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In this 24-week trial, glucosamine and chondroitin sulfate were not more effective, alone or in combination, than placebo in controlling pain in patients with osteoarthritis of the knee. In secondary analyses, however, in the subgroup of patients with moderate-to-severe osteoarthritis, those given both glucosamine and chondroitin sulfate were more likely than those given placebo to have a decrease in pain (79 percent vs. 54 percent). In this trial, glucosamine and chondroitin sulfate were not more effective, alone or in combination, than placebo in controlling pain in patients with osteoarthritis of the knee. Osteoarthritis is the most common of the arthritides, affecting at least 20 million Americans, a number that is expected to double over the next two decades. 1 , 2 Currently available medical therapies primarily address the treatment of joint pain in patients with osteoarthritis. 3 Analgesics as well as traditional and cyclooxygenase-2–selective nonsteroidal antiinflammatory drugs (NSAIDs) have suboptimal effectiveness, 4 , 5 and there is some question about their safety, especially in the light of recent reports of increased cardiovascular risk. 6 – 8 The dietary supplements glucosamine and chondroitin sulfate have been advocated, especially in the lay media, as safe and effective options for the management . . .

Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. Methods: The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Conclusions: Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context.

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ's 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE. We assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models. In 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%-125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802. The results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE and among those with DVT or PE.

Simultaneous measurements of CH3O2 radical concentrations have been performed using two different methods in the Leeds HIRAC (Highly Instrumented Reactor for Atmospheric Chemistry) chamber at 295 K and in 80 mbar of a mixture of 3:1 He/O2 and 100 or 1000 mbar of synthetic air. The first detection method consisted of the indirect detection ofCH3O2 using the conversion of CH3O2 into CH3O by excess NO with subsequent detection of CH3O by fluorescence assay by gas expansion (FAGE). The FAGE instrument was calibrated for CH3O2 in two ways. In the first method, a known concentration of CH3O2 was generated using the 185 nm photolysis of water vapour in synthetic air at atmospheric pressure followed by the conversion of the generated OH radicals to CH3O2 by reaction with CH4/O2. This calibration can be used for experiments performed in HIRAC at 1000 mbar in air. In the second method, calibration was achieved by generating a near steady state of CH3O2 and then switching off the photolysis lamps within HIRAC and monitoring the subsequent decay of CH3O2, which was controlled via its self-reaction, and analysing the decay using second-order kinetics. This calibration could be used for experiments performed at all pressures. In the second detection method, CH3O2 was measured directly using cavity ring-down spectroscopy (CRDS) using the absorption at 7487.98 cm-1 in the A←X (ν12) band with the optical path along the ∼1.4 m chamber diameter. Analysis of the second-order kinetic decays of CH3O2 by self-reaction monitored by CRDS has been used for the determination of theCH3O2 absorption cross section at 7487.98 cm-1, both at 100 mbar of air and at 80 mbar of a 3:1 He/O2 mixture, from which σCH3O2=(1.49±0.19)×10-20 cm2 molecule-1 was determined for both pressures. The absorption spectrum of CH3O2 between 7486 and 7491 cm-1 did not change shape when the total pressure was increased to 1000 mbar, from which we determined thatσCH3O2 is independent of pressure over the pressure range 100–1000 mbar in air. CH3O2 was generated in HIRAC using either the photolysis of Cl2 with UV black lamps in the presence of CH4 and O2 or the photolysis of acetone at 254 nm in the presence of O2. At 1000 mbar of synthetic air the correlation plot of [CH3O2]FAGE against [CH3O2]CRDS gave a gradient of 1.09±0.06. At 100 mbar of synthetic air the FAGE–CRDS correlation plot had a gradient of 0.95±0.024, and at 80 mbar of3:1 He/O2 mixture the correlation plot gradient was 1.03±0.05. These results provide a validation of the FAGE method to determine concentrations of CH3O2.

Objective Liver function test (LFT) elevations are reported with the use of tumour necrosis factor inhibitors (TNF-Is). The aim of this study was to compare LFT elevations in patients with rheumatoid arthritis receiving adalimumab (ADA), etanercept (ETN) or infliximab (INF) enrolled in the Consortium of Rheumatology Researchers of North America from October 2001 to March 2007. Methods Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) levels >1× upper limit of normal (ULN) were considered elevations and ALT/AST levels >2× ULN were considered abnormalities. Treatments included TNF-Is, methotrexate (MTX), leflunomide and other disease-modifying antirheumatic agents (DMARDs). Patients were censored after their first LFT elevation. Three analytical models were evaluated: (1) individual TNF-I vs non-biological DMARDs (primary model); (2) individual TNF-I plus MTX vs MTX monotherapy; and (3) limited to new users of individual TNF-I vs non-biological DMARDs. ORs for LFT elevations were estimated using generalised estimating equation logistic regression. Results 6861 patients (ADA: 849; ETN: 1383; INF: 1449) with 22 522 determinations were analysed. LFT elevations >1× ULN with TNF-I use were seen in 5.9% of AST/ALT determinations and abnormalities >2× ULN in 0.77%. In the primary model the adjusted ORs for LFT elevations >1× ULN were ADA 1.35 (95% CI 1.09 to 1.66), ETN 1.00 (95% CI 0.83 to 1.21) and INF 1.58 (95% CI 1.35 to 1.86). For 2× ULN, adjusted ORs were ADA 1.72 (95% CI 0.99 to 3.01), ETN 1.10 (95% CI 0.64 to 1.88) and INF 2.40 (95% CI 1.53 to 3.76). Similar results were obtained in other models. Conclusion The overall incidence of LFT elevations >1× ULN with TNF-I use was uncommon and abnormalities >2× ULN were rarely observed. Significant differences were most consistently observed with INF, less commonly with ADA and were not observed with ETN compared with comparator DMARDs.

The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or bilateral lower-limb amputation (BLLA) participated. Stepwise regression analysis was used to develop separate regression models of factors predicting CHAMP score. Regression models containing both rehabilitation factors and other factors explained 81% (TTA), 36% (TFA), and 91% (BLLA) of the variance in CHAMP score. Rehabilitation factors such as lower-limb strength and dynamic balance were found to be significantly related to CHAMP score and can be enhanced with the appropriate intervention. Further, the findings support the importance of salvaging the knee joint and its effect on high-level mobility capabilities. Lastly, the J-shaped energy storage and return feet were found to improve high-level mobility for SMs with TTA. These results could help guide rehabilitation and aid in developing appropriate interventions to assist in maximizing high-level mobility capabilities for SMs with traumatic lower-limb loss.

Background Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ's 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE. Methods We assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models. Results In 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%-125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802. Conclusion The results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE and among those with DVT or PE.

The authors examined (a) the extent to which kindergarten estimates of core language functions predicted teacher ratings of behavior problems in each of the child's first 4 years of elementary school and (b) the ability of core language measures to predict concurrent behavior problems at each of the early elementary school grades studied. Participants were 74 African American children who were recruited as infants into a longitudinal study of children's health and development. Sixty percent of the families were classified as low-income when the children entered kindergarten. Conduct problems and hyperactivity were assessed with the Conners' Teacher Rating Scale, core language functions with the Clinical Evaluation of Language Fundamentals-3 (CELF-3) and Peabody Picture Vocabulary Test-Revised (PPVT-R), and verbal working memory with the Competing Language Processing Task (CLPT). Results indicated that expressive and receptive language at kindergarten predicted teacher ratings of conduct problems, with increasing accuracy as children moved from kindergarten to third grade, particularly for receptive language. None of the early language measures predicted hyperactivity at any of the grades. Concurrent relationships, expressive language, conduct problems, and hyperactivity were stronger in second grade than in kindergarten, while lower scores in working memory predicted higher teacher-reported hyperactivity. These findings underscore the importance of core language functions in the prediction of behavior problems.