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"Bauer, K. A."
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Credit intelligence : boosting your credit smarts
The authors \"provide you with a roadmap to credit intelligence by sharing their shopping adventures and lessons learned about credit as 'Olympic level' shoppers who have fallen into and pulled each other out of many of the traps and pitfalls surrounding the use of credit and the behavioral buying manipulations by retailers\"--Amazon.com.
Book
Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis
Objectives To evaluate the risk of venous thromboembolic events associated with the use of progestin-only contraception and whether that risk differs with the mode of drug delivery (oral, intrauterine, or depot injection).Design Systematic review and meta-analysis of randomised controlled trials and observational studies.Data sources Pubmed, Embase, Cochrane Library, and reference lists of relevant reviews.Study selection Randomised controlled trials and case-control, cohort, and cross sectional studies with venous thromboembolic outcome for progestin-only contraception reported relative to a non-hormone comparator group.Data extraction Data were extracted by two independent investigators, and consensus for inclusion was reached after assessment by additional investigators.Results Among the 2022 unique references identified by all searches, eight observational studies fulfilled inclusion criteria. A total of 147 women across all studies were diagnosed with a venous thromboembolic event while taking progestin-only contraception, and the summary measure for the adjusted relative risk of a venous thromboembolic episode for users versus non-users of a progestin-only contraceptive was, based on the random effects model, 1.03 (95% CI 0.76 to 1.39). Subgroup analysis confirmed there was no association between venous thromboembolic risk and progestin-only pills (relative risk 0.90 (0.57 to 1.45)) or a progestin intrauterine device (0.61 (0.24 to 1.53)). The relative risk of a venous thromboembolic event for users of an injectable progestin versus non-users was 2.67 (1.29 to 5.53).Conclusions Published data assessing the risk of venous thromboembolism in women prescribed progestin-only contraception are limited. In this meta-analysis of eight observational studies, the use of progestin-only contraception was not associated with an increased risk of venous thromboembolism compared with non-users of hormonal contraception. The potential association between injectable progestins and thrombosis requires further study.
Journal Article
Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
Currently,
in vitro
synergy with colistin has not translated into improved clinical outcomes. This study aimed to compare colistin combination therapy to colistin monotherapy in critically ill patients with multi-drug resistant gram-negative (MDR-GN) pneumonia. This was a retrospective analysis of critically ill adult patients receiving intravenous colistin for MDR-GN pneumonia comparing colistin combination therapy to colistin monotherapy with a primary endpoint of clinical cure. Combination therapy was defined by administration of another antibiotic to which the MDR-GN pathogen was reported as susceptible or intermediate. Ninety patients were included for evaluation (41 combination therapy and 49 monotherapy). Baseline characteristics were similar between groups. No difference in clinical cure was observed between combination therapy and monotherapy in univariate analysis, nor when adjusted for APACHE II score and time to appropriate antibiotic therapy (57.1 vs. 63.4 %, adjusted OR 1.15,
p
= 0.78). Microbiological cure was significantly higher for combination therapy (87 vs. 35.5 %,
p
< 0.001). Colistin combination therapy was associated with a significant improvement in microbiological cure, without improvement in clinical cure. Based on the
in vitro
synergy and improvement in microbiological clearance, colistin combination therapy should be prescribed for MDR-GN pneumonia. Further research is warranted to determine if
in vitro
synergy with colistin translates into improved clinical outcomes.
Journal Article
Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer
A placebo-controlled trial assessed the efficacy of rivaroxaban to prevent venous thrombosis in patients with cancer at high risk for thrombosis. The thrombosis rate was lower with rivaroxaban, but for the 180-day assessment period, the difference was not significant. Bleeding was approximately twice as common in the rivaroxaban group.
Journal Article
Demonstration of hot-spot fuel gain exceeding unity in direct-drive inertial confinement fusion implosions
Irradiating a small capsule containing deuterium and tritium fuel directly with intense laser light causes it to implode, which creates a plasma hot enough to initiate fusion reactions between the fuel nuclei. Here we report on such laser direct-drive experiments and observe that the fusion reactions produce more energy than the amount of energy in the central so-called hot-spot plasma. This condition is identified as having a hot-spot fuel gain greater than unity. A hot-spot fuel gain of around four was previously accomplished at the National Ignition Facility in indirect-drive inertial confinement fusion experiments where the capsule is irradiated by X-rays. In that case, up to 1.9 MJ of laser energy was used, but in contrast, our experiments on the OMEGA laser system require as little as 28 kJ. As the hot-spot fuel gain is predicted to grow with laser energy and target size, our work establishes the direct-drive approach to inertial fusion as a promising path towards burning and ignited plasmas in the laboratory. Additionally, we report a record (direct-drive) fusion yield of 0.9 kJ on OMEGA, which we achieved with thin-ice deuterium–tritium liner targets.
Inertial confinement fusion experiments in a direct-drive configuration report more energy produced in deuterium–tritium fusion reactions than the amount of energy in the central part of the plasma created by laser irradiation of the fuel capsule.
Journal Article
Fondaparinux Compared with Enoxaparin for the Prevention of Venous Thromboembolism after Hip-Fracture Surgery
In a study of the prevention of venous thromboembolism after surgery for hip fracture, fondaparinux was compared with the low-molecular-weight heparin enoxaparin. Fondaparinux was superior to enoxaparin for thromboprophylaxis and was well tolerated.
For the prevention of venous thromboembolism after surgery for hip fracture, fondaparinux was superior to enoxaparin and was well tolerated.
Patients undergoing surgery for hip fracture are in the highest category of risk for postoperative venous thromboembolism.
1
,
2
Fatal pulmonary embolism occurs in 3.6 to 12.9 percent of patients who have not received prophylaxis against thromboembolism.
1
There are few data on thromboprophylaxis after surgery for hip fracture, and recommendations are based mainly on expert opinion.
1
Even with current methods of thromboprophylaxis, the incidence of venographically confirmed deep-vein thrombosis is 24 to 34 percent.
1
,
3
–
21
Fondaparinux is a new synthetic pentasaccharide that causes selective inhibition of activated factor X (factor Xa).
22
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25
A recent study of patients undergoing major orthopedic . . .
Journal Article
Demonstration of a hydrodynamically equivalent burning plasma in direct-drive inertial confinement fusion
Focussing laser light onto the surface of a small target filled with deuterium and tritium implodes it and leads to the creation of a hot and dense plasma, in which thermonuclear fusion reactions occur. In order for the plasma to become self-sustaining, the heating of the plasma must be dominated by the energy provided by the fusion reactions—a condition known as a burning plasma. A metric for this is the generalized Lawson parameter, where values above around 0.8 imply a burning plasma. Here, we report on hydro-equivalent scaling of experimental results on the OMEGA laser system and show that these have achieved core conditions that reach a burning plasma when the central part of the plasma, the hotspot, is scaled in size by at least a factor of 3.9 ± 0.10, which would require a driver laser energy of at least 1.7 ± 0.13 MJ. In addition, we hydro-equivalently scale the results to the 2.15 MJ of laser energy available at the National Ignition Facility and find that these implosions reach 86% of the Lawson parameter required for ignition. Our results support direct-drive inertial confinement fusion as a credible approach for achieving thermonuclear ignition and net energy in laser fusion.
Hydro-equivalent scaling of recent direct-drive inertial confinement fusion implosions shows that a burning plasma can be achieved with a higher laser energy.
Journal Article
Fondaparinux Compared with Enoxaparin for the Prevention of Venous Thromboembolism after Elective Major Knee Surgery
Major knee surgery poses a considerable risk of postoperative venous thromboembolism. In this study, fondaparinux, a new antithrombotic pentasaccharide, was found to surpass the ability of enoxaparin, a low-molecular-weight heparin, to prevent venous thromboembolism after knee surgery.
Fondaparinux, a new antithrombotic pentasaccharide, was found to surpass the ability of enoxaparin to prevent venous thromboembolism after knee surgery.
Venous thromboembolism is a frequent, life-threatening postoperative complication of total-knee-replacement surgery.
1
,
2
Without thromboprophylaxis, the prevalence rate is 40 to 84 percent for venographically verified postoperative deep-vein thrombosis and 2 to 7 percent for pulmonary embolism.
1
Thromboprophylaxis that is effective in hip-replacement surgery, such as low-dose heparin, low-molecular-weight heparin, or warfarin, is less successful in knee-replacement surgery and reduces the prevalence of deep-vein thrombosis only to 31 to 47 percent.
1
For this reason, more effective antithrombotic prophylaxis is needed in knee-replacement surgery.
Fondaparinux is one of a new class of antithrombotic agents, the selective inhibitors of activated factor X (factor . . .
Journal Article
Is the \Low-Hanging Fruit\ Worth Picking for Antimicrobial Stewardship Programs?
A new antimicrobial stewardship program can be overwhelmed at the breadth of interventions and education required to conduct a successful program. The expression \"low-hanging fruit,\" in reference to stewardship, refers to selecting the most obtainable targets rather than confronting more complicated management issues. These targets include intravenous-to-oral conversions, batching of intravenous antimicrobials, therapeutic substitutions, and formulary restriction. These strategies require fewer resources and less effort than other stewardship activities; however, they are applicable to a variety of healthcare settings, including limited-resource hospitals, and have demonstrated significant financial savings. Our stewardship program found that staged and systematic interventions that focus on obvious areas of need, that is, low hanging fruit, provided early successes in our expanded program with a substantial cumulative cost savings of $832 590.
Journal Article