Six Years of Denosumab Treatment in Postmenopausal Women with Osteoporosis: Results From the First Three Years of the FREEDOM Extension

Background/Purpose: Denosumab (DMAb) is an approved therapy for the treatment of postmenopausal women with osteoporosis at increased risk for fracture. A favorable risk/benefit profile was demonstrated in the pivotal, 3-year FREEDOM trial (Cummings et al NEJM 2009). The open-label, active-treatment FREEDOM Extension study is investigating the efficacy and safety of DMAb for up to 10 years. The Extension trial enrolled women who had received DMAb or placebo in FREEDOM and provides an opportunity to evaluate the long-term efficacy and safety of continuous DMAb treatment (long-term group), and to replicate the DMAb findings observed in FREEDOM (cross-over group). Here, we report the results from the first 3 years of the Extension, representing up to 6 continuous years of DMAb exposure. Methods: During the Extension, each woman is scheduled to receive 60 mg DMAb every 6 months and supplemental calcium and vitamin D daily. For the analyses reported here, women from the FREEDOM DMAb group received 3 more years of DMAb for a total of 6 years of exposure (long-term group) and women from the FREEDOM placebo group received 3 years of DMAb exposure (cross-over group). Results: Of the 5928 women eligible for the Extension, 4550 (77%) enrolled (N_2343 long-term; N_2207 cross-over). In the long-term group, further significant mean increases in bone mineral density (BMD) occurred 4044 for cumulative 6-year gains of 15.2% at the lumbar spine and 7.5% at the total hip (Figure). During the first 3 years of DMAb treatment during the Extension, the cross-over group had significant mean gains in BMD at the lumbar spine (9.4%) and total hip (4.8%), similar to those observed in the long-term DMAb group during the first 3 years of FREEDOM (lumbar spine, 10.1%; total hip, 5.7%). Serum CTX was rapidly and similarly reduced after the 1st (cross-over) or 7th (long-term) DMAb dose with the characteristic attenuation observed at the end of the dosing period. In the cross-over group, yearly incidences of new vertebral and nonvertebral fractures were lower than in the FREEDOM placebo group. Fracture incidence remained low in the long-term group. Incidences of adverse events (AEs) and serious AEs did not increase over time with DMAb treatment. There were 2 subjects with AEs adjudicated to ONJ in the cross-over group and 2 in the long-term group. Both cases in the cross-over group healed completely and without further complications; 1 of these subjects continues to receive DMAb. Both women in the long-term group continue to be followed. No atypical femur fractures have been observed to date. Figure. Percent changes in bone mineral density during FREEDOM and the Extension Conclusion: DMAb treatment for 6 continuous years (long-term group) remained well tolerated, maintained reduced bone turnover, and continued to significantly increase BMD. Fracture incidence remained low. DMAb treatment for 3 years in the cross-over group reproduced the original observations in FREEDOM

Frequency and determinants of urgent requests to home care agencies for community-dwelling elderly.

We analyzed a one-year case series and performed a longitudinal (4 month) cohort analysis of urgent requests made to home care agencies by and for their > or = 65 years old clients in order to estimate the frequency of unscheduled services delivered by home care agencies and to identify risk factors. All 40 home care agencies located in a Swiss region were included in the study and we registered 3,816 urgent requests (75/1,000 > or = 65 years residents per year). Among home care users, the presence of a urinary catheter, incontinence and the need for assistance in bathing were predictors of unscheduled services. Resources should be planned in order to help home care teams to handle unexpected, disruptive clusters of urgent requests that may compromise their scheduled activities.

Iowa Veterans Home, FY 2007

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Iowa Veterans Home, FY 2008

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2008

Report on the Iowa Veterans Home and the Iowa Department of Veterans Affairs for the year ended June 30, 2008

Passive knee-extension test to measure hamstring tightness: influence of gravity correction

CONTEXT: A passive knee-extension test has been shown to be a reliable method of assessing hamstring tightness, but this method does not take into account the potential effect of gravity on the tested leg. OBJECTIVE: To compare an original passive knee-extension test with 2 adapted methods including gravity's effect on the lower leg. DESIGN: Repeated measures. SETTING: Laboratory. PARTICIPANTS: 20 young track and field athletes (16.6 ± 1.6 y, 177.6 ± 9.2 cm, 75.9 ± 24.8 kg). INTERVENTION: Each subject was tested in a randomized order with 3 different methods: In the original one (M1), passive knee angle was measured with a standard force of 68.7 N (7 kg) applied proximal to the lateral malleolus. The second (M2) and third (M3) methods took into account the relative lower-leg weight (measured respectively by handheld dynamometer and anthropometrical table) to individualize the force applied to assess passive knee angle. MAIN OUTCOME MEASURES: Passive knee angles measured with video-analysis software. RESULTS: No difference in mean individualized applied force was found between M2 and M3, so the authors assessed passive knee angle only with M2. The mean knee angle was different between M1 and M2 (68.8 ± 12.4 vs 73.1 ± 10.6, P < .001). Knee angles in M1 and M2 were correlated (r = .93, P < .001). CONCLUSIONS: Differences in knee angle were found between the original passive knee-extension test and a method with gravity correction. M2 is an improved version of the original method (M1) since it minimizes the effect of gravity. Therefore, we recommend using it rather than M1.

Thrusting, extension, and doming during the polyphase tectonometamorphic evolution of the High Himalayan Crystalline Zone in NW India

In the NW Himalaya of India, high-grade metamorphic rocks of the High Himalayan Crystalline Zone (HHCZ) are exposed as a 50 km large dome along the Miyar and Gianbul valleys. This Gianbul dome is cored by migmatitic paragneiss formed at peak conditions around 750 degreesC and 8 kbar, and symmetrically surrounded by sillimanite, kyanite +/- staurolite, garnet, biotite, and chlorite Barrovian mineral zones. Thermobarometric and structural investigations reveal that the Gianbul dome results from a polyphase tectono-metamorphic evolution. The first phase corresponds to the NE-directed thrusting of the Shikar Beh nappe, that is responsible for the Barrovian prograde metamorphic field gradient in the southern limb of the dome. In the northern limb of the dome, the Barrovian prograde metamorphism is the consequence of a second tectonic phase, associated with the SW-directed thrusting of the Nyimaling-Tsarap nappe. Following these crustal thickening events, exhumation and doming of the HHCZ high-grade rocks were controlled by extension along the north-dipping Zanskar Shear Zone, in the frontal part of the Nyimaling-Tsarap nappe, as well as by coeval to late extension along the south-dipping Khanjar Shear Zone, in the southern limb of the Gianbul dome. Rapid syn-convergence extension along both of these detachments induced a nearly isothermal decompression, resulting in a high-temperature/low-pressure metamorphic overprint, as well as enhanced partial melting. Such a rapid exhumation within a compressional orogenic context appears unlikely to be controlled solely by granitic diapirism. Alternatively, large-scale doming in the Himalaya could reflect a sub-vertical ductile extrusion of partially melted rocks.

Lengua familiar y conocimiento de la lengua escolar en Cataluña al finalizar la Educación Infantil = Home Language and Knowledge of the School Language in Catalonia at the end of Nursery School

La infancia extranjera se escolariza en Cataluña en un programa de cambio de lengua del hogar a la escuela. Las investigaciones afirman que este alumnado tarda un mínimo de seis años en equiparar sus habilidades lingüístico-cognitivas con sus pares autóctonos, no así las habilidades conversacionales, las cuales se adquieren antes de los dos años de residencia. Sin embargo, no existen estudios sobre los efectos de la escolarización en el parvulario del alumnado alófono, así como de su lengua familiar, en relación con la adquisición de la lengua escolar. El artículo es un estudio comparativo de la adquisición del catalán de 567 autóctonos y 434 alófonos, al final del parvulario, en 50 escuelas de Cataluña que escolarizan a alumnado de origen extranjero. Las lenguas del alumnado autóctono son el catalán, el castellano y el bilingüismo catalán-castellano y las lenguas del alumnado alófono son el árabe, el soninké y el castellano. Los factores utilizados más relevantes han sido el nivel socioprofesional y educativo de las familias, el tiempo de residencia y el momento de escolarización del alumnado, el porcentaje de alumnado catalanohablante y de alumnado alófono en el aula y el contexto sociolingüístico del centro escolar. Los resultados muestran que el alumnado autóctono sabe más catalán que el alumnado alófono, pero las diferencias desaparecen respecto a algunos factores, de los cuales los más relevantes son los relacionados con las características del alumnado de las aulas. La lengua familiar del alumnado alófono no incide en sus resultados

Consumer Advisory Bulletin; Prevent Home Repair Scams and Disputes, May 2010

The Attorney General’s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: Prevent Home Repair Scams and Disputes

Literature review on advance care planning of nursing home residents

Aim: Conduct a search and analytic review of literature regarding attributes of Advance Care Planning (ACP) and Advance Directive in order to identify the experiences and the best care strategies for older adults resident in nursing homes or long term institutions. Methodology: An extensive electronic search was undertaken in the following databases: Pubmed (via Ovid search), Cumulative Index of Nursing and Allied Health (CINAHL, via EBHOST), psychINFO and Cochrane. After analyzing and eliminating duplicates and professional's point of view (19), 144 titles were considered relevant: 28 opinion papers, 94 descriptive/qualitative studies or predictive studies, 17 experimental and five systematic reviews. Most of them were produced in North America and only 10 were in French. Results: With regard to European experiences, studies are scarce and further research could benefit from North American evidence. Contrary to Europe, nurses in North America play a major role in the process of care planning. The major findings were related to the poor efficacy of the completion of Advance Directives, even in presence of a substantial variety of implementation strategies. The evidence supports interventions that conceptualize ACP as a process, with an emphasis on the ascertainment of patients' values and beliefs and the necessity to include the family or loved ones from the beginning of the process in order to favor the expression and sharing of one's life perspectives and priorities in care. The most relevant findings were associated with the conceptualization of the ACP as a change in health behaviors which needs an involvement in different stages to overcome a variety of barriers. Conclusion: Rigorous research in ACP for the older adults in Swiss nursing homes that promote respect and dignity in this frail population is needed. How to best achieve patients and families goals should be the focus of nursing intervention and research in this domain.

Report on the Juvenile Detention Home Fund administered by the Department of Human Services for the period July 1, 2007 through November 10, 2009

Report on the Juvenile Detention Home Fund administered by the Department of Human Services for the period July 1, 2007 through November 10, 2009