Association of ECG abnormalities and incident heart failure events

Background: With the aging of the population, the heart failure (HF) incidence and prevalence trends are expected to significantly worsen unless concentrated prevention efforts are undertaken. ECG abnormalities are common in the elderly but data are limited for their association with HF risk. Objective: To assess whether baseline ECG abnormalities or dynamic changes are associated with an increased risk of HF. Method: A prospective cohort study of 2915 participants aged 70 to 79 years without a preexisting HF followed for a median period of 11.4 (IQR 7.0-11.7) years from the Health Aging and Body Composition study. The Minnesota Code was used to define major and minor ECG abnormalities at baseline and at 4-year. Main outcome measure was adjudicated incident HF events. Using Cox models, the (1) the association between ECG abnormalities and incident HF and (2) incremental value of adding ECG to the Health ABC HF Risk Score, was assessed. Results: At baseline, 380 participants (13.0%) had minor and 620 (21.3%) had major ECG abnormalities. During follow-up, 485 (16.6%) participants developed incident HF. After adjusting for the eight clinical variables in the Health ABC HF Risk Score, the hazard ratio (HR) was 1.27 (95% confidence interval [CI] 0.96-1.68) for minor and 1.99 (CI 1.61-2.44) for major ECG abnormalities (P for trend <0.001) compared to no ECG abnormalities. The association did not change according to presence of baseline CHD. At 4-year, 263 participants developed new and 549 had persistent abnormalities and both were associated with increased HF risk (HR = 1.94, CI 1.38-2.72 for new and HR=2.35, CI 1.82-3.02 for persistent compared to no ECG abnormalities). Baseline ECG correctly reclassified 10.6% of overall participants across the categories of the Health ABC HF Risk Score. Conclusion: Among older adults, baseline ECG abnormalities and changes in them over time are common; both are associated with an increased risk of HF. Whether ECG should be incorporated in routine screening of older adults should be evaluated in randomized controlled trials.

Serum resistin concentrations and risk of new onset heart failure in older persons: the health, aging, and body composition (Health ABC) study.

OBJECTIVE: Resistin is associated with inflammation and insulin resistance and exerts direct effects on myocardial cells including hypertrophy and altered contraction. We investigated the association of serum resistin concentrations with risk for incident heart failure (HF) in humans. METHODS AND RESULTS: We studied 2902 older persons without prevalent HF (age, 73.6+/-2.9 years; 48.1% men; 58.8% white) enrolled in the Health, Aging, and Body Composition (Health ABC) Study. Correlation between baseline serum resistin concentrations (20.3+/-10.0 ng/mL) and clinical variables, biochemistry panel, markers of inflammation and insulin resistance, adipocytokines, and measures of adiposity was weak (all rho <0.25). During a median follow-up of 9.4 years, 341 participants (11.8%) developed HF. Resistin was strongly associated with risk for incident HF in Cox proportional hazards models controlling for clinical variables, biomarkers, and measures of adiposity (HR, 1.15 per 10.0 ng/mL in adjusted model; 95% CI, 1.05 to 1.27; P=0.003). Results were comparable across sex, race, diabetes mellitus, and prevalent and incident coronary heart disease subgroups. In participants with available left ventricular ejection fraction at HF diagnosis (265 of 341; 77.7%), association of resistin with HF risk was comparable for cases with reduced versus preserved ejection fraction. CONCLUSIONS: Serum resistin concentrations are independently associated with risk for incident HF in older persons.

Thin Maintenance Surfaces - Phase I, TR-435, 1999

The first phase of a two-phase research project was conducted to develop guidelines for Iowa transportation officials on the use of thin maintenance surfaces (TMS) for asphaltic concrete and bituminous roads. Thin maintenance surfaces are seal coats (chip seals), slurry seals, and micro-surfacing. Interim guidelines were developed to provide guidance on which roads are good candidates for TMS, when TMS should be placed, and what type of thin maintenance surface should be selected. The guidelines were developed specifically for Iowa aggregates, weather, traffic conditions, road user expectations, and transportation official expectations. In addition to interim guidelines, this report presents recommendations for phase-two research. It is recommended that test section monitoring continue and that further investigations be conducted regarding thin maintenance surface aggregate, additional test sections, placed, and a design method adopted for seal coats.

Thin Maintenance Surfaces - Phase II, TR-435, 2003

In recent years there has been renewed interest in using preventive maintenance techniques to extend pavement life and to ensure low life cycle costs for our road infrastructure network. Thin maintenance surfaces can be an important part of a preventive maintenance program for asphalt cement concrete roads. The Iowa Highway Research Board has sponsored Phase Two of this research project to demonstrate the use of thin maintenance surfaces in Iowa and to develop guidelines for thin maintenance surface uses that are specific to Iowa. This report documents the results of test section construction and monitoring started in Phase One and continued in Phase Two. The report provides a recommended seal coat design process based on the McLeod method and guidance on seal coat aggregates and binders. An update on the use of local aggregates for micro-surfacing in Iowa is included. Winter maintenance guidelines for thin maintenance surfaces are reported herein. Finally, Phase One's interim, qualitative thin maintenance surface guidelines are supplemented with Phase two's revised, quantitative guidelines. When thin maintenance surfaces are properly selected and applied, they can improve the pavement surface condition index and the skid resistance of pavements. For success to occur, several requirements must be met, including proper material selection, design, application rate, workmanship, and material compatibility, as well as favorable weather during application and curing. Specific guidance and recommendations for many types of thin maintenance surfaces and conditions are included in the report.

Sprinkle Treatment of Asphalt Surfaces, HR-199, 1984

Methods of improving highway safety are of major concern to everyone who is involved in the planning, development and construction of improvements of our vast highway network. Other major concerns are the conservation of our rapidly disappearing sources of energy and quality building materials. This research is devoted to further exploration of a process which will: 1. help preserve higher quality aggregates; and, 2. improve the frictional characteristics and surface texture of asphalt pavement surfaces. Sprinkle treatment of asphalt concrete pavement surfaces with a non-polishing aggregate, a procedure which was developed in Europe, is one method which has shown promise in accomplishing the above listed objectives. This research seeks to explore the feasibility and cost effectiveness of using standard asphalt mixtures of local, less expensive aggregates for surface courses followed by a surface sprinkle treatment of a hard, durable, non-polishing layer of precoated chips to produce a durable, non-skid pavement surface for safe highway travel. Three standard mixture types are being evaluated for aggregate retention characteristics and six sprinkle aggregates are being evaluated for durability, polishing and friction characteristics. In addition, measurements of the surface texture by the silicone putty method are being made. Another feature of this research is the evaluation of a rubberized asphalt material called Overflex MS as a crack filler. It has been reported that the material could be beneficial in reducing reflective cracking. The project was begun in July of 1978 and was completed in August. A review made in the spring of 1979 indicates very satisfactory performance. It was determined from slide photos taken after construction and again in the spring that aggregate retention was very good. However, many cracks had reflected indicating that the Overflex MS had not been effective. Follow up friction test results and texture analysis were also very good. The results of these tests are shown in Appendix A.

Improved Asphalt Surfaces and Asphalt Resurfacing Performance through Crack Maintenance, HR-213, 1987

In 1980, a Vanguard High Pressure Water Blaster capable of providing 10 gallons of water per minute at 2000 psi was purchased to evaluate water blasting as a crack cleaning method prior to crack filling on asphalt concrete pavements. Afer some iniital trials demonstrated its effectiveness of removing dirt, debris and vegetation, it was included in joint and crack maintenance research on Iowa 7 in Webster County. The objective of the research was to evaluate six crack preparation methods and seven "sealant" materials. The cleaning and sealing was performed in the spring of 1983. Visual evaluations of the performance were made in the fall of 1983 and spring of 1985. Compressed air and/or high pressure water did not adequately prepare cracks less than 3/8 inch wide. Routing or sawing was necessary to provide a sealant reservoir. The water blaster was more effective than compressed air in removing dirt, debris and vegetation but this did not yield significant improvement in sealant adhesion or longevity. Periodic crack filling is necessary on ACC surfaces throughout the remaining life of the pavement.

Importance of polyethylene thickness in total shoulder arthroplasty: a finite element analysis.

BACKGROUND: Articular surfaces reconstruction is essential in total shoulder arthroplasty. Because of the limited glenoid bone support, thin glenoid component could improve anatomical reconstruction, but adverse mechanical effects might appear. METHODS: With a numerical musculoskeletal shoulder model, we analysed and compared three values of thickness of a typical all-polyethylene glenoid component: 2, 4 (reference) and 6mm. A loaded movement of abduction in the scapular plane was simulated. We evaluated the humeral head translation, the muscle moment arms, the joint force, the articular contact pattern, and the polyethylene and cement stress. Findings Decreasing polyethylene thickness from 6 to 2mm slightly increased humeral head translation and muscle moment arms. This induced a small decreased of the joint reaction force, but important increase of stress within the polyethylene and the cement mantel. Interpretation The reference thickness of 4mm seems a good compromise to avoid stress concentration and joint stuffing.

Patterns of Adherence to Raltegravir-Based Regimens and the Risk of Virological Failure Among HIV-Infected Patients: The RALTECAPS Cohort Study.

ABSTRACT:: Adherence patterns and their influence on virologic outcome are well characterized for protease inhibitor (PI)- and non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. We aimed to determine how patterns of adherence to raltegravir influence the risk of virological failure. We conducted a prospective multicenter cohort following 81 HIV-infected antiretroviral-naive or experienced subjects receiving or starting twice-a-day raltegravir-based antiretroviral therapy. Their adherence patterns were monitored using the Medication Events Monitoring System. During follow-up (188 days, ±77), 12 (15%) of 81 subjects experienced virological failure. Longer treatment interruption [adjusted odds ratio per 24-hour increase: 2.4; 95% confidence interval: 1.2 to 6.9; P < 0.02] and average adherence (odds ratio per 5% increase: 0.68; 95% confidence interval: 0.46 to 1.00, P < 0.05) were both independently associated with virological failure controlling for prior duration of viral suppression. Timely interdose intervals and high levels of adherence to raltegravir are both necessary to control HIV replication.

Bond strength of orthodontic brackets using different light and self-curing cements

The purpose of the study was to evaluate the shear bond strength of stainless steel orthodontic brackets directly bonded to extracted human premolar teeth. Fifty teeth were randomly divided into ¿ve groups: (1) System One (chemically cured composite resin), (2) Light Bond (light-cured composite resin), (3) Vivaglass Cem (self-curing glass ionomer cement), (4) Fuji Ortho LC (light-cured glass ionomer cement) used after 37% orthophosphoric acid¿etching of enamel (5) Fuji Ortho LC without orthophosphoric acid¿etching. The brackets were placed on the buccal and lingual surfaces of each tooth, and the specimens were stored in distilled water (24 hours) at 378C and thermocycled. Teeth were mounted on acrylic block frames, and brackets were debonded using an Instron machine. Shear bond strength values at fracture (Nw)were recorded. ANOVA and Student-Newman-Keuls multiple comparison tests were performed (P , .05). Bonding failure site was recorded by stereomicroscope and analyzed by Chi-square test, selected specimens of each group were observed by scanning electron microscope. System One attained the highest bond strength. Light Bond and Fuji Ortho LC, when using an acid-etching technique, obtained bond strengths that were within the range of estimated bond strength values for successful clinical bonding. Fuji Ortho LC and Vivaglass Cem left an almost clean enamel surface after debracketing.

Determinants of methicillin-susceptible Staphylococcus aureus native bone and joint infection treatment failure: a retrospective cohort study.

BACKGROUND: Although methicillin-susceptible Staphylococcus aureus (MSSA) native bone and joint infection (BJI) constitutes the more frequent clinical entity of BJI, prognostic studies mostly focused on methicillin-resistant S. aureus prosthetic joint infection. We aimed to assess the determinants of native MSSA BJI outcomes. METHODS: Retrospective cohort study (2001-2011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment failure determinants were assessed using Kaplan-Meier curves and binary logistic regression. RESULTS: Sixty-six patients (42 males [63.6%]; median age 61.2 years; interquartile range [IQR] 45.9-71.9) presented an acute (n = 38; 57.6%) or chronic (n = 28; 42.4%) native MSSA arthritis (n = 15; 22.7%), osteomyelitis (n = 19; 28.8%) or spondylodiscitis (n = 32; 48.5%), considered as "difficult-to-treat" in 61 cases (92.4%). All received a prolonged (27.1 weeks; IQR, 16.9-36.1) combined antimicrobial therapy, after surgical management in 37 cases (56.1%). Sixteen treatment failures (24.2%) were observed during a median follow-up period of 63.3 weeks (IQR, 44.7-103.1), including 13 persisting infections, 1 relapse after treatment disruption, and 2 super-infections. Independent determinants of treatment failure were the existence of a sinus tract (odds ratio [OR], 5.300; 95% confidence interval [CI], 1.166-24.103) and a prolonged delay to infectious disease specialist referral (OR, 1.134; 95% CI 1.013-1.271). CONCLUSIONS: The important treatment failure rate pinpointed the difficulty of cure encountered in complicated native MSSA BJI. An early infectious disease specialist referral is essential, especially in debilitated patients or in presence of sinus tract.

Characteristics of Chemical Treated Roadway Surfaces, HR-33, 1963

Iowa Highway Commission Project HR-33, "Characteristics of Chemically Treated Roadway Surfaces", was investigated at the Iowa Engineering Experiment Station under Project 375-S. The purpose of the project as originally proposed was to study the physical and chemical characteristics of chemically treated roadway surfaces. All chemical treatments were to be included, but only sodium chloride and calcium chloride treated roadways were investigated. The uses of other types of chemical treatment were not discovered until recently, notably spent sulfite liquor and a commercial additive. Costs of stabilized secondary roads in Hamilton County averaged $4300.00 per mile even though remanent soil-aggregate material was used. The cost of similar roads in Franklin County was $4400.00 per mile. The Franklin County road surfaces were constructed entirely from materials that were hauled to the road site. Costs in Butler County were a little over $3000.00 per mile some eight years ago. Chemical investigations indicate that calcium chloride and sodium chloride are lost through leaching. Approximately 95 percent of the sodium chloride appears to have been lost, and nearly 65 percent of the calcium chloride has disappeared. The latter value may be much in error since surface dressings of calcium chloride are commonly used and have not been taken into account. Clay contents of the soil-aggregate-chemical stabilized roads range from about 6 to ll percent, averaging 8 or 9 percent. The thicknesses of stabilized mats are usually 2 to 4 inches, with in-place densities ranging from 130 to 145 pcf. Generally the densities found in sodium chloride stabilized roads were slightly higher than those found in the calcium chloride stabilized roads.

Relapsing acute respiratory failure induced by minocycline.

The antibiotic minocycline, which is used in the treatment of acne, has been associated with various pulmonary complications such as pulmonary lupus and hypersensitivity pneumonitis. We now report a particularly severe case of minocycline-related pulmonary toxicity that was characterized by a relapsing form of hypersensitivity eosinophilic pneumonia complicated by acute respiratory failure.

Learning from failure - rationale and design for a study about discontinuation of randomized trials (DISCO study).

BACKGROUND: Randomized controlled trials (RCTs) may be discontinued because of apparent harm, benefit, or futility. Other RCTs are discontinued early because of insufficient recruitment. Trial discontinuation has ethical implications, because participants consent on the premise of contributing to new medical knowledge, Research Ethics Committees (RECs) spend considerable effort reviewing study protocols, and limited resources for conducting research are wasted. Currently, little is known regarding the frequency and characteristics of discontinued RCTs. METHODS/DESIGN: Our aims are, first, to determine the prevalence of RCT discontinuation for specific reasons; second, to determine whether the risk of RCT discontinuation for specific reasons differs between investigator- and industry-initiated RCTs; third, to identify risk factors for RCT discontinuation due to insufficient recruitment; fourth, to determine at what stage RCTs are discontinued; and fifth, to examine the publication history of discontinued RCTs.We are currently assembling a multicenter cohort of RCTs based on protocols approved between 2000 and 2002/3 by 6 RECs in Switzerland, Germany, and Canada. We are extracting data on RCT characteristics and planned recruitment for all included protocols. Completion and publication status is determined using information from correspondence between investigators and RECs, publications identified through literature searches, or by contacting the investigators. We will use multivariable regression models to identify risk factors for trial discontinuation due to insufficient recruitment. We aim to include over 1000 RCTs of which an anticipated 150 will have been discontinued due to insufficient recruitment. DISCUSSION: Our study will provide insights into the prevalence and characteristics of RCTs that were discontinued. Effective recruitment strategies and the anticipation of problems are key issues in the planning and evaluation of trials by investigators, Clinical Trial Units, RECs and funding agencies. Identification and modification of barriers to successful study completion at an early stage could help to reduce the risk of trial discontinuation, save limited resources, and enable RCTs to better meet their ethical requirements.