Publications by authors named "Lindsay Martin"

19 Publications

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Immediate reactions following the first dose of the SARS-CoV2 mRNA vaccines do not preclude second dose administration.

Clin Infect Dis 2021 May 14. Epub 2021 May 14.

Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia, U.S.A.

Addressing COVID19 vaccine hesitancy and minimizing potential vaccine contraindications are critical to combat the ongoing pandemic. We describe a practical approach to immediate adverse events after the first dose of the SARS-CoV2 mRNA vaccines, focusing on allergic reactions with respect to their diagnosis and management.
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http://dx.doi.org/10.1093/cid/ciab448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194535PMC
May 2021

What influences the "when" of eating and sleeping?A qualitative interview study.

Appetite 2021 01 24;156:104980. Epub 2020 Sep 24.

The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA. Electronic address:

Timing of eating relative to sleep and endogenous circadian rhythm impacts weight and cardiometabolic health. We used qualitative methods to explore what influences the "when" of eating and sleeping. We conducted 37 one-on-one semi-structured interviews among participants with a body mass index (BMI) ≥ 25 kg/m recruited from three internal medicine clinics affiliated with an urban academic hospital. Participants (70.3% Female; 51.4% White; Age range: 21-83 years old) completed measures of social jetlag, physical activity, eating habits, and mobile application use and participated in interviews following a guide developed by the study team. Responses were recorded, transcribed and coded sequentially by two trained researchers using editing-style analysis to identify themes. We identified two main themes, each with subthemes: 1) influences on the "when" of eating and sleeping, with subthemes including social jetlag and being overscheduled, and 2) contextualizing beliefs and perceptions about the "when" of eating and sleeping, with subthemes including perceived recommendations for timing of eating and sleeping, and alignment of behaviors with perceived recommendations. Many participants noted being more flexible in their eating and sleeping times on work-free vs work days. The themes this study identified should be considered when designing interventions that influence the timing of eating and sleeping for weight management.
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http://dx.doi.org/10.1016/j.appet.2020.104980DOI Listing
January 2021

Perspectives of pregnant and postpartum women and obstetric providers to promote healthy lifestyle in pregnancy and after delivery: a qualitative in-depth interview study.

BMC Womens Health 2020 03 4;20(1):44. Epub 2020 Mar 4.

Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD, 21205, USA.

Background: Pregnancy provides an opportunity to promote healthy lifestyle behaviors. This study's aim was to explore the perspectives of pregnant and postpartum women and obstetric providers around behavioral lifestyle changes in pregnancy and postpartum.

Methods: We conducted a qualitative study with pregnant and postpartum patients recruited from 2 prenatal care clinics at an urban, academic hospital in the United States. In-depth interviews with 23 pregnant or postpartum women and 11 obstetric providers were completed between October 2015-April 2016. Interviews were audio-recorded and transcribed verbatim. We coded transcripts for thematic content and applied the PRECEDE-PROCEED framework for results to directly inform program development.

Results: Six themes highlighted the predisposing, enabling and reinforcing factors that enable and sustain health behavior changes in pregnancy and postpartum: 1) "Motivation to have a healthy baby" during pregnancy and to "have my body back" after delivery, 2) Pre-pregnancy knowledge and experiences about pregnancy and the postpartum period, 3) Prioritizing wellness during pregnancy and postpartum, 4) The power of social support, 5) Accountability, 6) Integration with technology to reinforce behavior change.

Conclusions: In this qualitative study, pregnant and postpartum women and obstetric providers described themes that are aimed at encouraging lifestyle changes to promote healthy weight gain in pregnancy and can directly inform the development of a behavioral weight management intervention for pregnant and postpartum women that is patient-centered and tailored to their needs.
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http://dx.doi.org/10.1186/s12905-020-0896-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057562PMC
March 2020

Convergence of ecophysiological traits drives floristic composition of early lineage vascular plants in a tropical forest floor.

Ann Bot 2019 05;123(5):793-803

Department of Biology, Colgate University, Hamilton, NY, USA.

Background And Aims: Tropical understorey plant communities are highly diverse and characterized by variable resource availability, especially light. Plants in these competitive environments must carefully partition resources to ensure ecological and evolutionary success. One mechanism of effective resource partitioning is the optimization of functional traits to enhance competition in highly heterogeneous habitats. Here, we surveyed the ecophysiology of two early lineage vascular plant groups from a tropical forest understorey: Selaginella (a diverse lineage of lycophytes) and ferns.

Methods: In a lowland rain forest in Costa Rica, we measured a suite of functional traits from seven species of Selaginella and six fern species. We evaluated species microclimate and habitat; several photosynthetic parameters; carbon, nitrogen and phosphorus content; chlorophyll concentration; leaf mass per area (LMA); and stomatal size and density. We then compare these two plant lineages and search for relationships between key functional parameters that already exist on a global scale for angiosperms.

Key Results: Convergence of trait function filtered Selaginella species into different habitats, with species in heavily shaded environments having higher chlorophyll concentrations and lower light compensation points compared with open habitats. Alternatively, lower foliar nitrogen and higher stomatal densities were detected in species occupying these open habitats. Selaginella species had denser and smaller stomata, lower LMA and lower foliar nutrient content than ferns, revealing how these plant groups optimize ecophysiological function differently in tropical forest floors.

Conclusions: Our findings add key pieces of missing evidence to global explorations of trait patterns that define vascular plant form and function, which largely focus on seed plants. Broadly predictable functional trait relationships were detected across both Selaginella and ferns, similar to those of seed plants. However, evolutionary canalization of microphyll leaf development appears to have driven contrasting, yet successful, ecophysiological strategies for two coexisting lineages of extant homosporous vascular plants.
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http://dx.doi.org/10.1093/aob/mcy210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534666PMC
May 2019

Discordance Between Resting and Hyperemic Indices of Coronary Stenosis Severity: The VERIFY 2 Study (A Comparative Study of Resting Coronary Pressure Gradient, Instantaneous Wave-Free Ratio and Fractional Flow Reserve in an Unselected Population Referred for Invasive Angiography).

Circ Cardiovasc Interv 2016 11;9(11)

From the University of Glasgow, United Kingdom (B.H., K.G.O., C.B., P.M., M.B.M., H.E., M.C.P., P.R., R.G., M.M.L., S.H., S.W.); Cardiology Department, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (B.H., K.G.O., C.B., J.M.); and The Weatherhead PET Imaging Center, Houston, TX (N.J.).

Background: Distal coronary to aortic pressure ratio (Pd/Pa) and instantaneous wave-free ratio (iFR) are indices of functional significance of a coronary stenosis measured without hyperemia. It has been suggested that iFR has superior diagnostic accuracy to Pd/Pa when compared with fractional flow reserve (FFR).We hypothesized that in comparison with FFR, revascularization decisions based on either binary cutoff values for iFR and Pd/Pa or hybrid strategies incorporating iFR or Pd/Pa will result in similar levels of disagreement.

Methods And Results: This is a prospective study in consecutive patients undergoing FFR for clinical indications using proprietary software to calculate iFR. We measured Pd/Pa, iFR, FFR, and hyperemic iFR. Diagnostic accuracy versus FFR ≤0.80 was calculated using binary cutoff values of ≤0.90 for iFR and ≤0.92 for Pd/Pa, and adenosine zones for iFR of 0.86 to 0.93 and Pd/Pa of 0.87 to 0.94 in the hybrid strategy. One hundred ninety-seven patients with 257 stenoses (mean diameter stenosis 48%) were studied. Using binary cutoffs, diagnostic accuracy was similar for iFR and resting Pd/Pa with misclassification rates of 21% versus 20.2% (P=0.85). In the hybrid analysis, 54% of iFR cases and 53% of Pd/Pa cases were outside the adenosine zone and rates of misclassification were 9.4% versus 11.9% (P=0.55).

Conclusions: Binary cutoff values for iFR and Pd/Pa result in misclassification of 1 in 5 lesions. Using a hybrid strategy, approximately half of the patients do not receive adenosine, but 1 in 10 lesions are still misclassified. The use of nonhyperemic indices of stenosis severity cannot be recommended for decision making in the catheterization laboratory.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02377310.
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.116.004016DOI Listing
November 2016

Decision-Making and Problem-Solving Approaches in Pharmacy Education.

Am J Pharm Educ 2016 Apr;80(3):52

Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.

Domain 3 of the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes recommends that pharmacy school curricula prepare students to be better problem solvers, but are silent on the type of problems they should be prepared to solve. We identified five basic approaches to problem solving in the curriculum at a pharmacy school: clinical, ethical, managerial, economic, and legal. These approaches were compared to determine a generic process that could be applied to all pharmacy decisions. Although there were similarities in the approaches, generic problem solving processes may not work for all problems. Successful problem solving requires identification of the problems faced and application of the right approach to the situation. We also advocate that the CAPE Outcomes make explicit the importance of different approaches to problem solving. Future pharmacists will need multiple approaches to problem solving to adapt to the complexity of health care.
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http://dx.doi.org/10.5688/ajpe80352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857647PMC
April 2016

Mindful decision making and inhibitory control training as complementary means to decrease snack consumption.

Appetite 2016 08 13;103:176-183. Epub 2016 Apr 13.

Drexel University, 3141 Chestnut St., Department of Psychology, Philadelphia, PA, 19104, United States.

Objective: Obesity is largely attributable to excess caloric intake, in particular from "junk" foods, including salty snack foods. Evidence suggests that neurobiological preferences to consume highly hedonic foods translate (via implicit processes) into poor eating choices, unless overturned by inhibitory mechanisms or interrupted by explicit processes. The primary aim of the current study was to test the independent and combinatory effects of a computerized inhibitory control training (ICT) and a mindful decision-making training (MDT) designed to facilitate de-automatization.

Methods: We randomized 119 habitual salty snack food eaters to one of four short, training conditions: MDT, ICT, both MDT and ICT, or neither (i.e., psychoeducation). For 7 days prior to the intervention and 7 days following the intervention, participants reported on their salty snack food consumption 2 times per day, on 3 portions of their days, using a smartphone-based ecological momentary assessment system. Susceptibility to emotional eating cues was measured at baseline.

Results: Results indicated that the effect of MDT was consistent across levels of trait emotional eating, whereas the benefit of ICT was apparent only at lower levels of emotional eating. No synergistic effect of MDT and ICT was detected.

Conclusions: These results provide qualified support for the efficacy of both types of training for decreasing hedonically-motivated eating. Moderation effects suggest that those who eat snack foods for reasons unconnected to affective experiences (i.e., lower in emotional eating) may derive benefit from a combination of ICT and MDT. Future research should investigate the additive benefit of de-automization training to standard weight loss interventions.
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http://dx.doi.org/10.1016/j.appet.2016.04.014DOI Listing
August 2016

The Employer-Led Health Care Revolution.

Harv Bus Rev 2015 Jul-Aug;93(7-8):38-50, 133

To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.
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December 2015

Reoperation After Robotic and Vaginal Mesh Reconstructive Surgery: A Retrospective Cohort Study.

Female Pelvic Med Reconstr Surg 2015 Nov-Dec;21(6):315-8

From the *Division of Urogynecology, Department of Obstetrics and Gynecology, and †Department of Biostatistics, Winthrop University Hospital, Mineola, NY.

Objectives: Our primary objective was to compare reoperations after robotic-assisted sacrocolpopexy and transvaginal mesh for apical prolapse repair. Our secondary aim was to record perioperative complications after robotic and vaginal surgeries.

Methods: We reviewed medical records of women who underwent vaginal apical mesh support procedures or robotic sacrocolpopexy at Winthrop University Hospital between August 2009 and August 2013. We compared reoperations and perioperative complications between the 2 groups.

Results: There were 245 eligible cases during the 4-year study period. One hundred eighty-one women underwent robotic-assisted sacrocolpopexy and 64 women underwent transvaginal mesh. Women who underwent robotic surgery were younger and had decreased blood loss. Patients were followed up for a median of 3 months after robotic surgery and 11.5 months after transvaginal mesh. We found no difference in overall rate of reoperation between robotic and transvaginal mesh repair for apical prolapse. Specifically, there was no difference in the rate of reoperation for mesh exposure.

Conclusions: Despite recent controversies, transvaginal mesh offers the benefit of an effective minimally invasive procedure with shorter operative times, and may not pose additional risk for reoperation when compared to robotic-assisted sacrocolpopexy.
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http://dx.doi.org/10.1097/SPV.0000000000000194DOI Listing
August 2016

New evidence in the treatment of overactive bladder.

Curr Opin Obstet Gynecol 2015 Oct;27(5):366-72

Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose Of Review: Overactive bladder (OAB) in women is highly prevalent. It can be very bothersome and affect quality of life. Treatment differs significantly depending on the clinical presentation, and includes behavioural modification, medicinal therapies and surgical procedures. New treatment options have become available in recent years, and can offer great benefit to patients with persistent, bothersome OAB.

Recent Findings: First-line management for OAB consists of lifestyle and behavioural therapy, followed by antimuscarinic therapy or oral beta-3 agonists. Sacral neuromodulation, onabotulinumtoxinA and posterior tibial nerve stimulation are additional well tolerated and efficacious treatment options that should be considered in carefully selected, refractory OAB patients. These recent advances in OAB therapy are discussed in this review.

Summary: The treatment of OAB is often complex, and can require trials of multiple different treatment modalities. Although the treatment advances discussed in this review have augmented treatment of OAB, the condition continues to negatively impact quality of life for our ageing female population. Clinical trials and development of novel therapies continue to be paramount.
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http://dx.doi.org/10.1097/GCO.0000000000000207DOI Listing
October 2015

Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines.

Int J Eat Disord 2015 Nov 27;48(7):866-73. Epub 2015 Jan 27.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Objective: Cohort study from February 2003 through May 2011 to determine weight restoration and refeeding complication outcomes for patients with anorexia nervosa (AN) treated in an integrated inpatient-partial hospital eating disorder program designed to produce rapid weight gain and weight restoration in the majority.

Method: Consecutive admissions (females and males, adolescents and adults; N = 361 patients, 461 admissions) at least 1.8 kg below target weight with AN or subthreshold variants were included. Main outcome measures were rates of hypophosphatemia, transfer to medicine, or death; rates of weight gain and percent achieving weight restoration.

Results: Hypophosphatemia was present in 7.9% of cases at admission and in 18.5% at some point during treatment. Hypophosphatemia was mild to moderate. Lower admission body mass index (BMI), but not rate of weight gain, predicted hypophosphatemia [OR = 0.65; p < .00001 (95% CI 0.57-0.76)]. Five patients (1.1%) were transferred to medicine or surgery, none because of refeeding. There were no deaths. Mean inpatient weight gain was 1.98 kg/week; mean partial hospital weight gain was 1.36 kg/week. By program discharge, 71.8% of adults reached a BMI of 19, 58.5% a BMI of 20. For adolescents, 80.4% came within 2 kg of their target weight; 76.1% came within 1 kg.

Discussion: Refeeding patients with AN using a hospital-based, behavioral protocol may be accomplished safely and more rapidly than generally recognized, weight restoring most patients by discharge. Helpful elements may include the program's integrated, step-down structure; multidisciplinary team approach emphasizing group therapy to effect behavior change; and close medical monitoring for those with BMI < 15.
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http://dx.doi.org/10.1002/eat.22390DOI Listing
November 2015

Upward appearance comparison and the development of eating pathology in college women.

Int J Eat Disord 2014 Jul 29;47(5):467-70. Epub 2013 Dec 29.

Department of Psychology, Drexel University, Philadelphia, Pennsylvania.

Objective: Body dissatisfaction and disordered eating behaviors are common among college women, yet only a subset of this population develops clinically significant disordered eating symptoms during college. Appearance-based social comparisons, particularly those made to others with "better" bodies (i.e., upward appearance comparisons), have demonstrated concurrent relationships with body dissatisfaction and disordered eating. Little is known about the value of these comparisons for predicting the development of eating pathology, however.

Method: The present study examined the predictive value of upward appearance comparisons, as well as established risk factors (e.g., body dissatisfaction, negative affect), for the onset of clinically significant eating pathology over one college semester. College women (N = 454) completed validated self-report measures at the beginning of one semester, and again nine weeks later.

Results: Women who were newly above the clinical threshold for eating pathology at follow-up (n = 31) exhibited stronger baseline tendencies toward upward appearance comparisons than women who were below the threshold at both time points. In contrast, women who were already above the clinical threshold at baseline scored higher on established risk factors.

Discussion: These findings suggest that the extent of upward appearance comparison may be useful for identifying college women at particular risk for developing clinically significant disordered eating symptoms.
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http://dx.doi.org/10.1002/eat.22240DOI Listing
July 2014

Healthy employees, lower premiums and costs. Employers, providers and health plans have a new shared aim.

Healthc Exec 2013 Mar-Apr;28(2):84-6

Institute for Healthcare Improvement.

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June 2013

Starting out - Even when pushed for time, it is vital to keep up routine checks.

Authors:
Lindsay Martin

Nurs Stand 2009 Aug;23(51):29

University of Nottingham.

During my first week on a male orthopaedic ward I participated in a drug round while being supervised by my mentor.
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http://dx.doi.org/10.7748/ns.23.51.29.s32DOI Listing
August 2009

A comparison of computational color constancy algorithms--part II: experiments with image data.

IEEE Trans Image Process 2002 ;11(9):985-96

Simon Fraser University, Burnaby, BC, Canada.

We test a number of the leading computational color constancy algorithms using a comprehensive set of images. These were of 33 different scenes under 11 different sources representative of common illumination conditions. The algorithms studied include two gray world methods, a version of the Retinex method, several variants of Forsyth's gamut-mapping method, Cardei et al.'s neural net method, and Finlayson et al.'s Color by Correlation method. We discuss a number of issues in applying color constancy ideas to image data, and study in depth the effect of different preprocessing strategies. We compare the performance of the algorithms on image data with their performance on synthesized data. All data used for this study are available online at http://www.cs.sfu.ca/(tilde)color/data, and implementations for most of the algorithms are also available (http://www.cs.sfu.ca/(tilde)color/code). Experiments with synthesized data (part one of this paper) suggested that the methods which emphasize the use of the input data statistics, specifically color by correlation and the neural net algorithm, are potentially the most effective at estimating the chromaticity of the scene illuminant. Unfortunately, we were unable to realize comparable performance on real images. Here exploiting pixel intensity proved to be more beneficial than exploiting the details of image chromaticity statistics, and the three-dimensional (3-D) gamut-mapping algorithms gave the best performance.
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http://dx.doi.org/10.1109/TIP.2002.802529DOI Listing
May 2010

Type I diabetic bone phenotype is location but not gender dependent.

Histochem Cell Biol 2007 Aug 3;128(2):125-33. Epub 2007 Jul 3.

Department of Physiology, Biomedical Imaging Research Center, Michigan State University, 2201 Biomedical Physical Science Bldg, East Lansing, MI 48824, USA.

Bone is highly dynamic and responsive. Bone location, bone type and gender can influence bone responses (positive, negative or none) and magnitude. Type I diabetes induces bone loss and increased marrow adiposity in the tibia. We tested if this response exhibits gender and location dependency by examining femur, vertebrae and calvaria of male and female, control and diabetic BALB/c mice. Non-diabetic male mice exhibited larger body, muscle, and fat mass, and increased femur BMD compared to female mice, while vertebrae and calvarial bone parameters did not exhibit gender differences. Streptozotocin-induced diabetes caused a reduction in BMD at all sites examined irrespective of gender. Increased marrow adiposity was evident in diabetic femurs and calvaria (endochondrial and intramembranous formed bones, respectively), but not in vertebrae. Leptin-deficient mice also exhibit location dependent bone responses and we found that serum leptin levels were significantly lower in diabetic compared to control mice. However, in contrast to leptin-deficient mice, the vertebrae of T1-diabetic mice exhibit bone loss, not gain. Taken together, our findings indicate that TI-diabetic bone loss in mice is not gender, bone location or bone type dependent, while increased marrow adiposity is location dependent.
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http://dx.doi.org/10.1007/s00418-007-0308-4DOI Listing
August 2007

A comparison of important international and national standards for limiting exposure to EMF including the scientific rationale.

Health Phys 2007 Jun;92(6):635-41

Australian Radiation Protection and Nuclear Safety Agency, Yallambie, Victoria, Australia.

A comparison of Eastern (from Russia, Hungary, Bulgaria, Poland, and the Czech Republic) and Western (represented by the International Commission on Non-Ionizing Radiation Protection guidelines and the Institute of Electrical and Electronic Engineers standards) radiofrequency standards reveals key differences. The Eastern approach is to protect against non-thermal effects caused by chronic exposure to low level exposure, and the occupational basic restriction is power load (the product of intensity and exposure duration). In contrast, the Western approach is to protect against established acute biological effects that could signal an adverse health effect, and the principal basic restriction is the specific absorption rate to protect against thermal effects. All of the standards are science-based, but a fundamental difference arises from a lack of agreement on the composition of the reference scientific database and of which adverse effect needs to be protected against. However, differences also exist between the ICNIRP and IEEE standards. An additional complication arises when standards are derived or modified using a precautionary approach. For ELF the differences between ICNIRP and IEEE are more fundamental; namely, differences in the basic restriction used (induced current; in-situ electric field) and the location of breakpoints in the strength-frequency curves result in large differences. In 2006, ICNIRP will initiate the review of their ELF and radiofrequency guidelines, and this will provide an opportunity to address differences in standards and the move towards harmonization of EMF standards and guidelines.
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http://dx.doi.org/10.1097/01.HP.0000248111.57701.27DOI Listing
June 2007

Cost-effectiveness of an intervention to improve adherence to antiretroviral therapy in HIV-infected patients.

J Acquir Immune Defic Syndr 2006 Dec;43 Suppl 1:S113-8

Divisions of General Medicine and Infectious Diseases and the Partners AIDS Research Center, Massachusetts General Hospital, Boston, MA 02114, USA.

Adherence to antiretroviral medications has been shown to be an important factor in predicting viral suppression and clinical outcomes. The objective of this analysis was to assess the cost-effectiveness of a nursing intervention on antiretroviral adherence using data from a randomized controlled clinical trial as input to a computer-based simulation model of HIV disease. For a cohort of HIV-infected patients similar to those in the clinical trial (mean initial CD4 count of 319 cells/mm), implementing the nursing intervention in addition to standard care yielded a 63% increase in virologic suppression at 48 weeks. This produced increases in expected survival (from 94.5 to 100.9 quality-adjusted life months) and estimated discounted direct lifetime medical costs ($253,800 to $261,300). The incremental cost-effectiveness ratio for the intervention was $14,100 per quality-adjusted life year gained compared with standard care. Adherence interventions with modest effectiveness are likely to provide long-term survival benefit to patients and to be cost-effective compared with other uses of HIV care funds.
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http://dx.doi.org/10.1097/01.qai.0000248334.52072.25DOI Listing
December 2006