The objective of this study was to evaluate the effectiveness of an automated telephone system reminding patients with hypertension and/or cardiovascular disease to obtain overdue medication refills. ...The authors compared the intervention with usual care among patients with an overdue prescription for a statin or lisinopril‐hydrochlorothiazide (lisinopril‐HCTZ). The primary outcome was refill rate at 2 weeks. Secondary outcomes included time to refill and change in low‐density lipoprotein cholesterol and blood pressure. Significantly more patients who received a reminder call refilled their prescription compared with the usual‐care group (statin cohort: 30.3% vs 24.9% P<.0001; lisinopril‐HCTZ cohort: 30.7% vs 24.2% P<.0001). The median time to refill was shorter in patients receiving the reminder call (statin cohort: 29 vs 36 days P<.0001; lisinopril‐HCTZ cohort: 24 vs 31 days P<.0001). There were no statistically significant differences in mean low‐density lipoprotein cholesterol and blood pressure. These findings suggest the need for interventions that have a longer‐term impact.
Structural genomics discovery projects require ready access to both X-ray diffraction and NMR spectroscopy which support the collection of experimental data needed to solve large numbers of novel ...protein structures. The most productive X-ray crystal structure determination laboratories make extensive use of tunable synchrotron X-ray light to solve novel structures by anomalous diffraction methods. This requires that frozen cryo-protected crystals be shipped to large multi acre synchrotron facilities for data collection. In this paper we report on the development and use of the first laboratory-scale synchrotron light source capable of performing many of the state-of-the-art synchrotron applications in X-ray science. This Compact Light Source is a first-in-class device that uses inverse Compton scattering to generate X-rays of sufficient flux, tunable wavelength and beam size to allow high-resolution X-ray diffraction data collection from protein crystals. We report on benchmarking tests of X-ray diffraction data collection with hen egg white lysozyme, and the successful high-resolution X-ray structure determination of the Glycine cleavage system protein H from Mycobacterium tuberculosis using diffraction data collected with the Compact Light Source X-ray beam.
Objective To determine whether obstructive sleep apnea (OSA) and/or nocturnal hypoxemia are associated with the severity of liver injury in patients with pediatric nonalcoholic fatty liver disease ...(NAFLD). Study design Obese children aged 10-18 years with liver biopsy–proven NAFLD were enrolled. Demographic, clinical, and laboratory data were collected, polysomnography was performed, and liver histology was scored. Subjects were divided into those with OSA/hypoxemia and those without OSA/hypoxemia for analysis. Results Of 25 subjects with NAFLD, OSA/hypoxemia was present in 15 (60%) (mean age, 12.8 ± 1.9 years; 68% male; 88% Hispanic; mean body mass index z -score, 2.3 ± 0.3). Subjects with and without OSA/hypoxemia had similar levels of serum aminotransferases, serum lipids, and inflammatory and insulin resistance markers. Although there were no differences between groups in the histological severity of steatosis, inflammation, ballooning degeneration, NAFLD activity score, or histological grade, subjects with OSA/hypoxemia had significantly more severe hepatic fibrosis. Moreover, oxygen saturation nadir during polysomnography was related to hepatic fibrosis stage ( r = −0.49; P = .01) and aspartate aminotransferase level ( r = 0.42; P < .05). Increasing percentage of time with oxygen saturation ≤90% was related to NAFLD inflammation grade ( r = 0.44; P = .03), degree of hepatic steatosis ( r = −0.50; P = .01), NAFLD activity score ( r = 0.42; P = .04), aspartate aminotransferase level ( r = 0.56; P = .004), and alanine aminotransferase level ( r = 0.44; P = .03). Conclusion Moderate OSA/hypoxemia is common in pediatric patients with biopsy-proven NAFLD. OSA and the severity/duration of hypoxemia are associated with biochemical and histological measures of NAFLD severity.
As our society ages, age-related diseases assume increasing prominence as both personal and public health concerns. Disorders of cognition are particularly important in both regards, and Alzheimer's ...disease is by far the most common cause of dementia of aging. In 2000, the prevalence of Alzheimer's disease in the United States was estimated to be 4.5 million individuals, and this number has been projected to increase to 14 million by 2050. Although not an inevitable consequence of aging, these numbers speak to the dramatic scope of its impact. This article focuses on Alzheimer's disease and the milder degrees of cognitive impairment that may precede the clinical diagnosis of probable Alzheimer's disease, such as mild cognitive impairment.
Primary nonadherence to a medication occurs when a drug is prescribed but the patient fails to pick the prescription up from the pharmacy. Managed care organizations that provide integrated care ...using electronic medical records (EMR) are an ideal setting to study primary nonadherence.
To identify patient and provider characteristics that are significantly associated with primary nonadherence to statin medications compared with a population of patients who picked up their first statin order.
This was a retrospective cohort study of patients with a new statin prescription. Patients with a new order for a statin prescription between December 1, 2009, and February 28, 2010, were eligible. A statin order was considered new if the patient had no statin prescriptions in the previous 12 months. Study participants were 24 years and older with 12 months of continuous membership prior to the statin order. Patients were defined as primary nonadherent if they did not pick up their new prescription within 90 days. Descriptive and multivariate (conditional logistic regression) analyses of patients who did and did not pick up their new statin prescriptions were performed using demographic and socioeconomic information, health care utilization, health conditions, medical benefits, and prescriber characteristics.
A total of 19,826 patients with a new statin order that met all of the inclusion and exclusion criteria was identified. Of these, 3,049 patients (15.4%) did not pick up their statin prescriptions within 90 days of the order date. Primary nonadherent patients tended to be younger (55 vs. 57 years, P less than 0.001) and healthier, with fewer comorbid conditions (Charlson Comorbidity Index ≥ 1, 42.2% vs. 52.3%, P less than 0.001), lower rates of hospitalizations (7.2% vs. 12.0%, P less than 0.001), fewer concurrent prescriptions (3 vs. 4, P less than 0.001) and fewer clinic (4 vs. 5, P less than 0.001) and emergency department visits (18.2% vs. 24.6%, P less than 0.001) in the prior year than adherent patients. Although the multivariate model agreed well with the observed data, the characteristics included had a poor ability to predict primary nonadherence (c-statistic = 0.603).
Primary nonadherence has been recognized as a significant problem for many years, and electronic health records are allowing researchers to investigate the extent of the problem. In this study, almost 1 in 6 patients (15.4%) failed to pick up their new statin order within 90 days. However, clinical and demographic information available in electronic health care data may not be useful in predicting primary nonadherence. New methods and interventions need to be developed to improve primary adherence.
Interleukin-1 induces release of NO and PGE(2) and production of matrix degrading enzymes in chondrocytes. In osteoarthritis (OA), IL-1 continually, or episodically, acts on chondrocytes in a ...paracrine and autocrine manner. Human chondrocytes in chondron pellet culture were treated chronically (up to 14 days) with IL-1beta. Chondrons from OA articular cartilage were cultured for 3 weeks before treatment with IL-1beta (0.05-10 ng/ml) for an additional 2 weeks. Spontaneous release of NO and IL-1beta declined over the pretreatment period. In response to IL-1beta (0.1 ng/ml), NO and PGE(2) release was maximal on Day 2 or 3 and then declined to near basal level by Day 14. Synthesis was recovered by addition of 1 ng/ml IL-1beta on Day 11. Expression of inducible nitric oxide synthase (iNOS), detected by immunofluorescence, was elevated on Day 2 and declined through Day 14, which coordinated with the pattern of NO release. On the other hand, IL-1beta-induced MMP-13 synthesis was elevated on Day 3, declined on Day 5, and then increased again through Day 14. IL-1beta increased glucose consumption and lactate production throughout the treatment. IL-1beta stimulated proteoglycan degradation in the early days and inhibited proteoglycan synthesis through Day 14. Chondron pellet cultures from non-OA cartilage released the same amount of NO but produced less PGE(2) and MMP-13 in response to IL-1beta than OA cultures. Like the OA, IL-1beta-induced NO and PGE(2) release decreased over time. In conclusion, with prolonged exposure to IL-1beta, human chondrocytes develop selective tolerance involving NO and PGE(2) release but not MMP-13 production, metabolic activity, or matrix metabolism.
PDF
