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Little D.M.,Baylor Scott and White Healthcare | Little D.M.,Texas A&M University | Cook A.J.,Texas A&M University | Morissette S.B.,Texas A&M University | Klocek J.W.,Baylor University
Handbook of Clinical Neurology | Year: 2015

Population-based studies have demonstrated that a history positive for traumatic brain injury (TBI) can result in cognitive impairment, behavioral alterations, and pain. These outcomes can and do influence occupational function, can affect others in the workplace, and raise concerns about workplace safety upon re-entry to the workplace. Risk for long-term impairment and disability can in some cases be mitigated by assessment of capabilities relative to job duties, conservative return-to-work schedules, and, in some cases, interventions to support that return. For those in occupations at high risk for brain injury, including first responders, soldiers, and construction workers, the long-term risk of brain injury as a risk factor for neurodegenerative disease must and should inform increased concern for those with repeated injuries to the brain over the course of their lifetime and career. This chapter reviews the risks of TBI, considers factors that optimize functional recovery, and discusses potential interventions and factors that aid in return to the workplace. © 2015 Elsevier B.V. Source

Ory M.G.,Texas A&M University | Smith M.L.,Texas A&M University | Smith M.L.,University of Georgia | Jiang L.,University of California at Irvine | And 4 more authors.
Journal of Aging and Physical Activity | Year: 2015

This study examines the effectiveness of Texercise Select, a 12-week lifestyle program to improve physical functioning (as measured by gait speed) and quality of life. Baseline and 12-week follow-up assessments were collected from 220 enrollees who were older (mean = 75 years), predominantly female (85%), White (82%), and experiencing multiple comorbidities (mean = 2.4). Linear mixed-models were fitted for continuous outcome variables and GEE models with logit link function for binary outcome variables. At baseline, over 52% of participants had Timed Up-and-Go (TUG) test times of 12 s or more, which indicates below-normal performance. On average, participants showed significant reductions in TUG test scores at the postintervention (11% reduction, p < .001). Participants also showed significant improvements in general health status (p = .002), unhealthy physical days (p = .032), combined unhealthy physical and mental days (p = .006), and days limited from usual activity (p = .045). Findings suggest that performance indicators can be objectively collected and integrated into evaluation designs of community-based, activity-rich lifestyle programs. © 2015 Human Kinetics, Inc. Source

Hogg R.J.,Baylor Scott and White Healthcare | Bay R.C.,A.T. Still University | Jennette J.C.,University of North Carolina at Chapel Hill | Sibley R.,Stanford University | And 12 more authors.
American Journal of Kidney Diseases | Year: 2015

Background Previous randomized controlled trials evaluating the efficacy of mycophenolate mofetil (MMF) in patients with immunoglobulin A nephropathy (IgAN) have produced varying results. Study Design Double-blind placebo-controlled randomized controlled trial. Setting & Participants 52 children, adolescents, and adults with biopsy-proven IgAN in 30 centers in the United States and Canada. Entry criteria: age older than 7 to younger than 70 years; urine protein-creatinine ratio (UPCR), ≥0.6 g/g (males) or ≥0.8 g/g (females); and estimated glomerular filtration rate ≥ 50 mL/min/1.73 m2 (≥40 mL/min/1.73 m2 if receiving angiotensin-converting enzyme inhibitor). Mean age, 32 ± 12 (SD) years; 62% men; and 73% white. Intervention Lisinopril (or losartan) plus a highly purified omega-3 fatty acid (Omacor [Pronova Biocare]) was given to 94 patients for 3 months; 52 of the patients with persistent UPCR ≥ 0.6 g/g (males) and ≥0.8 g/g (females) were randomly assigned to MMF or placebo (target dose, 25-36 mg/kg/d) in addition to lisinopril/losartan plus Omacor. Outcomes Change in UPCR after 6 and 12 months treatment with MMF/placebo and 12 months after the end of treatment. Measurements UPCR measured on 24-hour urine samples. Glomerular filtration rate estimated with the Schwartz (age < 18 years) or Cockcroft-Gault (age ≥ 18 years) formula. Results 44 patients completed 6 months of treatment with MMF (n = 22) or placebo (n = 22). The trial was terminated early at the recommendation of the Data Monitoring Committee because of the lack of benefit. No patient achieved a complete remission (UPCR < 0.2 g/g). Mean UPCRs at randomization and after 6 months were 1.45 (95% CI, 1.16-1.75) and 1.40 (95% CI, 1.09-1.70) for MMF and 1.41 (95% CI, 1.17-1.65) and 1.58 (95% CI, 1.13-2.04) for placebo, respectively. The mean difference in UPCR change between these groups (MMF minus placebo) was -0.22 (95% CI, -0.75 to 0.31; P = 0.4). Adverse events were rare apart from nausea (MMF, 8.7%; placebo, 3.7%); one of these MMF patients withdrew. Limitations Low patient enrollment and short follow-up. Conclusions MMF did not reduce proteinuria significantly in patients with IgAN who had persistent proteinuria after lisinopril/losartan plus Omacor. © 2015 National Kidney Foundation, Inc. Source

Thourani V.H.,Emory University | Kodali S.,Columbia University | Makkar R.R.,Cedars Sinai Medical Center | Herrmann H.C.,University of Pennsylvania | And 30 more authors.
The Lancet | Year: 2016

Background Transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve demonstrates good 30 day clinical outcomes in patients with severe aortic stenosis who are at intermediate risk of surgical mortality. Here we report longer-term data in intermediate-risk patients given SAPIEN 3 TAVR and compare outcomes to those of intermediate-risk patients given surgical aortic valve replacement. Methods In the SAPIEN 3 observational study, 1077 intermediate-risk patients at 51 sites in the USA and Canada were assigned to receive TAVR with the SAPIEN 3 valve [952 [88%] via transfemoral access) between Feb 17, 2014, and Sept 3, 2014. In this population we assessed all-cause mortality and incidence of strokes, re-intervention, and aortic valve regurgitation at 1 year after implantation. Then we compared 1 year outcomes in this population with those for intermediate-risk patients treated with surgical valve replacement in the PARTNER 2A trial between Dec 23, 2011, and Nov 6, 2013, using a prespecified propensity score analysis to account for between-trial differences in baseline characteristics. The clinical events committee and echocardiographic core laboratory methods were the same for both studies. The primary endpoint was the composite of death from any cause, all strokes, and incidence of moderate or severe aortic regurgitation. We did non-inferiority (margin 7·5%) and superiority analyses in propensity score quintiles to calculate pooled weighted proportion differences for outcomes. Findings At 1 year follow-up of the SAPIEN 3 observational study, 79 of 1077 patients who initiated the TAVR procedure had died (all-cause mortality 7·4%; 6·5% in the transfemoral access subgroup), and disabling strokes had occurred in 24 (2%), aortic valve re-intervention in six (1%), and moderate or severe paravalvular regurgitation in 13 (2%). In the propensity-score analysis we included 963 patients treated with SAPIEN 3 TAVR and 747 with surgical valve replacement. For the primary composite endpoint of mortality, strokes, and moderate or severe aortic regurgitation, TAVR was both non-inferior (pooled weighted proportion difference of -9·2%; 90% CI -12·4 to -6; p<0·0001) and superior (-9·2%, 95% CI -13·0 to -5·4; p<0·0001) to surgical valve replacement. Interpretation TAVR with SAPIEN 3 in intermediate-risk patients with severe aortic stenosis is associated with low mortality, strokes, and regurgitation at 1 year. The propensity score analysis indicates a significant superiority for our composite outcome with TAVR compared with surgery, suggesting that TAVR might be the preferred treatment alternative in intermediate-risk patients. Funding None. © 2016 Elsevier Ltd. Source

Su B.W.,Mt Tam Orthopedics and Spine Center | Chaput C.D.,Baylor Scott and White Healthcare
Operative Techniques in Orthopaedics | Year: 2015

Cortical screws in the lumbar spine are an alternative to traditional pedicle screw fixation. The starting point is on the dorsal pars and the trajectory is up and out toward the lateral junction of the pedicle with the vertebral body. It allows for a smaller incision and less lateral dissection when compared with pedicle screw placement. Biomechanical studies have shown that cortical screws are equivalent to pedicle screws, and there is limited evidence of improved fixation with this technique in the setting of low bone density. Clinical studies demonstrate equivalent clinical and radiographic results between cortical screw and pedicle screws when used in conjunction with posterior interbody support. The indications, contraindications, surgical technique, special considerations, and literature surrounding the use of lumbar cortical screws are reviewed. © 2015 Published by Elsevier Inc. Source

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