Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials

OBJECTIVES: The purpose of this research was to determine the relative safety and efficacy of multiple (> or =2) overlapping Cypher sirolimus-eluting stents (SES) (Johnson ; Johnson, New Brunswick, New Jersey). BACKGROUND: Overlapping coronary stents are common. The periprocedural and late clinical and angiographic consequences of overlapped coronary stents are not clearly defined, particularly for drug-eluting stents. METHODS: All patients enrolled into five clinical trials of the SES were analyzed. Three of these trials were prospective randomized comparisons of the SES to the bare-metal stent (BMS), and two were prospective non-randomized trials of SES-treated patients with historical controls. All clinical and angiographic outcomes in overlap-stent-treated patients were compared by stent type and with single-stent-treated patients for the same stent device. RESULTS: In all, 575 patients with stent overlap (337 SES, 238 BMS) and 1,162 patients with single stents (697 SES, 465 BMS) were analyzed. Stent overlap was associated with a greater late lumen loss in stent and more frequent angiographic restenosis regardless of stent type. Among overlap-stent-treated patients, the SES provided similar magnitude of restenosis benefit as observed for single-stent-treated patients. Overlapped SES was not associated with an increase in myocardial infarction. CONCLUSIONS: The strategy of SES overlap, when required, is both safe and efficacious in reducing restenosis with no increase in the incidence of myocardial infarction or major adverse cardiovascular events, when compared with a bare metal coronary stent prosthesis.

The Other Side of the Doors: Butte & Beyond -- Congressman Pat Williams “In the Crucible of Change”

Pat Williams emerged from the Mining City of Butte, Montana with a sense of grassroots, people-oriented politics. His inherent belief in the power of ordinary citizens carried him through the Montana Legislature and into Congress for a record-setting period. The accomplishments of his long career partially obscured his innate progressive and populist instinct that is reflective of the period of “in the Crucible of Change.” This film addresses Pat’s early years when his progressive instincts and activities resulted in pushback from the giant Anaconda Company which had held Montana hostage for 75 years. Pat is joined for part of the film by former campaign staffer, and now prominent media consultant, Michael Fenenbock for reflections on Pat’s 1978 “Door-to-Door to Congress” campaign, which demonstrated the power of his belief in the people on the other side of the doors. Pat Williams (b. 1937) rose from teaching grade school in his hometown of Butte, MT, to serving for the longest number of consecutive terms (9 terms, 18 years) in the US House of Representatives of anyone in Montana history. Pat was a member of the National Guard and attended UM in Missoula and William Jewel College, graduating from the University of Denver. Pat also served in the Montana legislature for 2 terms (1966 & 1968 elections). In 1969. Pat helped his legislative seat-mate John Melcher get elected as Montana’s Eastern District Congressman in the Special Election that June. Pat went to Washington DC as Melcher’s Executive Assistant. Upon returning to Montana, Pat headed up the Montana offices of the innovative Mountain Plains Family Education Program. In 1974, Pat ran unsuccessfully for Montana’s Western District Congressional seat in a three-way race with former Congressman Arnold Olsen and state Legislator Max Baucus. After the drafting and passage of the 1972 Montana Constitution, Pat was named a member of Montana’s first-ever Reapportionment Commission. In 1978 he successfully ran for Congress, conducting a massive grass-roots door-to-door campaign of 1½ years, reaching 50,000 doors. In a hotly contested 6-way Democratic primary, Pat won going away and also handily won the general election. Pat served in Congress from January, 1979 until January of 1997, 14 years representing the Western District and 4 years representing the entire state. Upon his retirement from Congress, in 1997 Williams returned to Montana where has been an instructor at the University of Montana and Senior Fellow and Regional Policy Associate at the Center for the Rocky Mountain West. He is a former member of the Montana Board of Regents and serves on a number of national education-related boards. In Congress Pat was a Deputy Whip of the U.S. House of Representatives and sat on committees on: Budget, Natural Resources, Education and Labor, and Agriculture. Pat’s leadership helped pass trailblazing legislation to assist hard-working middle-class families and ensure opportunities for every child. Pat’s fingerprints are on many pieces of important legislation, including the College Middle Income Assistance Act, the Family and Medical Leave Act, the Toddlers and Childhood Disability Act, the Library Services and Construction Act, and the Museum Services Act. Pat successfully sponsored the Lee Metcalf Wilderness Area and the Rattlesnake Wilderness area, helped save the Bob Marshall Wilderness from oil and gas exploration, and helped ban geothermal energy drilling near the borders of Yellowstone National Park. As Chairman of The Post-Secondary Education Committee, he protected the National Endowment for the Arts from elimination, a remarkable undertaking during a very trying time for the Agency. Pat worked tirelessly with Tribal College Leaders to build Montana’s seven Tribal Colleges. He was also responsible for the legislation that created The American Conservation Corps, which became the Corporation for National Service, giving thousands of America’s young people a chance to serve their country and pursue higher education. Pat lives in Missoula with his wife Carol Griffith Williams, former Montana Senate Majority Leader. They have three children and five grandchildren.

Inequality in Income and Wealth in Switzerland from 1970 to 2010

The supposed rise of inequality in income and wealth is a much-discussed issue. Since in a number of industrialized countries a trend towards more inequality was observed over the last decades, it is often assumed that Switzerland has experienced a similar development. Yet, although a variety of studies exists that provide inequality estimates for the Swiss society at different points in time, no conclusive picture of the changes in inequality can be drawn from these studies. For example, recent estimates by the Swiss Federal Statistical Office indicate that – against expectations – inequality in disposable equivalent-incomes has not risen since the end of the 1990ies, whereas other studies indicate that earnings from employment – especially top salaries – have become more unequal. The reasons for the inconclusive picture are manifold. For example, trends might have been different for different income types and results might strongly depend on the quality of the used data. To close the knowledge gap in inequality research in Switzerland a new Swiss National Science Foundation project by the University of Bern and the Bern University of Applied Sciences has been started in 2013. Individual tax data from cantons will be analyzed along with aggregate data from the Swiss Federal Tax Administration, covering a period from the early 1970ies to the present. The goal is to gain a systematic overview of the development of inequality in income and wealth in Switzerland as a whole and within cantons, and to determine how changes can be explained. In our talk we will present first results from this project.

Factors determining the use of universal precautions by emergency department nurses

The Health Belief Model (HBM) provided the theoretical framework for examining Universal Precautions (UP) compliance factors by Emergency Department nurses. A random sample of Emergency Nurses Association (ENA) clinical nurses (n = 900) from five states (New York, New Jersey, California, Texas, and Florida), were surveyed to explore the factors related to their decision to comply with UP. Five-hundred-ninety-eight (598) useable questionnaires were analyzed. The responders were primarily female (84.9%), hospital based (94.6%), staff nurses (66.6%) who had a mean 8.5 years of emergency nursing experience. The nurses represented all levels of hospitals from rural (4.5%) to urban trauma centers (23.7%). The mean UP training hours was 3.0 (range 0-38 hours). Linear regression was used to analyze the four hypotheses. The first hypothesis evaluating perceived susceptibility and seriousness with reported UP use was not significant (p = $>$.05). Hypothesis 2 tested perceived benefits with internal and external barriers. Both perceived benefits and internal barriers as well as the overall regression were significant (F = 26.03, p = $<$0.001). Hypothesis 3 which tested modifying factors, cues to action, select demographic variables, and the main effects of the HBM with self reported UP compliance, was also significant (F = 12.39, p = $<$0.001). The additive effects were tested by use of a stepwise regression that assessed the contribution of each of the significant variables. The regression was significant (F = 12.39, p = $<$0.001) and explained 18% of the total variance. In descending order of contribution, the significant variables related to compliance were: internal barriers (t = $-$6.267; p = $<$0.001) such as the perception that because of the nature of the emergency care environment there is sometimes inadequate time to put on UP; cues to action (t = 3.195; p = 0.001) such as posted reminder signs or verbal reminders from peers; the number of Universal Precautions training hours (t = 3.667; p = $<$0.001) meaning that as the number of training hours increase so does compliance; perceived benefits (t = 3.466; p = 0.001) such as believing that UP will provide adequate barrier protection; and perceived susceptibility (t = 2.880; p = 0.004) such as feeling that they are at risk of exposure. ^

The origin of oriented lakes: evidence from the Bolivian Amazon

The presence of hundreds of rectangular and oriented lakes is one of the most striking characteristics of the Llanos de Moxos (LM) landscape in the Bolivian Amazon. Oriented lakes also occur in the Arctic coastal plains of Russia, Alaska and Canada and along the Atlantic Coastal Plain from northeast Florida to southeast New Jersey and along the coast of northeast Brazil. Many different mechanisms have been proposed for their formation. In the LM, Plafker's (1964) tectonic model, in which subsidence results from the propagation of bedrock faults through the foreland sediments, is the most accepted. However, this model has not been verified. Here, we present new results from stratigraphic transects across the borders of three rectangular and oriented lakes in the LM. A paleosol buried under mid-Holocene sediments is used as a stratigraphic marker to assess the vertical displacement of sediments on both sides of the alleged faults. Our results show that there is no vertical displacement and, therefore, that Plafker's model can be ruled out. We suggest that, among all the proposed mechanisms behind lake formation, the combined action of wind and waves is the most likely. The evidence from the LM provides new hints for the formation of oriented lakes worldwide.

Na 1 Nachlass Max Horkheimer, 7 - Korrespondenzen u.a. mit Familie Cahn (p. I 4, 1-297a)

1 Brief von Max Horkheimer an die Cadillac Motor Division, 05.06.1939; 148 Briefe zwischen Erwin Cahn, Lotte Cahn, Ilse Cahn, Max Cahn, Lilo Cahn, Lina Cahn und Max Horkheimer, 1938-1942; 10 Briefe zwischen dem Transmigration Bureau og the American Jewish Joint Distribution Committee und Friedrich Pollock, 1941-1942; 3 Briefe zwischen dem National Refugee Service und Max Horkheimer, 07.04.1941, 1941; 1 Brief von Julius S. Bach an die National City Bank of New York, 27.06.1940; 1 Brief von Julius S. Bach an den American Consul General Berlin, 15.04.1940; 1 Brief von Max Horkheimer an Julius S. Bach, 15.05.1940; 16 Briefe von Max Horkheimer an den American Consul General Stuttgart, 1938-1941; 2 Briefe zwischen der Auswandererstelle Marx und Max Horkheimer, 02.06.1941; 5 Briefe zwischen dem Reisebüro Anselm Stuttgart und Max Horkheimer, 1941; 9 Briefe zwischen der Sapt A.G und Max Horkheimer, 1940-1941; 3 Briefe zwischen Emanuel Green und Max Horkheimer, 26.09.1940, 1940; 3 Briefe zwischen der Zweigstelle Wüttemberg der Reichsvereinigung der Juden in Deutschland und Max Horkheimer, 1940, 19.09.1940; 2 Briefe zwischen der Auswandererstelle Adler und Max Horkheimer, 25.05.1940; 2 Briefe von Max Horkheimer an den American Consul General Berlin, 1939; 1 Brief von Max Horkheimer an S. Klein, 20.03.1939; 1 Brief von Max Horkheimer an den Collector of Customs, 27.02.1939; 1 Brief von Max Horkheimer an Ludwig Lewisohn,. 03.01.1939; 1 Brief von Friedlaender an Kahn, 15.12.1938; 1 Brief von Erwin Cahn an Max Horkheimer, 07.02.1935;

Na 1 Nachlass Max Horkheimer, 38 - Korrespondenzen u.a. mit Arthur E. Nadel (p. I 19, 1-102)

40 Briefe zwischen Arthur E. Nadel und Max Horkheimer, 1934-1939; 1 Brief von Arthur E. Nadel an Armin Hodler, 02.02.1939; 18 Briefe zwischen Otto Nathan und Max Horkheimer, 1934-1940; 1 Brief von Friedrich Pollock an Paul Tillich, 12.11.1938; 5 Briefe zwischen dem National Council of Jewish Women New York Section und Max Horkheimer, 1937-1939; 1 Brief vom National Council of Parent Education Poughkeepsie, New York an Max Horkheimer, 17.06.1940; 1 Brief vom National Research Council Washington an Max Horkheimer, 15.02.1941; 2 Briefe zwischen dem National Roster of Scientific and Specialized Personnel Washington und Max Horkheimer, 1940; 2 Briefe zwischen Lisel Nädele und Max Horkheimer, 11.12.1939, 22.01.1940; 1 Brief von Benjamin Nathaniel Nelson an Max Horkheimer, 20.04.1938 sowie Briefwechsel mit der C.R.B. Educational Foundation, New York; 2 Briefe zwischen der C.R.B. Educational Foundation, New York und Max Horkheimer, 16.12.1937; 1 Brief von Max Horkheimer an Neumann, 08.07.1934; 3 Briefe und Beilage zwischen Fritz Neumark, Jenny Neumark und Max Horkheimer, 08.08.1939 sowie Briefwechsel mit Otto Strauß; 2 Briefe zwischen Otto Strauß vom Selfhelp for German Emigree New York und Max Horkheimer, 01.08.1939, 04.08.1939;

Na 1 Nachlass Max Horkheimer, 44 - Korrespondenzen u.a. mit Marthe Roth (p. I 21, 313-463)

2 Briefe und 1 Lebenslauf von Max Horkheimer an Arthur Rosenberg, 1939, 1941; 2 Briefe zwischen Kurt Rosenfeld und Karl Brandt, 22.04.1937, 27.04.1937; 5 Briefe von Kurt Rosenfeld an Max Horkheimer, 1937-19378; 4 Brief und Beilage an Kurt Rosenfeld, 1937-1943; 11 Briefe zwischen Hans W. Rosenhaupt und Max Horkheimer, 1935, 1941, 1942, 1947; 4 Briefe zwischen Samuel I. Roseman und Max Horkheimer, 1939, 03.01.1940; 2 Briefe zwischen J. Rosenstock und Max Horkheimer, 15.07.1946; 2 Briefe zwischen Joseph Adolphe Rosenthal und Max Horkheimer, 09.04.1941, 08.05.1941, sowie Briefwechsel mit Sophie Ries; 2 Briefe zwischen Sophie Ries und Max Horkheimer, 08.05.1941, 11.05.1941; 1 Brief von Max Horkheimer an Lore Woedthke, 08.05.1941; 2 Briefe zwischen Morris Rosenthal und Max Horkheimer, 01.10.1935, 04.10.1935; 1 Brief von Max Horkheimer an das Rosenwald Capital Outlay Fund New York, 30.01.1940; 1 Brief B. Lifschitz an Marthe Roth, 21.04.1937; 1 Brief von Chamorel et Simond an Marthe Roth, 11.06.1937; 1 Brief von F.K. Sung an Marthe Roth, 24.06.1937; 12 Briefe zwischen Marthe Roth und Max Horkheimer, Juli 1937-1938, sowie Briefwechsel mit Louis Vogt; 4 Briefe zwischen Louis Vogt und Max Horkheimer, 10.08.1937, 1937; 1 Brief von Max Horkheimer an Dr. Rothen, 31.01.1935; 1 Umzugsmitteilung von Hans Rothmann; 2 Briefe zwischen Richard C. Rothschild und Max Horkheimer, 11.05.1940, 13.05.1940; 4 Briefe zwischen Ludwig Rothschild, Hilde Rothschild und Max Horkheimer, 1936-15.09.1939; 2 Briefe zwischen S. Rothschildt und Max Horkheimer, 23.11.1940, 29.11.1940; 4 Brief zwischen J. S. Roucek und Max Horkheimer, 1941; 1 Brief von Joseph Rovan an Max Horkheimer, 11.05.1948; 2 Brief zwischen Wilmina Rowland und Max Horkheimer, 13.03.1949, 11.04.1949; 2 Briefe zwischen dem Royal Automobile Club und Max Horkheimer, 26.08.1937, 22.09.1937; 2 Briefe zwischen Royal Motors Inc. und Max Horkheimer, 05.02.1940, 06.03.1940; 1 Beitrag von Nina Rubinstein zur Soziologie des Fremden; 1 Brief von Theodor W. Adorno an Rudd, 09.09.1940; 1 Brief von Jay Rumney an Goldstein, 18.06.1936; 20 Briefe und Beilage zwischen Jay Rumney und Max Horkheimer, 1934- 1937, 1949 sowie Briefwechsel mit D. Mitrany; 3 Briefe zwischen D. Mitrany und Max Horkheimer, 01.12.1937, 1937; 3 Briefe von Theodor W. Adorno an Dagobert D. Runes, 1941; 1 Brief und 1 Beilage von N. Waterman an Georg Rusche, 03.05.1939; 12 Briefe und Beilage zwischen Georg Rusche und Max Horkheimer, 1939-1942 sowie Briefwechsel mit N. Waterman; 1 Brief von N. Waterman an Georg Rusche, 03.04.1939; 2 Briefe zwischen N. Waterman und Max Horkheimer, 21.04.1939, 05.05.1939; 1 Brief von Ruth an Max Horkheimer;

Automated soldier medical readiness: Prevalence of " medically not ready" using data from the electronic soldier readiness processing system (ESRP)

Identifying accurate numbers of soldiers determined to be medically not ready after completing soldier readiness processing may help inform Army leadership about ongoing pressures on the military involved in long conflict with regular deployment. In Army soldiers screened using the SRP checklist for deployment, what is the prevalence of soldiers determined to be medically not ready? Study group. 15,289 soldiers screened at all 25 Army deployment platform sites with the eSRP checklist over a 4-month period (June 20, 2009 to October 20, 2009). The data included for analysis included age, rank, component, gender and final deployment medical readiness status from MEDPROS database. Methods.^ This information was compiled and univariate analysis using chi-square was conducted for each of the key variables by medical readiness status. Results. Descriptive epidemiology Of the total sample 1548 (9.7%) were female and 14319 (90.2%) were male. Enlisted soldiers made up 13,543 (88.6%) of the sample and officers 1,746 (11.4%). In the sample, 1533 (10.0%) were soldiers over the age of 40 and 13756 (90.0%) were age 18-40. Reserve, National Guard and Active Duty made up 1,931 (12.6%), 2,942 (19.2%) and 10,416 (68.1%) respectively. Univariate analysis. Overall 1226 (8.0%) of the soldiers screened were determined to be medically not ready for deployment. Biggest predictive factor was female gender OR (2.8; 2.57-3.28) p<0.001. Followed by enlisted rank OR (2.01; 1.60-2.53) p<0.001. Reserve component OR (1.33; 1.16-1.53) p<0.001 and Guard OR (0.37; 0.30-0.46) p<0.001. For age > 40 demonstrated OR (1.2; 1.09-1.50) p<0.003. Overall the results underscore there may be key demographic groups relating to medical readiness that can be targeted with programs and funding to improve overall military medical readiness.^

Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

An evaluation of the centers for Medicare & Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program

Objective: This dissertation evaluated three aspects of the Centers for Medicare and Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program (HACPOA program) to produce three journal articles for publication. ^ Methods: All payer admission records from state inpatient databases from Arizona, New Jersey and Washington states were analyzed for the year 2008. However some analyses required a sample of adult only Medicare patients in the first two studies. California's inpatient data (2004 – 2010) was also analyzed in the third study to examine the reporting and non-payment program elements' impact on the incidence of hospital acquired conditions. ^ Results: Majority diagnoses reported in inpatient prospective payment systems hospitals were present on admission. However, some diagnoses are still coded as "not present on admission" and "insufficient documentation to determine whether or not conditions are present on admission or not". This is important because it reveals that hospital complications still occur in hospitals. Hospital fall and trauma injuries were the most common hospital acquired conditions observed in this study. Predictors of hospital fall injuries include age, gender, number of diagnoses, number of procedures, number of chronic conditions while predictors of hospital trauma injuries include number of e-codes, number of diagnoses and the presence of chronic conditions on a patient's admission records. Finally, the implementation of the present on admission reporting requirement increased reports of certain hospital acquired conditions while the non-payment policy element in the Hospital Acquired Conditions program reduced the incidence of hospital fall and trauma injuries in particular. ^ Conclusion: The implementation of the Hospital Acquired Conditions and Present on Admission Indicator Reporting program has made the state inpatient database a more useful source of data capable of now identifying hospital complications. The reporting and nonpayment program elements in the HACPOA program have also impacted the incidence of hospital acquired conditions. ^