Healthcare Resource Utilization in Persons with Sickle Cell Disease

The objectives of this study were to determine prevalence of sickle cell disease (SCD) in a Medicaid population, to determine all-cause health care resource utilization and incremental health care resource utilization associated with SCD. An observational database analysis was conducted using information from a large administrative claims database. Individuals continuously enrolled in a tracked health plan during the period from January 1, 2012 through December 31, 2012, were eligible for inclusion in the sample for determination of SCD prevalence. To select the sample for estimating all-cause resource utilization and incremental resource utilization associated with SCD, administrative claims and enrollment records from January 1, 2012 through December 31, 2012 were examined to select 8,652 individuals with SCD based on ICD-9-CM diagnosis codes. SCD patients were linked one-to-one on age, gender, and race with individuals without SCD resulting in 8,652 persons in the comparison group and a total of 17,304 persons in the overall sample

Development of Different Aptitude Test (DAT) for Secondary School Students

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and Health Beliefs toward Osteoporosis Screening in a Community Pharmacy

The aim of this study was to examine women's attitudes and health beliefs towards osteoporosis screening in a community pharmacy setting, utilizing the theoretical framework of Health Belief Model. A nonexperimental, cross-sectional research design, examining a convenience sample of women aged 18 and over, from several New York City senior care centers, a church, and a university campus in New York, was employed to assess the study objectives. Osteoporosis Health Belief Scale questionnaire was used to study the attitudes and health beliefs of participants towards bone mineral density screening in community pharmacy. From the study, it was observed that perceptions of severity and susceptibility towards osteoporosis and subjects' demographic characteristics did not seem to significantly influence the decision to screen in a community pharmacy setting. The perceptions of benefits of community pharmacy-based osteoporosis screening and the perceived barriers were found to be of greater importance in women's decisions to engage in osteoporosis-specific preventive behavior

Women’s Attitudes and Health Beliefs toward Osteoporosis Screening in a Community Pharmacy

The aim of this study was to examine women’s attitudes and health beliefs towards osteoporosis screening in a community pharmacy setting, utilizing the theoretical framework of Health Belief Model. A nonexperimental, cross-sectional research design, examining a convenience sample of women aged 18 and over, from several New York City senior care centers, a church, and a university campus in New York, was employed to assess the study objectives. Osteoporosis Health Belief Scale questionnaire was used to study the attitudes and health beliefs of participants towards bone mineral density screening in community pharmacy. From the study, it was observed that perceptions of severity and susceptibility towards osteoporosis and subjects’ demographic characteristics did not seem to significantly influence the decision to screen in a community pharmacy setting. The perceptions of benefits of community pharmacy-based osteoporosis screening and the perceived barriers were found to be of greater importance in women’s decisions to engage in osteoporosis-specific preventive behavior

A 28-year clinical and radiological follow-up of alumina ceramic-on-crosslinked polyethylene total hip arthroplasty: a follow-up report and analysis of the oxidation of a shelf-aged acetabular component

Aims: Our aim in this study was to describe a continuing review of 11 total hip arthroplasties using 22.225 mm Alumina ceramic femoral heads on a Charnley flanged femoral component, articulating against a silane crosslinked polyethylene. Patients and Methods: Nine patients (11 THAs) were reviewed at a mean of 27.5 years (26 to 28) post-operatively. Outcome was assessed using the d’Aubigne and Postel, and Charnley scores and penetration was recorded on radiographs. In addition, the oxidation of a 29-year-old shelf-aged acetabular component was analysed. Results: The mean clinical outcome scores remained excellent at final follow-up. The mean total penetration remained 0.41 mm (0.40 to 0.41). There was no radiographic evidence of acetabular or femoral loosening or osteolysis. There was negligible oxidation in the shelf-aged sample despite gamma irradiation and storage in air. Conclusion: These results highlight the long-term stability and durability of this type of crosslinked, antioxidant containing polyethylene when used in combination with a small diameter alumina ceramic femoral head

Controlling the Growth of the Skin Commensal Staphylococcus epidermidis Using d-Alanine Auxotrophy.

Using live microbes as therapeutic candidates is a strategy that has gained traction across multiple therapeutic areas. In the skin, commensal microorganisms play a crucial role in maintaining skin barrier function, homeostasis, and cutaneous immunity. Alterations of the homeostatic skin microbiome are associated with a number of skin diseases. Here, we present the design of an engineered commensal organism, Staphylococcus epidermidis, for use as a live biotherapeutic product (LBP) candidate for skin diseases. The development of novel bacterial strains whose growth can be controlled without the use of antibiotics or genetic elements conferring antibiotic resistance enables modulation of therapeutic exposure and improves safety. We therefore constructed an auxotrophic strain of S. epidermidis that requires exogenously supplied d-alanine. The S. epidermidis NRRL B-4268 Δalr1 Δalr2 Δdat strain (SEΔΔΔ) contains deletions of three biosynthetic genes: two alanine racemase genes, alr1 and alr2 (SE1674 and SE1079), and the d-alanine aminotransferase gene, dat (SE1423). These three deletions restricted growth in d-alanine-deficient medium, pooled human blood, and skin. In the presence of d-alanine, SEΔΔΔ colonized and increased expression of human β-defensin 2 in cultured human skin models in vitro. SEΔΔΔ showed a low propensity to revert to d-alanine prototrophy and did not form biofilms on plastic in vitro. These studies support the potential safety and utility of SEΔΔΔ as a live biotherapeutic strain whose growth can be controlled by d-alanine.IMPORTANCE The skin microbiome is rich in opportunities for novel therapeutics for skin diseases, and synthetic biology offers the advantage of providing novel functionality or therapeutic benefit to live biotherapeutic products. The development of novel bacterial strains whose growth can be controlled without the use of antibiotics or genetic elements conferring antibiotic resistance enables modulation of therapeutic exposure and improves safety. This study presents the design and in vitro evidence of a skin commensal whose growth can be controlled through d-alanine. The basis of this strain will support future clinical studies of this strain in humans

Identification of incident poisoning, fracture and burn events using linked primary care, secondary care, and mortality data from England: implications for research and surveillance

Background: English national injury data collection systems are restricted to hospitalisations and deaths. With recent linkage of a large primary care database, the Clinical Practice Research Datalink (CPRD), with secondary care and mortality data we aimed to assess the utility of linked data for injury research and surveillance by examining recording patterns and comparing incidence of common injuries across data sources. Methods: The incidence of poisonings, fractures and burns was estimated for a cohort of 2,147,853 0-24 year olds using CPRD linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data between 1997-2012. Time-based algorithms were developed to identify incident events, distinguishing between repeat follow-up records for the same injury, and those for a new event. Results: We identified 42,985 poisoning, 185,517 fracture and 36,719 burn events in linked CPRD-HES-ONS data; incidence rates were 41.9 per 10,000 person-years (95% confidence interval 41.4–42.4), 180.8 (179.8–181.7) and 35.8 (35.4–36.1), respectively. Of the injuries, 22,628(53%) poisonings, 139,662(75%) fractures, and 33,462(91%) burns were only recorded within CPRD. Only 16% of deaths from poisoning (n=106) or fracture (n=58) recorded in ONS were recorded within CPRD and/or HES records. None of the 10 deaths from burns were recorded in CPRD or HES records. Conclusion: It is essential to use linked primary care, hospitalisation and deaths data to estimate injury burden, as many injury events are only captured within a single data source. Linked routinely-collected data offer an immediate and affordable mechanism for injury surveillance and analyses of population based injury epidemiology in England

Technology-enabled medication adherence for seniors living in the community: Experiences, lessons, and the road ahead

Singapore National Research Foundation; Singapore Ministry of National Developmen

Ceramic on ceramic bearing fractures in total hip arthroplasty : an analysis of data from the national joint registry

Aims: Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) are commonly used but concerns exist regarding ceramic fracture. This study aims to report the risk of revision for fracture of modern CoC bearings and identify factors that might influence this risk, using data from the National Joint Registry (NJR). Patients and Methods: We analysed data on 111,681 primary CoC THA’s and 182 linked revisions for bearing fracture recorded in NJR. We used implant codes to identify ceramic bearing composition and generated Kaplan-Meier estimates for implant survivorship. Logistic regression analyses were performed for implant size and patient specific variables to determine any associated risks for revision. Results: 99.8% of bearings were CeramTec Biolox® products. Revisions for fracture were linked to 7 of 79,442 (0.009%) Biolox® Delta heads, 38 of 31,982 (0.119%) Biolox® Forte heads, 101 of 80,170 (0.126%) Biolox® Delta liners and 35 of 31,258 (0.112%) Biolox® Forte liners. Regression analysis of implant size revealed smaller heads had significantly higher odds of fracture (χ2=68.0, p<0.0001). The highest fracture risk were observed in the 28mm Biolox® Forte subgroup (0.382%). There were no fractures in the 40mm head group for either ceramic type. Liner thickness was not predictive of fracture (p=0.67). BMI was independently associated with revision for both head fractures (OR 1.09 per unit increase, p=0.031) and liner fractures (OR 1.06 per unit increase, p=0.006). Conclusions: We report the largest study of CoC bearing fractures to date. The risk of revision for CoC bearing fracture is very low, however previous studies have underestimated this risk. There is good evidence that the latest generation of ceramic has greatly reduced the odds of head fracture but not of liner fracture. Small head size and high patient BMI are associated with an increased risk of ceramic bearing fracture