Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial.

Aims: Risk stratification in patients admitted with worsening heart failure (HF) is essential for tailoring therapy and counselling. Risk models are available but rarely used, in part because many require laboratory and imaging results that are not routinely available. Body temperature is associated with prognosis in other illnesses, and we hypothesized that low body temperature would be associated with worse outcomes in patients admitted with worsening HF.

Body temperature circadian rhythm variability corresponds to left ventricular systolic dysfunction in decompensated cardiomyopathic hamsters.

Background: A declining amplitude of body temperature circadian rhythm (BTCR) predicts decompensation or death in cardiomyopathic hamsters. We tested the hypothesis that changes in BTCR amplitude accompany significant changes in left ventricular (LV) size and function.

Methods And Results: Using intraperitoneal transmitters, we continuously monitored the temperature of 30 male BIO TO-2 Syrian dilated cardiomyopathic hamsters.

Americans on health care reform: results from polls conducted with Zogby International, Inc.

During a time of uncertainty regarding the future of the American health care system, an assessment, over time, of Americans' opinion on different legislative or health policy directions is a valuable asset to decision makers. After polling over 10,000 Americans via three polls on these topics over four months, a few distinct trends have emerged. When it comes to health care reform, Americans want a "tune-up," not a "trade-in" of their health care system by implementing reforms that allow the system to work more efficiently for the largest number of people possible, paying for it through savings found by reducing extraneous and wasteful spending and by increasing the quality of care.

Utilizing a trauma systems approach to benchmark and improve combat casualty care.

Background: Derived from the necessity to improve the outcomes of soldiers injured on the battlefield, the U.S. military forces developed and implemented the Joint Theater Trauma System (JTTS) and the Joint Theater Trauma Registry based on U.

Circadian body temperature variability is an indicator of poor prognosis in cardiomyopathic hamsters.

Background: Low body temperature is an independent predictor of poor prognosis in patients with congestive heart failure. The cardiomyopathic hamster develops progressive biventricular dysfunction, resulting in heart failure death at 9 months to 1 year of life. Our goal was to use cardiomyopathic hamsters to examine the relationship between body temperature and heart failure decompensation and death.

Factors contributing to suboptimal vaccination against influenza: results of a nationwide telephone survey of persons with cardiovascular disease.

Vaccination against influenza averts cardiovascular events and is recommended for all patients with coronary heart disease. Because data were unavailable regarding vaccination rates among such patients' household contacts, we sought to estimate the rate of influenza vaccination in persons with cardiovascular disease and their contacts. In 2004, we conducted a random, nationwide telephone survey of 1,202 adults (age, > or = 18 yr) to ascertain knowledge, attitudes, and behaviors regarding influenza vaccination.

Use of oseltamivir after influenza infection is associated with reduced incidence of recurrent adverse cardiovascular outcomes among military health system beneficiaries with prior cardiovascular diseases.

Background: Influenza infection has been associated with increased risk of adverse cardiac and cerebral vascular outcomes. Oseltamivir, a treatment for influenza, has been shown to decrease the severity of an influenza episode, but few data exist regarding its potentially protective effect against recurrent vascular outcomes among influenza patients with a history of vascular disease.

Methods And Results: Electronic healthcare service and pharmacy records for 37,482 TRICARE beneficiaries, aged 18 and older, with a coded history of cardiovascular (CV) disease and a subsequent diagnosis of influenza from October 1, 2003, through September 30, 2007, were examined.

Antibody-labeled liposomes for CT imaging of atherosclerotic plaques: in vitro investigation of an anti-ICAM antibody-labeled liposome containing iohexol for molecular imaging of atherosclerotic plaques via computed tomography.

We evaluated the specific binding of anti-intercellular adhesion molecule 1 (ICAM-1) conjugated liposomes (immunoliposomes, or ILs) to activated human coronary artery endothelial cells (HCAEC) with the purpose of designing a computed tomographic imaging agent for early detection of atherosclerotic plaques. Covalent attachment of anti-ICAM-1 monoclonal antibodies to pre-formed liposomes stabilized with polyethylene glycol yielded ILs, with a coupling efficiency of the ICAM-1 to the liposomes of 10% to 24%. The anti-ICAM-1-labeled ILs had an average diameter of 136 nm as determined by dynamic light-scattering and cryogenic electron microscopy.

Influenza virus directly infects, inflames, and resides in the arteries of atherosclerotic and normal mice.

Objective: Influenza can trigger heart attacks, and vaccination against influenza reduces the risk of cardiovascular events. Currently, it is believed that influenza virus in general does not disseminate to extra-pulmonary tissues. We assessed the vascular effects of influenza infection and whether the virus can directly infect atherosclerotic arteries in mice.

Temporal trends in anti-diabetes drug use in TRICARE following safety warnings in 2007 about rosiglitazone.

Purpose: To describe utilization patterns for anti-diabetes medications among a cohort of diabetes patients in the Military Health System (MHS) before and after warnings about rosiglitazone issued in May 2007.

Methods: We used segmented regression analysis to compare changes in the level and trend of rosiglitazone utilization and use of other anti-diabetes therapies in the period prior to the drug warnings (between April 2006 and May 2007) and the period after the warnings were issued (between October 2007 and May 2008).

Results: The level and trend of rosiglitazone use changed after the highly publicized warnings.

Racial and ethnic health disparities in TRICARE.

Background: As a major provider of health care for racial and ethnic minority groups, the federal government has affirmed its commitment to the elimination of health disparities. Although numerous studies have examined health care disparities in various federal systems of care, few have examined these issues within TRICARE, the Department of Defense (DoDJ's program for providing health care coverage to members of the uniformed services and their dependents.

Methods: This study provides an exploratory analysis examining apparent disparities in health status, access to and satisfaction with care, and use of preventive care using the 2007 Health Care Survey of DoD Beneficiaries.

Pomegranate (Punica granatum) purified polyphenol extract inhibits influenza virus and has a synergistic effect with oseltamivir.

Influenza epidemics cause numerous deaths and millions of hospitalizations each year. Because of the alarming emergence of resistance to anti-influenza drugs, there is a need to identify new naturally occurring antiviral molecules. We tested the hypothesis that pomegranate polyphenol extract (PPE) has anti-influenza properties.

The association between oseltamivir use and adverse neuropsychiatric outcomes among TRICARE beneficiaries, ages 1 through 21 years diagnosed with influenza.

Unlabelled: Recent reports out of Japan have linked therapeutic use of the oral neuraminidase inhibitor oseltamivir with adverse neuropsychiatric outcomes in adolescents.

Objective: To assess if protective measures should be taken to mitigate potential adverse outcomes among United States Department of Defense (DoD) pediatric beneficiaries who are prescribed oseltamivir therapeutically.

Study Group: DoD healthcare beneficiaries, ages 1 through 21 years, who received a diagnosis of influenza from 1 October 2006 through 30 September 2007.

Humanitarian assistance and disaster relief: changing the face of defense.

The US Department of Defense (DOD) is evolving to meet new security challenges in the twenty-first century. Today's challenges result from growing political, environmental, and economic instability in important areas of the globe that threaten national and global security. Immediate outreach to foreign nations in times of violent instability or natural disaster fosters security and stability both for the affected country and for the United States.

TRICARE Management Activity Healthcare Facility Evidence-Based Design Survey.

Unlabelled: This report summarizes findings from the TRICARE Management Activity (TMA) Healthcare Facility Evidence-Based Design Survey. TMA conducted 382 telephone interviews with active duty (AD) personnel and 36 interviews with AD spouses to solicit their opinions regarding 10 proposed healthcare facility design features that could improve the comfort and convenience of a hospital stay. The survey was composed of 10 multiple-choice questions that were based on recent findings in evidence-based healthcare facility design features.

Creating healing environments in support of the U.S. Military: a commitment to quality through the built environment.

The U.S. Military Health System (MHS) provides care to 9.

An iodinated liposomal computed tomographic contrast agent prepared from a diiodophosphatidylcholine lipid.

Herein we report a novel vesicle-forming iodinated contrast agent for applications in computed tomographic (CT) imaging and drug delivery. Specifically, we have chemically modified a phosphatidylcholine lipid that is commonly used in liposome formation to create an iodinated lipid that self-assembles into approximately 50-150 nm iodoliposomes possessing as-prepared imaging contrast functionality. These iodoliposomes are structurally organized such that the iodinated moieties are contained within the vesicle's bilayer, leaving the liposomal interior unoccupied and thus available for encapsulating drugs.

Decreasing body temperature predicts early rehospitalization in congestive heart failure.

Background: In congestive heart failure (CHF), a low body temperature at hospital admission predicts in-hospital mortality. We hypothesized that a postdischarge reduction in body temperature predicts early CHF rehospitalization and death.

Methods: We reviewed the records of 198 patients discharged after CHF hospitalization.

Silent myocardial ischemia: Current perspectives and future directions.

Silent myocardial ischemia (SMI) is increasingly being recognized as part of the spectrum of ischemic heart disease. The spectrum of SMI ranges from asymptomatic coronary artery disease to critical illness necessitating intensive care. Although many diagnostic tools have been used to identify low- and high-risk subgroups, their use is limited by modest sensitivities and specificities.

Devices in heart failure: potential methods for device-based monitoring of congestive heart failure.

Congestive heart failure has long been one of the most serious medical conditions in the United States; in fact, in the United States alone, heart failure accounts for 6.5 million days of hospitalization each year. One important goal of heart-failure therapy is to inhibit the progression of congestive heart failure through pharmacologic and device-based therapies.

A comparison of select cardiovascular outcomes by antidiabetic prescription drug classes used to treat type 2 diabetes among Military Health System beneficiaries, fiscal year 2003-2006.

Background: Recent research suggests that there is an increased risk of cardiovascular outcomes among individuals with type 2 diabetes taking rosiglitazone (Avandia).

Objective: To determine if there is an increased incidence of select cardiovascular events, specifically acute myocardial infarction (AMI) and congestive heart failure (CHF), among Military Health System beneficiaries with type 2 diabetes who filled a prescription for Avandia compared with those who filled prescriptions for other antidiabetic medications.

Design: Cross-sectional analysis of data from fiscal year 2003-2006.