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  • 1
    Language: English
    In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, April 2014, Vol.20(4), pp.299-304
    Description: To establish the prevalence of reliable self-monitored blood glucose (r-SMBG) data at office visits for diabetes and to determine whether r-SMBG is associated with changes in glycemic control and other clinical parameters. We conducted a chart review of 500 patients followed in an Endocrinology Faculty/Commercial Insurance Practice (FP) or a Managed Medicare/Medicaid Diabetes Clinic (MDC). Follow-up visits for patients with type 1 or type 2 diabetes from January 1, 2012 to June 30, 2012 were analyzed for anthropometric data, creatinine (Cr), glomerular filtration rate (GFR), low-density lipoprotein cholesterol (LDL-C), medications, hemoglobin A1C (A1C), change in A1C from the previous visit (ΔA1C), and availability of r-SMBG data at the visit. Our sample was composed of 215 MDC patients (43%) and 285 FP patients (57%). Overall, 151 patients (30%) provided r-SMBG data at their visit, with no difference between MDC or FP patients. Mean A1C at MDC was 9.1%, while mean A1C at FP was 7.9% (P8.0% demonstrated an A1C reduction of 1.2% if they provided r-SMBG, compared to an increase of 0.1% for MDC patients who did not (P〈.05). Providing r-SMBG did not affect A1C in FP patients in any A1C range. Only a minority of diabetes patients, mostly insulin-treated, made r-SMBG data available to their providers. Insulin-requiring Managed Medicare/Medicaid patients with poorly controlled diabetes had an A1c reduction associated with r-SMBG. Prospective studies are needed to determine whether this patient population may be more likely to benefit from r-SMBG at their visits.
    Keywords: Blood Glucose Self-Monitoring ; Blood Glucose -- Analysis ; Diabetes Mellitus -- Blood
    ISSN: 1530-891X
    E-ISSN: 19342403
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  • 2
    Language: English
    In: International Journal of Environmental Research and Public Health, 01 August 2016, Vol.13(8), p.809
    Description: The objective of our study was to measure the impact of transportation-related noise and total environmental noise on sleep disturbance for the residents of Montreal, Canada. A telephone-based survey on noise-related sleep disturbance among...
    Keywords: Transportation Noise ; Sleep Disturbance ; Land Use Regression ; Public Health
    ISSN: 16617827
    E-ISSN: 1660-4601
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  • 3
    Language: English
    In: Environmental health perspectives, November 2016, Vol.124(11), pp.1694-1699
    Description: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs. We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP. A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000-2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. 〈 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program. We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods. These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached. Citation: Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J. 2016. A difference-in-differences approach to assess the effect of a heat action plan on heat-related mortality, and differences in effectiveness according to sex, age, and socioeconomic status (Montreal, Quebec). Environ Health Perspect 124:1694-1699; http://dx.doi.org/10.1289/EHP203.
    Keywords: Program Evaluation ; Socioeconomic Factors ; Heat Stress Disorders -- Mortality
    E-ISSN: 1552-9924
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 4
    In: Journal of Periodontology, July 2011, Vol.82(7), pp.990-999
    Description: Endosseous dental implants are a popular treatment to replace missing teeth. Although many advances have occurred and affected the macrogeometry and surface characteristics of dental implants, among other aspects, it is important to document how the implants perform in patients over time. Such evaluations are helpful not only to document the clinical survival of the implants but also patient satisfaction over an extended period. A formal prospective multicenter human clinical was performed at five centers involving 200 patients and 626 implants. Specific inclusion and exclusion criteria were used and detailed data collected at specified times using case report forms. An independent study monitor reviewed all study data before entry into the study database. Two implant designs were used in two different clinical indications. A non‐submerged titanium plasma‐sprayed (TPS) hollow cylindrical implant with a smooth transgingival collar was evaluated in the maxillary anterior sextant and a non‐submerged TPS solid screw implant with similar collar in the mandible. Over the course of the 5‐year clinical trial, there was one early failure occurring before definitive prosthesis delivery. Three late failures were documented, one occurring at each of the 6, 12, and 18 months postoperative visits. Life table analysis at 5 years revealed a 99.4% survival rate and a 92.5% success rate. Patient satisfaction was rated as good to excellent for 96.1% of implants in regards to esthetics after 5 years; 98.8% for appearance; and 99.4% for prosthesis comfort, ability to chew and taste, fit, and general satisfaction. No serious adverse events were reported. Implant success and survival was over 92% and 99%, respectively, in a formal 5‐year prospective multicenter clinical trial involving 200 patients and 626 non‐submerged TPS implants. These implants included hollow cylinder implants in the anterior maxilla and solid screw implants placed in the mandible. These findings document the predictability and patient satisfaction of tooth replacement using a non‐submerged surgical technique involving a tissue‐level, rough surfaced endosseous dental implant.
    Keywords: Clinical Trial ; Dental Implants ; Life Tables ; Patient Satisfaction
    ISSN: 0022-3492
    E-ISSN: 1943-3670
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  • 5
    Language: English
    In: The Journal of Prosthetic Dentistry, 2005, Vol.93(1), pp.21-23
    Description: Commonly observed complications associated with a conventional fixed partial denture (FPD) include loss of retention and tooth fracture. This report describes the occurrence of an unusual FPD abutment fracture and subsequent treatment. The distal abutment of an FPD developed severe periodontal disease with mobility. The anterior abutment fractured in the middle of the clinical crown and experienced cement failure.
    Keywords: Dentistry
    ISSN: 0022-3913
    E-ISSN: 1097-6841
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  • 6
    In: Archives of Ophthalmology, May, 2001, Vol.119(5), p.667
    Description: Objective: To assess, the course of change of visual function outcome variables in 5 patients with gyrate atrophy before a gene replacement therapy clinical trial. Methods: The outcome variables selected were visual field sensitivity and electroretinogram amplitude. The course of change of these outcome variables was determined by calculation of their half-lives. Results: In the 4 to 6 years during which each patient was followed up for this study, median visual field half-lives were 17.0 years (static perimetry) and 11.4 years (kinetic perimetry). Median electroretinogram half-lives were 16.0 years (maximal response) and 10.7 years (flicker response). Conclusions: The course of the decline of visual function outcome variables is frequently slow. Thus, a long-term clinical trial would be required to assess the efficacy of the intervention in the preservation of visual function. Arch Ophthalmol. 2001;119:667-669
    Keywords: Retinal Diseases -- Care And Treatment ; Gene Therapy -- Usage
    ISSN: 0003-9950
    E-ISSN: 15383601
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  • 7
    Language: English
    In: Ophthalmology, May 2012, Vol.119(5), pp.1001-1010
    Description: To demonstrate noninferiority of ranibizumab in combination with verteporfin photodynamic therapy (PDT) versus ranibizumab monotherapy in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). Prospective, multicenter, double-masked, randomized, phase IIIb clinical trial. Three hundred twenty-one patients randomized to receive either ranibizumab 0.5 mg monotherapy (n = 112), standard fluence (SF) verteporfin PDT combination therapy (n = 104), or reduced fluence (RF) verteporfin PDT combination therapy (n = 105). Ranibizumab was administered monthly in the monotherapy group. In both combination therapy groups, ranibizumab was initiated with 3 consecutive monthly injections, followed by retreatment as needed ( ) with monthly monitoring. All patients were evaluated monthly for 12 months. Mean change in best-corrected visual acuity (BCVA) from baseline at month 12 and proportion of patients randomized to either combination therapy with a ranibizumab treatment-free interval of 3 months or longer. Two hundred eighty-six patients (89.1%) completed the 12-month study. Mean BCVA change at month 12 was +5.3 and +4.4 letters with verteporfin SF (n = 103) or verteporfin RF (n = 105) plus ranibizumab, respectively, compared with +8.1 letters with ranibizumab monotherapy (n = 110; adjusted 97.5% confidence interval [CI], (−7.90 to infinity); = 0.0666; and 97.5% CI, (−8.51 to infinity); = 0.1178; for combination regimens vs. monotherapy, respectively). Noninferiority of either combination regimen to monthly ranibizumab monotherapy was not demonstrated (primary end point). A ranibizumab treatment-free interval of 3 months or longer was achieved in 92.6% and 83.5% of the patients randomized to verteporfin SF or verteporfin RF groups, respectively, with a mean of 5.1 and 5.7 ranibizumab injections, respectively, and patients in the ranibizumab monotherapy arm received 10.5 injections. At month 12, mean central retinal thickness decreased by 151.7 μm and 140.9 μm for the verteporfin SF and RF groups, respectively, and by 172.2 μm with ranibizumab monotherapy. Safety and tolerability of all 3 regimens were similar to and consistent with previous studies in neovascular AMD. The number of ocular serious adverse events was low and occurred largely as single cases. Ranibizumab monotherapy or combined with verteporfin PDT improved BCVA at month 12; however, noninferiority (7-letter margin) of combination regimens to ranibizumab monotherapy was not demonstrated. Verteporfin RF did not confer clinical benefits over verteporfin SF. All treatments were well tolerated. Proprietary or commercial disclosure may be found after the references.
    Keywords: Medicine
    ISSN: 0161-6420
    E-ISSN: 1549-4713
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  • 8
    In: British Journal of Haematology, August 2013, Vol.162(3), pp.348-359
    Description: Multiple myeloma () is a heterogeneous disease. International Staging System/fluorescence hybridization (/)‐based model and gene expression profiles () are effective approaches to define clinical outcome, although yet to be improved. The discovery of a class of small non‐coding s (micro s, mis) has revealed a new level of biological complexity underlying the regulation of gene expression. In this work, 163 presenting samples from patients were analysed by global mi profiling, and distinct mi expression characteristics in molecular subgroups with prognostic relevance (4p16, and 11q13 translocations) were identified. Furthermore we developed an “outcome classifier”, based on the expression of two mis (17 and 886‐5p), which is able to stratify patients into three risk groups (median 19·4, 40·6 and 65·3 months, =0·001). The mi‐based classifier significantly improved the predictive power of the / approach (=0·0004), and was independent of ‐derived prognostic signatures (〈0·002). Through integrative genomics analysis, we outlined the potential biological relevance of the mis included in the classifier and their putative roles in regulating a large number of genes involved in biology. This is the first report showing that mis can be built into molecular diagnostic strategies for risk stratification in .
    Keywords: Myeloma ; Micro ; Risk Stratification ; Outcome Classifier ; Genomic Profiling
    ISSN: 0007-1048
    E-ISSN: 1365-2141
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  • 9
    Language: English
    In: 2012, Vol.7(9), p.e44948
    Description: International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors. ; To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables. ; We conducted a longitudinal study in a sample of international non-governmental organizations. Study outcomes included anxiety, depression, burnout, and life and job satisfaction. We performed bivariate regression analyses at three time points. We fitted generalized estimating equation multivariable regression models for the longitudinal analyses. ; Study participants from 19 NGOs were assessed at three time points: 212 participated at pre-deployment; 169 (80%) post-deployment; and 154 (73%) within 3–6 months after deployment. Prior to deployment, 12 (3.8%) participants reported anxiety symptoms, compared to 20 (11.8%) at post-deployment (p = 0·0027); 22 (10.4%) reported depression symptoms, compared to 33 (19.5%) at post-deployment (p = 0·0117) and 31 (20.1%) at follow-up (p = .00083). History of mental illness (adjusted odds ratio [AOR] 4.2; 95% confidence interval [CI] 1·45–12·50) contributed to an increased risk for anxiety. The experience of extraordinary stress was a contributor to increased risk for burnout depersonalization (AOR 1.5; 95% CI 1.17–1.83). Higher levels of chronic stress exposure during deployment were contributors to an increased risk for depression (AOR 1·1; 95% CI 1·02–1.20) comparing post- versus pre-deployment, and increased risk for burnout emotional exhaustion (AOR 1.1; 95% CI 1.04–1.19). Social support was associated with lower levels of depression (AOR 0·9; 95% CI 0·84–0·95), psychological distress (AOR = 0.9; [CI] 0.85–0.97), burnout lack of personal accomplishment (AOR 0·95; 95% CI 0·91–0·98), and greater life satisfaction (p = 0.0213). ; When recruiting and preparing aid workers for deployment, organizations should consider history of mental illness and take steps to decrease chronic stressors, and strengthen social support networks.
    Keywords: Research Article ; Medicine ; Social And Behavioral Sciences ; Public Health And Epidemiology ; Mental Health ; Non-clinical Medicine
    E-ISSN: 1932-6203
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  • 10
    In: The New England Journal of Medicine, 2006, Vol.355(14), pp.1419-1431
    Description: Background Ranibizumab — a recombinant, humanized, monoclonal antibody Fab that neutralizes all active forms of vascular endothelial growth factor A — has been evaluated for the treatment of neovascular age-related macular degeneration. Methods In this multicenter, 2-year, double-blind, sham-controlled study, we randomly assigned patients with age-related macular degeneration with either minimally classic or occult (with no classic lesions) choroidal neovascularization to receive 24 monthly intravitreal injections of ranibizumab (either 0.3 mg or 0.5 mg) or sham injections. The primary end point was the proportion of patients losing fewer than 15 letters from baseline visual acuity at 12 months. Results We enrolled 716 patients in the study. At 12 months, 94.5% of the group given 0.3 mg of ranibizumab and 94.6% of those given 0.5 mg lost fewer than 15 letters, as compared with 62.2% of patients receiving sham injections (P〈0.001 for both comparisons). Visual acuity improved by 15 or more letters in 24.8% of the 0.3-mg group and 33.8% of the 0.5-mg group, as compared with 5.0% of the sham-injection group (P〈0.001 for both doses). Mean increases in visual acuity were 6.5 letters in the 0.3-mg group and 7.2 letters in the 0.5-mg group, as compared with a decrease of 10.4 letters in the sham-injection group (P〈0.001 for both comparisons). The benefit in visual acuity was maintained at 24 months. During 24 months, presumed endophthalmitis was identified in five patients (1.0%) and serious uveitis in six patients (1.3%) given ranibizumab. Conclusions Intravitreal administration of ranibizumab for 2 years prevented vision loss and improved mean visual acuity, with low rates of serious adverse events, in patients with minimally classic or occult (with no classic lesions) choroidal neovascularization secondary to age-related macular degeneration. (ClinicalTrials.gov number, NCT00056836 .) Previous studies have suggested that targeting intravitreal vascular endothelial growth factor A (VEGF-A) counters choroidal neovascularization and hence age-related macular degeneration. A double-blind, placebo-controlled trial of ranibizumab, which neutralizes all isoforms of VEGF-A, for treatment of minimally classic and occult age-related macular degeneration retarded the progression of the disease and improved visual acuity in some patients. For the treatment of minimally classic and occult age-related macular degeneration, ranibizumab retarded the progression of the disease and improved visual acuity in some patients. Age-related macular degeneration is a leading cause of irreversible blindness among people who are 50 years of age or older in the developed world.1–3 The neovascular form of the disease usually causes severe vision loss and is characterized by the abnormal growth of new blood vessels under or within the macula, the central portion of the retina responsible for high-resolution vision. Neovascularization in this disease is classified by fluorescein angiography into major angiographic patterns termed classic and occult, which may be associated with various degrees of aggressiveness of disease, vision loss, and response to various treatment options.4 Pharmacologic therapies . . .
    Keywords: Medicine;
    ISSN: 0028-4793
    E-ISSN: 1533-4406
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