this view. Not only are private security firms proliferating at the national level; private military companies are also taking over an increasing range of military functions in both national defence and international interventions. This article seeks to provide an examination of the theoretical and practical implications of the shift from states to markets in the provision of security. Specifically, it discusses how the conceptualization of security as a commodity rather than a collective good affects the meaning and implementation of security in Western democracies.ESR

The Lantern Vol. 62, No. 1, December 1994

• Hollow • A Little Knowledge is Dangerous • My Old Block • Life • The Natural Born Fool • Oracle • Formation of a Triangle • Marie on the Beach • The Tweed Derby • Tripping • In Vitro • The Character • Coming Home for Christmas • Unkempt • Too Much • Reimertanti-Ode • Seeds • Secrethttps://digitalcommons.ursinus.edu/lantern/1145/thumbnail.jp