Effect of Continuous and Sequential Therapy among Veterans Receiving Daptomycin or Linezolid for Vancomycin-Resistant Enterococcus faecium Bacteremia

Vancomycin-resistant Enterococcus faecium bloodstream infections (VREF-BSI) cause significant mortality, highlighting the need to optimize their treatment. We compared the effectiveness and safety of daptomycin (DAP) and linezolid (LZD) as continuous or sequential therapy for VREF-BSI in a national, retrospective, propensity score (PS)-matched cohort study of hospitalized Veterans Affairs patients (2004 to 2014). We compared clinical outcomes and adverse events among patients treated with continuous LZD, continuous DAP, or sequential LZD followed by DAP (LZD-to-DAP). Secondarily, we analyzed the impact of infectious diseases (ID) consultation and source of VREF-BSI. A total of 2,630 patients were included in the effectiveness analysis (LZD [n = 1,348], DAP [n = 1,055], LZD-to-DAP [n = 227]). LZD was associated with increased 30-day mortality versus DAP (risk ratio [RR], 1.11; 95% confidence interval [CI], 1.01 to 1.22; P = 0.042). After PS matching, this relationship persisted (RR, 1.13; 95% CI, 1.02 to 1.26; P = 0.015). LZD-to-DAP switchers had lower mortality than those remaining on LZD (RR, 1.29; 95% CI, 1.03 to 1.63; P = 0.021), suggesting a benefit may still be derived with sequential therapy. LZD-treated patients experienced more adverse events, including a ≥50% reduction in platelets (RR, 1.07; 95% CI, 1.03 to 1.11; P = 0.001). DAP was associated with lower mortality than was LZD in patients with endocarditis (RR, 1.20; 95% CI, 1.02 to 1.41; P = 0.024); however, there was no statistically significant association between treatment group and mortality with regard to other sources of infection. Therefore, source of infection appears to be important in selection of patients most likely to benefit from DAP over LZD

WII-FIT FOR BALANCE AND GAIT IN SKILLED NURSING FACILITY: A RETROSPECTIVE STUDY

Background: Falls in elderly are a major public health problem. Poor balance and gait abnormalities are risk factors for falls. Exercise improves gait and balance in elderly. However, it is difficult to engage patients in exercise programs. Wii-Fit might bridge this gap by providing high level of engagement at an affordable price. Wii-Fit is a Nintendo game used for balance, yoga, aerobics, and strength training. It is a TV based self-directed activity. Virtual trainers talk the user through the activity and track progress while visual and auditory feedback improve engagement. Anecdotal reports suggest improvement in balance and social benefits with Wii-Fit, but no systematic studies are available. Objective: To compare the effect of Wii-Fit augmentation to physical therapy alone in subjects undergoing rehabilitation in skilled nursing facility (SNF) using a retrospective chart review. Methods: 100 charts were reviewed of which seventeen patients were noted to have used Wii-Fit during their rehabilitation. These subjects were matched with seventeen controls who did physical therapy alone. Results: There were no baseline differences between the groups. The mean age was 77.7 years, with 11 females in each group. All the subjects were Caucasians. The average length of stay was 30 days in each group. Mean duration of the Wii-Fit use was 4-weeks. Wii-Fit augmentation group improved significantly in Activities of Daily Living (p=0.008), balance (p=0.0001), and assistance with gait (p=0.05) when compared to the control group. Conclusion: Wii-Fit can be used safely in a SNF, and it may improve balance, gait, and functional status

Thrombosis Is Reduced by Inhibition of COX-1, but Unaffected by Inhibition of COX-2, in an Acute Model of Platelet Activation in the Mouse

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Identification of outcomes to inform the development of a core outcome set for surgical innovation:a targeted review of case studies of novel surgical devices

OBJECTIVE: Outcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS. DESIGN: A targeted review of 11 purposive selected case studies of innovative surgical devices. METHODS: Electronic database searches in PubMed (July 2018) identified publications reporting the introduction and evaluation of each device. Outcomes were extracted and categorised into domains until no new domains were conceptualised. Outcomes specifically relevant to evaluating innovation were further scrutinised. RESULTS: 112 relevant publications were identified, and 5926 outcomes extracted. Heterogeneity in study type, outcome selection and reporting was observed across surgical devices. Categorisation of outcomes was performed for 2689 (45.4%) outcomes into five broad outcome domains. Outcomes considered key to the evaluation of innovation (n=66; 2.5%) were further categorised as surgeon/operator experience (n=40; 1.5%), unanticipated events (n=15, 0.6%) and modifications (n=11; 0.4%). CONCLUSION: Outcome domains unique to evaluating innovative surgical devices have been identified. Findings have been combined with multiple other data sources relevant to the evaluation of surgical innovation to inform the development of a COS to measure and report in all studies evaluating novel surgical procedures/devices

The correlation between reading and mathematics ability at age twelve has a substantial genetic component

Dissecting how genetic and environmental influences impact on learning is helpful for maximizing numeracy and literacy. Here we show, using twin and genome-wide analysis, that there is a substantial genetic component to children’s ability in reading and mathematics, and estimate that around one half of the observed correlation in these traits is due to shared genetic effects (so-called Generalist Genes). Thus, our results highlight the potential role of the learning environment in contributing to differences in a child’s cognitive abilities at age twelve

Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies

<p>Background: Genetic and epidemiological evidence suggests an inverse association between B-type natriuretic peptide (BNP) levels in blood and risk of type 2 diabetes (T2D), but the prospective association of BNP with T2D is uncertain, and it is unclear whether the association is confounded.</p> <p>Methods and Findings: We analysed the association between levels of the N-terminal fragment of pro-BNP (NT-pro-BNP) in blood and risk of incident T2D in a prospective case-cohort study and genotyped the variant rs198389 within the BNP locus in three T2D case-control studies. We combined our results with existing data in a meta-analysis of 11 case-control studies. Using a Mendelian randomization approach, we compared the observed association between rs198389 and T2D to that expected from the NT-pro-BNP level to T2D association and the NT-pro-BNP difference per C allele of rs198389. In participants of our case-cohort study who were free of T2D and cardiovascular disease at baseline, we observed a 21% (95% CI 3%-36%) decreased risk of incident T2D per one standard deviation (SD) higher log-transformed NT-pro-BNP levels in analysis adjusted for age, sex, body mass index, systolic blood pressure, smoking, family history of T2D, history of hypertension, and levels of triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The association between rs198389 and T2D observed in case-control studies (odds ratio = 0.94 per C allele, 95% CI 0.91-0.97) was similar to that expected (0.96, 0.93-0.98) based on the pooled estimate for the log-NT-pro-BNP level to T2D association derived from a meta-analysis of our study and published data (hazard ratio = 0.82 per SD, 0.74-0.90) and the difference in NT-pro-BNP levels (0.22 SD, 0.15-0.29) per C allele of rs198389. No significant associations were observed between the rs198389 genotype and potential confounders.</p> <p>Conclusions: Our results provide evidence for a potential causal role of the BNP system in the aetiology of T2D. Further studies are needed to investigate the mechanisms underlying this association and possibilities for preventive interventions.</p&gt

Marketing (as) Rhetoric: paradigms, provocations, and perspectives

In this collection of short, invited essays on the topic of marketing (as) rhetoric we deal with a variety of issues that demonstrate the centrality of rhetoric and rhetorical considerations to the pursuit of marketing scholarship, research and practice. Stephen Brown examines the enduring rhetorical power of the 4Ps; Chris Hackley argues for the critical power of rhetorical orientations in marketing scholarship but cautions us on the need to work harder in conceptually connecting rhetorical theory and modern marketing frameworks; Shelby Hunt explains how rhetorical processes are incorporated in his inductive realist model of theory generation, using one of his most successful publications as an illustration; Charles Marsh demonstrates what Isocrates’ broad rhetorical project has to teach us about the importance of reputation cultivation in modern marketing; Nicholas O’Shaughnessy uses an analysis of Trump’s discourse to argue that political marketing as it is currently conceived is ill-equipped to engage effectively with the rhetorical force of Trump’s ‘unmarketing’; Barbara Phillips uses Vygotsky’s work on imagination to investigate the important of pleasure and play in advertising rhetoric; and finally, David Tonks, who in many ways started it all, reiterates the need for marketers to recognise the strength of the relationship between marketing and persuasion