Cryoablation and cementoplasty of a pathologic fracture in the sternum.

A 49-year-old man with metastatic melanoma and pathologic fracture of the sternum was deemed to be a poor candidate for general anaesthesia. He suffered severe pain and range of motion limitation that did not respond to narcotic therapy. Ultimately, the lesion was managed with computed tomography-guided cryoablation and subsequent cementoplasty, and saw good initial clinical results.

Responsiveness of the testing morbidities index in colonoscopy.

Objectives: The Testing Morbidities Index (TMI) was developed to measure the effects of any diagnostic or screening procedure on health-related quality of life (HRQOL); it includes seven domains incorporating mental and physical aspects before, during, and after testing. To add to prior work on the validity of the TMI classification, responsiveness of a summated scale version was evaluated in 71 colonoscopy patients. Further data on construct validity were also obtained.

Breast cancer detection of large size to DCIS by hypoxia and angiogenesis using NIRS.

This investigation aimed to test all tumor-bearing patients who undergo biopsy to see if angiogenesis and hypoxia can detect cancer. We used continuous-wave near-infrared spectroscopy (NIRS) to measure blood hemoglobin concentration to obtain blood volume or total hemoglobin [Hbtot] and oxygen saturation for the angiogenesis and hypoxic biomarkers. The contralateral breast was used as a reference to derive the difference from breast tumor as a difference in total hemoglobin Δ[HBtot] and a difference in deoxygenation Δ([Hb]-[HbO2]).

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011.

Objectives: To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners' experience, personal characteristics or role at work.

Design: Cross-sectional survey of 345 National Health Service (NHS) staff members.

Setting: The study was conducted across 11 English Primary Care Trusts between 2010 and 2011.

Patient and societal value functions for the testing morbidities index.

Background: We developed preference-based and summated scale scoring for the Testing Morbidities Index (TMI) classification, which addresses short-term effects on quality of life from diagnostic testing before, during, and after testing procedures.

Methods: The two TMI preference functions use multiattribute value techniques; one is patient-based and the other has a societal perspective, informed by 206 breast biopsy patients and 466 (societal) subjects. Because of a lack of standard short-term methods for this application, we used the visual analog scale (VAS).

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients.

Background: Initiation of cholinesterase inhibitor (ChEI) therapy for delirium during hospitalization is ineffective and may be associated with increased morbidity and mortality.

Objective: To describe the incidence of initiating ChEI therapy during hospitalization.

Design: A retrospective cross-sectional study.

Nonequilibrium distributions and hydrodynamic coupling distort the measurement of nanoscale forces near interfaces.

We calculate the displacement of a single spherical particle from the minimum of a harmonic well positioned near a plane wall and immersed in a uniform flow. A failure to account for the fluctuations in particle position orthogonal to the plane (leading to fluctuations in hydrodynamic drag) results in large discrepancies, with the naive displacement calculated by assuming no fluctuations in the balance of forces. The chief criterion for neglecting such fluctuations is that the stiffness of the harmonic potential exceeds the thermal stresses on the particle by at least two orders of magnitude.

Peripheral stimulation and its effect on perceived spatial scale in virtual environments.

The following series of experiments explore the effect of static peripheral stimulation on the perception of distance and spatial scale in a typical head-mounted virtual environment. It was found that applying constant white light in an observer's far periphery enabled the observer to more accurately judge distances using blind walking. An effect of similar magnitude was also found when observers estimated the size of a virtual space using a visual scale task.

Measuring thermal rupture force distributions from an ensemble of trajectories.

Rupture, bond breaking, or extraction from a deep and narrow potential well requires considerable force while producing minimal displacement. In thermally fluctuating systems, there is not a single force required to achieve rupture, but a spectrum, as thermal forces can both augment and inhibit the bond breaking. We demonstrate measurement and interpretation of the distribution of rupture forces between pairs of colloidal particles bonded via the van der Waals attraction.

Patient-centered outcomes in imaging: quantifying value.

The Patient-Centered Outcomes Research Institute was created in response to a mandate to conduct comparative effectiveness research in clinical care to inform decision making. The institute will be funded by the Patient-Centered Outcomes Research Trust Fund, through congressional set-asides, and by Medicare and private health insurers, through a per beneficiary fee. The institute is governed by a board with a broad stakeholder constitution.

A simpler expression for Henry's function describing the electrophoretic mobility of spherical colloids.

An approximate expression for Henry's function, describing the electrophoretic mobility of a spherical colloidal particle in the limit of low surface potentials, is developed through a physical analogy to a colloidal particle with a linearly slipping surface (i.e. satisfies the Navier slip condition).

Multi-scale kinetics of a field-directed colloidal phase transition.

Polarizable colloids are expected to form crystalline equilibrium phases when exposed to a steady, uniform field. However, when colloids become localized this field-induced phase transition arrests and the suspension persists indefinitely as a kinetically trapped, percolated structure. We anneal such gels formed from magneto-rheological fluids by toggling the field strength at varied frequencies.

Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures.

Antipsychotic use and diagnosis of delirium in the intensive care unit.

Introduction: Delirium is an independent risk factor for prolonged hospital length of stay (LOS) and increased mortality. Several antipsychotics have been studied for the treatment of intensive care unit (ICU) delirium that has led to a high variability in prescribing patterns for these medications. We hypothesize that in clinical practice the documentation of delirium is lower than the incidence of delirium reported in prospective clinical trials.

Effective treatment of etanercept and phototherapy-resistant psoriasis using the excimer laser.

Treatment of moderate-to-severe plaque psoriasis often requires the use of phototherapy or systemic therapy, which includes immunosuppressants, retinoids, and biologic agents. Although biologic use is becoming increasingly popular, it is not uncommon for patients to experience treatment failure. We describe a patient who had a suboptimal response to etanercept monotherapy after twelve weeks of induction dosing (50 mg twice weekly), as well as to a combination of etanercept (50 mg once weekly-maintenance dosing) and narrowband ultraviolet B (NB-UVB) phototherapy three times weekly for an additional twelve weeks.

Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia.

In published studies, cohorts of patients with bacteremia due to vancomycin-resistant Enterococcus (VRE) have predominantly been infected with Enterococcus faecium. Little is known about the epidemiology and outcomes associated with bacteremia due to VR Enterococcus faecalis. A retrospective study of isolates obtained from January 2008 to October 2010 was conducted at Detroit Medical Center (DMC).

Decoloring hemoglobin as a feedstock for second-generation bioplastics.

The color of red blood cell concentrate (RBCC) limits its application in human food, but there is potential to use it for second-generation bioplastics. Several methods have been developed to remove color from RBCC, but they are expensive or may produce difficult-to-remove toxic residues. Hydrogen peroxide treatment is a cheaper alternative.

Long-term outcome of eight clinical trials of CBT for anxiety disorders: symptom profile of sustained recovery and treatment-resistant groups.

Background: Few clinical trials of cognitive behaviour therapy (CBT) for anxiety disorders have conducted follow-up beyond one year post-treatment. This paper summarises the long-term outcome of eight clinical trials of CBT for anxiety disorders in terms of diagnostic status, healthcare usage and symptom severity and compares the symptom profile of participants with the best and worst outcomes relative to chronic depression and the normal population.

Methods: Follow-up at 2-14years with 396 patients (51% of those available to contact) employed structured diagnostic interview, assessment of healthcare usage and self-report measures of symptom severity.

Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery.

The role of computer-assisted surgery in maintaining the level of the joint in primary knee joint replacement (TKR) has not been well defined. We undertook a blinded randomised controlled trial comparing joint-line maintenance, functional outcomes, and quality-of-life outcomes between patients undergoing computer-assisted and conventional TKR. A total of 115 patients were randomised (computer-assisted, n = 55; conventional, n = 60).