Stricklandrichard1020

The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, we used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees. Compared to buprenorphine discontinuation around the National Quality Forum benchmark (six to nine months), longer treatment (at least fifteen months) was associated with relative reductions in the risk of having all-cause inpatient (-52 percent) and emergency department (-26 percent) use, opioid-related hospital use (-128 percent), overdose events (-173 percent), and opioid prescriptions (-120 percent) and in the rate of prescription opioid use (-124 percent). We argue that these clinical benefits provide a rationale for policies that increase access to longer-term buprenorphine treatment, including lengthening the standards for minimum treatment duration.PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]-bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) and chronic GVHD (cGVHD)-free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n = 838), haploidentical (n = 159), 7/8-BM (n = 241), or 7/8-PB (n = 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P less then .0071 in multivariable analysis and P less then .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overalFS, and OS of all groups.PURPOSE Anaplastic thyroid carcinoma is an aggressive malignancy that is almost always fatal and lacks effective systemic treatment options for patients with BRAF-wild type disease. As part of a phase I/II study in patients with advanced/metastatic solid tumors, patients with anaplastic thyroid carcinoma were treated with spartalizumab, a humanized monoclonal antibody against the programmed death-1 (PD-1) receptor. METHODS We enrolled patients with locally advanced and/or metastatic anaplastic thyroid carcinoma in a phase II cohort of the study. Patients received 400 mg spartalizumab intravenously, once every 4 weeks. The overall response rate was determined according to RECIST v1.1. RESULTS Forty-two patients were enrolled. Adverse events were consistent with those previously observed with PD-1 blockade. Most common treatment-related adverse events were diarrhea (12%), pruritus (12%), fatigue (7%), and pyrexia (7%). The overall response rate was 19%, including three patients with a complete response and five with a partial response. Most patients had baseline tumor biopsies positive for PD-L1 expression (n = 28/40 evaluable), and response rates were higher in PD-L1-positive (8/28; 29%) versus PD-L1-negative (0/12; 0%) patients. The highest rate of response was observed in the subset of patients with PD-L1 ≥ 50% (6/17; 35%). Responses were seen in both BRAF-nonmutant and BRAF-mutant patients and were durable, with a 1-year survival of 52.1% in the PD-L1-positive population. CONCLUSION To our knowledge, this is the first clinical trial to show responsiveness of anaplastic thyroid carcinoma to PD-1 blockade.OBJECTIVES The first of two articles is to show how Florence Nightingale became a leading, effective hospital reformer. AIM The aim of the first paper is to relate how Nightingale was influenced by the great defects in the war hospitals of the Crimean War (1854-1856) and how she learned the lessons from those defects to set a different course. The article shows how her famous Notes on Nursing is a positive treatment of the lessons learned, turning the sanitary defects, notably in ventilation, into chapters of the book. The importance of the pavilion model of hospital design is highlighted. There is coverage of the advances made by Semmelweis at the Vienna General Hospital. METHODS This is a purely historical study drawing on the extensive publications by Nightingale, augmented by her (massive) surviving correspondence and notes. The search for archival materials was done for the publication of the 16-volume Collected Works of Florence Nightingale, written by the author of this article. The collected works was peer reviewed, and the research process succeeded in locating material in more than 200 archives worldwide.Objective Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education).Method Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the laten combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.PURPOSE To compare the hydrocoated silicone stent (Coloplast Imajin® hydro) to PercuflexTM Plus stent (Boston Scientific) in terms of patient comfort and quality of life after flexible ureteroscopy (fURS) for stone disease over a 5-week prospective follow-up.Materials and MethdosThis is a multicenter, single-blind, prospective, randomized trial of 141 patients treated with fURS for renal stones. Primary outcome was USSQ Body Pain Index recorded before DJ removal at day 20 (D20). Secondary endpoints were USSQ scores at intermediate dates (D2, D7, D20) and 2 weeks after stent withdrawal (D35), occurrence of adverse events and stent encrustation. https://www.selleckchem.com/products/PLX-4720.html RESULTS The trial was completed by 113 (80.1%) patients. Mean (SD) USSQ body pain scores were 25% lower at D20 for the silicone stent 18.7 (11.4) vs 25.1 (14.2), p=0.015. No difference in term of adverse events and safety profile was observed. USSQ urinary symptoms scores at D2, D7 and D20 were lower in the silicone stent group 26.4 (7.7) vs 31.8 (8.1) at D20 p less then 0.001. The use of USSQ self-questionnaires was associated with a limited number of missing or incomplete answers. CONCLUSIONS The primary results of this large sample prospective randomized controlled study comparing the silicone Imajin® hydro stents to the PercuflexTM Plus stent show that silicone stents are associated with significantly less patient discomfort. We would recommend their use in patients who require stenting for stone disease.Patient SummaryIn this randomized prospective trial, silicone DJ stents Imajin® hydro result in lower pain and discomfort following flexible ureteroscopy as compared to PercuflexTM Plus.PURPOSE To investigate the efficacy and analyze the complication risk factors of peritoneovenous shunt (PVS) in treating refractory chylous ascites (CA) following retroperitoneal lymph node dissection (RPLND) in patients with urologic malignancies. MATERIALS AND METHODS From April 2001 to March 2019, all patients with refractory CA after RPLND treated with PVS were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Univariate and multivariate logistic regression analysis was performed to identify predictors of complications. RESULTS Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of CA was 21 days (SD 15, range 4-65 days). Ascites permanently resolved after PVS in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141days). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6g/dl before, 3.9±0.8g/dl after; p less then 0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients receiving more than 5 paracenteses before PVS placement (AR 0.71% vs 0.25%, RR 2.9, p less then 0.048 and AR 0.6% vs 0.125%, RR 4.8, p less then 0.04, respectively). CONCLUSION PVS permanently treated CA in 90% of patients after RPLND. PVS was removed in 85% of patients. Shunt placement is an effective and safe treatment option for refractory CA. These patients might benefit from earlier intervention, after 4-6 week of conservative management as opposed to 2-3 months.In all animal species, oxygen consumption is a key process that is partially impaired in a large number of pathological situations and thus provides informative details on the physiopathology of the disease. In this study, we describe a simple and affordable method to precisely measure oxygen consumption in living zebrafish larvae using a spectrofluorometer and the MitoXpress Xtra Oxygen Consumption Assay. In addition, we used zebrafish larvae treated with mitochondrial respiratory chain inhibitors, antimycin A or rotenone, to verify that our method enables precise and reliable measurements of oxygen consumption.Canine parvovirus type 2 (CPV2) is a highly contagious cause of serious and often fatal disease in young dogs. Despite the widespread availability of attenuated vaccines, safer, more stable, and more effective CPV2 vaccine candidates are still under exploration. Vaccinia virus (VV) has already been proved to be a safe, stable, and effective vaccine vector. In this study, we generated a VV-based CPV2 vaccine candidate (VV-CPV-VP2) and then evaluated its immunogenicity in mice and dogs. The exogenous vp2 gene of CPV2, which replaced the major virulence gene hemagglutinin (ha) of VV, expressed efficiently and stably in vitro. Subsequently, intramuscular immunization of mice induced robust and lasting systemic immune responses, including neutralizing antibody against both CPV2a and CPV2b, and CPV2-VP2-specific interferon gamma (IFN-γ) secreting T cell. In addition, administration with a high-dose of VV-CPV-VP2 did not cause significant side effects for mice, thus indicating marked safety of this vaccine candidate.