To Transplant or Not to Transplant? The Successful Treatment of a Lateral Meniscus Transplant

The purpose of this case report was to demonstrate how physical therapists can successfully manage a young patient who received the rare lateral meniscal transplant procedure.https://soar.usa.edu/flsaspring2018/1011/thumbnail.jp

ErythropoieSIS stimulating agent (ESA) use is increased following missed dialysis sessions

Missed dialysis sessions can have a cascading effect on patient clinical outcomes. In addition to missing the dialysis itself, patients fail to receive medications—such as ESAs—that are dosed at each session. This analysis assessed ESA dose changes following missed session episodes in order to evaluate “catch-up dosing.”In a retrospective analysis, we assessed missed session and epoetin alfa (EPO) utilization data in 2010 from adult (≥ 18 yrs old), hemodialysis (HD) patients. Consecutive misses were considered part of a missed session “episode.” All misses were included (even if patient was hospitalized). Differences in EPO utilization in the periods 14 days, 30 days and 31-60 days before and after missed session episodes were calculated and stratified by length of episode, and whether additional sessions were missed in the before/after periods. Total monthly EPO dose was also calculated and stratified by number of missed sessions.Patients used significantly more EPO after a missed session episode, and differences in per session EPO dose were generally greater the longer the episode. For missed session episodes with no additional misses in the 30 day before/after period, increases of 18% to 30% per session were seen, depending on episode length. For longer episodes, usually due to hospitalization, differences were sustained over 60 days. Analyses which included additional missed sessions in the before/after period showed similar patterns. Beyond these per-session associations, the total amount of EPO used in a month increased with number of missed sessions (through up to 5 missed sessions), even though these patients (by definition) were not receiving as many administrations of EPO.Missed session episodes result in significant increases in ESA utilization in the post-miss period, and also in total monthly ESA use. Such increases should be considered in any assessment of impact of missed sessions: both clinical and economic

Impact of 13-valent pneumococcal conjugate vaccine (PCV13) in a pandemic similar to the 2009 H1N1 in the United States

Background: High rates of bacterial coinfection in autopsy data from the 2009 H1N1 influenza (“flu”) pandemic suggest synergies between flu and pneumococcal disease (PD) during pandemic conditions, and highlight the importance of interventions like the 13-valent pneumococcal conjugate vaccine (PCV13) that may mitigate the impact of a pandemic. Methods: We used a decision-analytic model, estimated from published sources, to assess the impact of pediatric vaccination with PCV13 versus the 7-valent vaccine (PCV7) on PD incidence and mortality in a normal flu season (10% flu incidence) and in a pandemic similar to 2009-2010 H1N1 (20% flu incidence, mild virulence, high impact in children). Both direct and indirect (herd) effects against PD were considered. Effectiveness of PCV13 was extrapolated from observed PCV7 data, using assumptions of serotype prevalence and PCV13 protection against the 6 serotypes not in PCV7. To simulate 2009–2010 H1N1, autopsy data were used to estimate the overall proportion of flu deaths with bacterial coinfections. By assuming that increased risk of death during the pandemic occurred among those with comorbidity (using obesity as proxy) and bacterial coinfections primarily due to S. pneumoniae or S. aureus, we estimated the proportion co-infected among all (fatal and non-fatal) flu cases (7.6% co-infected with any organism; 2.2% with S. pneumoniae). PD incidence, mortality, and total healthcare costs were evaluated over a 1-year horizon. Results: In a normal flu season, compared to PCV7, PCV13 is expected to prevent an additional 13,400 invasive PD (IPD) cases, 399,000 pneumonia cases, and 2,900 deaths, leading to cost savings of $472 M. In a pandemic similar to 2009–2010 H1N1, PCV13 would prevent 22,800 IPD cases, 872,000 pneumonia cases, and 3,700 deaths, resulting in cost savings of$1.0 B compared to PCV7. Conclusions: In a flu pandemic similar to the 2009–2010 H1N1, protection against the 6 additional serotypes in PCV13 would likely be effective in preventing pandemic-related PD cases, mortality, and associated costs

Modeling the impact of the 13-valent pneumococcal conjugate vaccine serotype catch-up program using United States claims data

Background: Analysis of US claims data from April 2010 to June 2011 estimated that 39% of the 13-valent pneumococcal conjugate vaccine (PCV13) catch-up eligible cohort would ever receive the catch-up vaccination; a previous analysis assumed 87%. Methods: This updated figure was applied to a previously published 10-year Markov model while holding all other inputs constant. Results: Our model estimated that the catch-up program as currently implemented is estimated to prevent an additional 1.7 million cases of disease in children aged ≤59 months over a 10-year period, compared with routine PCV13 vaccination with no catch-up program. Conclusions: Because 39% catch-up uptake is less than the level of completion of the 4-dose primary PCV13 series, vaccine-preventable cases of pneumococcal disease and related deaths could be decreased further with additional uptake of catch-up vaccination in the catch-up eligible cohort

Use of Daptomycin for the Treatment of Methicillin-Resistant Coagulase-Negative Staphylococcal Ventriculitis

Coagulase-negative staphylococci (CoNS) are the main pathogens causing hospital-acquired external-ventricular-drain- (EVD-) and lumbar-drain- (LD-) associated meningitis and ventriculitis. The treatment of these infections can be challenging and may require combination of intraventricular and intravenous administration of antibiotics. Limited animal data demonstrate rapid daptomycin bactericidal activity, adequate penetration in the setting of inflamed meninges, and extended half-life in the ventricles Steenbergen et al. (2009). There are limited clinical data using daptomycin intravenously and/or intraventricularly for the treatment of central nervous system infections (CNS) Elvy et al. (2008), Stucki et al. (2007), Lee et al. (2008) and Wallace et al. (2009). We report here our experience in the treatment of an EVD-related infection

Noise Probe of the Dynamic Phase Separation in La2/3Ca1/3MnO3

Giant Random Telegraph Noise (RTN) in the resistance fluctuation of a macroscopic film of perovskite-type manganese oxide La2/3Ca1/3MnO3 has been observed at various temperatures ranging from 4K to 170K, well below the Curie temperature (TC = 210K). The amplitudes of the two-level-fluctuations (TLF) vary from 0.01% to 0.2%. We use a statistical analysis of the life-times of the TLF to gain insight into the microscopic electronic and magnetic state of this manganite. At low temperature (below 30K) The TLF is well described by a thermally activated two-level model. An estimate of the energy difference between the two states is inferred. At higher temperature (between 60K and 170K) we observed critical effects of the temperature on the life-times of the TLF. We discuss this peculiar temperature dependence in terms of a sharp change in the free energy functional of the fluctuators. We attribute the origin of the RTN to be a dynamic mixed-phase percolative conduction process, where manganese clusters switch back and forth between two phases that differ in their conductivity and magnetization.Comment: 15 pages, PDF only, Phys. Rev. Lett. (in press

Activity of 2-Aryl-2-(3-indolyl)acetohydroxamates Against Drug-Resistant Cancer Cells

Many types of tumor, including glioma, melanoma, non-small cell lung, esophageal, head and neck cancer, among others, are intrinsically resistant to apoptosis induction and poorly responsive to current therapies with proapoptotic agents. In addition, tumors often develop multi-drug resistance based on the cellular efflux of chemotherapeutic agents. Thus, novel anticancer agents capable of overcoming these intrinsic or developed tumor resistance mechanisms are urgently needed. We describe a series of 2-aryl-2-(3-indolyl)acetohydroxamic acids, which are active against apoptosis- and multidrug-resistant cancer cells as well as glioblastoma neurosphere stem-like cell cultures derived from patients. Thus, the described compounds serve as a novel chemical scaffold for the development of potentially highly effective clinical cancer drugs

Economic Model of a Birth Cohort Screening Program for Hepatitis C Virus

Recent research has identified high hepatitis C virus (HCV) prevalence among older U.S. residents who contracted HCV decades ago and may no longer be recognized as high risk. We assessed the cost-effectiveness of screening 100% of U.S. residents born 1946-1970 over 5 years (birth-cohort screening), compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources. We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is U.S. residents born 1946-1970 with no previous HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants, and 78,000 fewer HCV-related deaths. Birth-cohort screening leads to higher overall costs than risk-based screening ($80.4 billion versus$53.7 billion), but yields lower costs related to advanced liver disease ($31.2 billion versus$39.8 billion); birth-cohort screening produces an incremental costeffectiveness ratio (ICER) of $37,700 per quality-adjusted life year gained versus riskbased screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER; similarly, decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs. Conclusion: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths and is cost-effective at conventional willingness-topay thresholds. (HEPATOLOGY 2012;55:1344-1355 H epatitis C virus (HCV) is the most common blood-borne viral infection in the United States, 1 affecting an estimated 3.6 million U.S. residents. 2 The majority of infected individuals develop chronic hepatitis; persistent liver injury leads to cirrhosis in 5$5 billion per year, 4 with projected HCV-related societal costs for the years 2010-2019 estimated to total $54.2 billion. 5 For the last decade, the standard of care for treating HCV has been the combination of pegylated interferon (Peg-IFN) and ribavirin (RBV), 6 which successfully eradicates virus (sustained virologic response; SVR) in 40%-80% of treated patients

A pattern-search-based inverse method

Uncertainty in model predictions is caused to a large extent by the uncertainty in model parameters, while the identification of model parameters is demanding because of the inherent heterogeneity of the aquifer. A variety of inverse methods has been proposed for parameter identification. In this paper we present a novel inverse method to constrain the model parameters (hydraulic conductivities) to the observed state data (hydraulic heads). In the method proposed we build a conditioning pattern consisting of simulated model parameters and observed flow data. The unknown parameter values are simulated by pattern searching through an ensemble of realizations rather than optimizing an objective function. The model parameters do not necessarily follow a multi-Gaussian distribution, and the nonlinear relationship between the parameter and the response is captured by the multipoint pattern matching. The algorithm is evaluated in two synthetic bimodal aquifers. The proposed method is able to reproduce the main structure of the reference fields, and the performance of the updated model in predicting flow and transport is improved compared with that of the prior model.The authors gratefully acknowledge the financial support from the Ministry of Science and Innovation, project CGL2011-23295. The first author also acknowledges the scholarship provided by the China Scholarship Council (CSC [2007] 3020). The authors would like to thank Gregoire Mariethoz (University of New South Wales) and Philippe Renard (University of Neuchatel) for their enthusiastic help in answering questions about the direct sampling algorithm. Gregoire Mariethoz and two anonymous reviewers are also thanked for their comments during the reviewing process, which helped improving the final paper.Zhou ., H.; Gómez-Hernández, JJ.; Li ., L. (2012). A pattern-search-based inverse method. 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