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A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study

OBJECTIVE

Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone.

RESEARCH DESIGN AND METHODS

Patients with diabetes and chronic DFUs were randomized (double-blind) to either active TWO2 therapy or sham control therapy—both in addition to optimal SOC. The primary outcome was the percentage of ulcers in each group achieving 100% healing at 12 weeks. A group sequential design was used for the study with three predetermined analyses and hard stopping rules once 73, 146, and ultimately 220 patients completed the 12-week treatment phase.

RESULTS

At the first analysis point, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% compared with 13.5%. This difference in outcome produced an odds ratio (OR) of 4.57 (97.8% CI 1.19, 17.57), P = 0.010. After adjustment for University of Texas Classification (UTC) ulcer grade, the OR increased to 6.00 (97.8% CI 1.44, 24.93), P = 0.004. Cox proportional hazards modeling, also after adjustment for UTC grade, demonstrated >4.5 times the likelihood to heal DFUs over 12 weeks compared with the sham arm with a hazard ratio of 4.66 (97.8% CI 1.36, 15.98), P = 0.004. At 12 months postenrollment, 56% of active arm ulcers were closed compared with 27% of the sham arm ulcers (P = 0.013).

CONCLUSIONS

This sham-controlled, double-blind randomized controlled trial demonstrates that, at both 12 weeks and 12 months, adjunctive cyclical pressurized TWO2 therapy was superior in healing chronic DFUs compared with optimal SOC alone.




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“Cubicle Activism”: Companies Face Growing Demands from Workers to Cut Ties with ICE and Others in Immigration Arena

From online petitions to organized walkouts, corporate America is facing increasing employee activism over its business involvement with agencies implementing the federal government's immigration policies. This "cubicle activism," seen at companies ranging from Amazon and Google to Bank of America and Wayfair, has garnered mixed success to date, forcing divestiture from private prison contractors but fewer results in other contexts, as this article explores.




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Will Supreme Court Ruling on DACA Finally Force Congress to Break the Ice on Immigration Reform?

The fate of the Deferred Action for Childhood Arrivals (DACA) program has ping ponged between all three branches of government. But with the Supreme Court poised to decide DACA's future in spring 2020, Congress may finally be forced to act to resolve the status of DREAMers after nearly two decades of considering various DREAM Act bills. Could this break the long stalemate Congress has had on passing substantive immigration legislation, and pave the way for other actions?




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Former ADA vice president dies at 87

Dr. Chauncey Cross, who served as vice president of the American Dental Association from 1997-98, died Sept. 5, 2019, on his 87th birthday.




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2019 marks big year for Washington office

The Association’s Washington office covered a wide range of advocacy issues in 2019 — from vaping to student loan reform to making sure dentistry was exempt from the U.S. Mexico-Tourism Act.




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Addressing caries through the lens of social justice, health equity, human rights

It’s a conviction that was published in the November issue of The Journal of the American Dental Association and the basis for the October 2019 forum that Dr. Francisco Ramos-Gomez fostered, where dentists, physicians, nurses and public health and public policy experts proposed, discussed and recommended solutions for preventing early childhood caries through the lens of social justice, health equity and human rights.




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Dental practice sued for allegedly sending unsolicited text messages

A class action lawsuit alleging that a Florida dental practice sent unsolicited text messages in violation of the Telephone Consumer Protection Act was filed in the U.S. District Court for the Southern District of Florida Jan. 6.




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Florida oral surgeon stays atop branding as practice expands

There is an art to conveying just who you are at every stage of your dental practice. One minute you could be a single-dentist practice with a hygienist and a receptionist, and then, the next thing you know, you could have a group practice and maybe even several locations.




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Dental service leaders visit Washington

Dental service leaders met with the ADA Council on Government Affairs Jan. 25 in Washington to discuss legislative and regulatory issues.




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Indian Health Service honoring National Children’s Dental Health Month

The Indian Health Service is presenting a four-part series of messages focused on their younger patients’ oral heath in honor of the February observance of National Children’s Dental Health Month.




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ADA unveils dental licensure interactive map

The ADA Council on Dental Education and Licensure launched in December an interactive map in an effort to assist dentists with keeping track of current initial licensure requirements by state.




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Dr. Bettie McKaig, first female ADA vice president, dies

Dr. Bettie R. McKaig, who served as the Association’s first vice president from 1998-99, died Feb. 3. She was 70.




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New dentists, ADA officers and Board members meet Feb. 9 to exchange ideas

Dr. Emily Mattingly, chair, New Dentist Committee, 6th District, shares her experience as a new dentist in a rural Missouri town. Three other NDC members also shared new dentist perspectives.




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Indian Health Service, ADA collaborate on Give Kids A Smile for first time

It was a Give Kids A Smile event not only for the children of the Mississippi Band of Choctaw Indians but also no fewer than 117 Indian Health Service dental programs across 24 states that were participating in GKAS with the events alone estimated to involve 14,000 American Indian/Alaska Native children.




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American Institute of Dental Public Health mentors next generation of service-oriented dentists

Dr. David P. Cappelli, Ph.D., acknowledges that as providers, we don’t often understand difficulties that some patients face to receive needed dental care.




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ADA Practice Transitions offering promotional trial for dentists who sign up through March 1

ADA Practice Transitions, a service offered by the ADA focused on helping dentists make the process of joining or leaving a practice successful, is offering a free three-month trial.




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New compendium summarizes best practices in oral health service delivery

Titled “Compendium of Innovations in Oral Health Service Delivery,” the 64-page digital booklet features organizations from across the country that have found success through varied measures in expanding oral care to underserved populations.




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Study: Dental fluorosis generally less noticeable over time

Results from a University of Iowa College of Dentistry study suggest that mild and moderate dental fluorosis is generally less noticeable over time, validating the beliefs of some supporters of community water fluoridation that there have been overestimates of fluorosis prevalence made by anti-fluoridation activists.




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Private practice pays $100,000 settlement for potential HIPAA violation

Ogden, Utah — The Office for Civil Rights announced March 3 that it had reached a settlement with Dr. Steven A. Porter’s medical practice to settle a potential violation of the Health Insurance Portability and Accountability Act security rule.




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ADA seeks clarification from HHS regarding chief dental officer

The American Dental Association is applauding the U.S. Department of Health and Human Services’ decision to appoint a chief dental officer at the Centers for Medicare & Medicaid but would like to confirm the position is exclusive to CMS.




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HPI poll examines impact of COVID-19 on dental practices

The ADA Health Policy Institute launched an ongoing biweekly poll the week of March 23 that shows 76% of dentists surveyed had closed their offices to all but emergency patients during the COVID-19 pandemic. Another 19% indicated their offices are closed completely.




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Office of Federal Student Aid has an FAQ for student loan questions

The U.S. Department of Education’s Office of Federal Student Aid has published an extensive FAQ addressing student loans, including answered questions that cover several new provisions from the Coronavirus Aid, Relief and Economic Security Act.




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New clinical dental licensure examination to launch in June

The Dental Licensure Objective Structured Clinical Examination, or DLOSCE, is expected to launch in June, the Joint Commission on National Dental Examinations announced April 2.




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ADA president appoints task force for dental practice recovery after COVID-19 pandemic

American Dental Association President Chad P. Gehani has assembled an advisory task force to oversee the ADA’s development of tools for dentists as they bounce back from the effects of practice restrictions and closures caused by the COVID-19 pandemic.




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ADA urges HHS to federally recognize licensed dentists to administer point of service COVID-19 tests

The ADA sent a letter to the U.S. Department of Health and Human Services April 17 asking the agency to “issue federal recognition that licensed dentists may administer point of service tests authorized by the Food and Drug Administration” during the COVID-19 pandemic.




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ADA president: Reopening dental practices needs a team approach

As some dental practices begin plans to reopen and provide nonemergency care — as some states reopen following the direction of their state — the Association is urging dentists to have robust communication and engage their dental team members to address any concerns related to returning to work amid the COVID-19 pandemic.




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Two new dental benefit guides address common hurdles anticipated when reopening practices

In the face of economic challenges, the ADA has released two online guides relating to third-party payment programs available at ADA.org/virus that are intended to help smooth the path of reopening practices: Handling Contract Negotiations and Handling Eligibility Verification




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PracticeUpdate Clinical Dentistry Channel unveiled to keep dentists current

The ADA announced May 1 the creation and launch of the PracticeUpdate Clinical Dentistry Channel, which delivers free evidence-based clinical content in general dentistry and specialty topics curated by a world-renowned editorial and advisory board.




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3M granted injunction against New Jersey company in N95 price-gouging scheme

A federal judge on May 4 granted 3M, the maker of N95 masks, an injunction against a New Jersey-based company accused of using 3M’s trademarks and deliberately inflating the price of the face masks.




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Oil prices ease on renewed concern about a weaker economy

Crude oil prices fell Monday amid renewed concerns about potentially declining crude oil demand resulting from weaker economic outlook.




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U.S. fuel pumps see first weekly price rise since October

Fuel prices in the United States on average were just a penny higher at $2.25 per gallon, ending consecutive price declines that had occurred since October.




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Crude prices rise after positive news from China

Oil prices rose early Tuesday, after Monday declines, possibly helped by some positive news from China -- but doubts remain as to whether that direction will hold.




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Crude oil prices drop after API reported lower-than-expected draw

Oil prices fell early Wednesday, likely a result of lower-than-expected draws in an API with traders awaiting official EIA inventory data later in the day.




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EIA sees fuel prices below 2018 average for the next two years

U.S. retail fuel prices will drop this year and in 2020 from 2018, but in both cases higher than January levels due to mandated lower sulfur in marine fuel.




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Oil prices led lower by rising U.S. production, inventories

Oil prices fell early Thursday despite an OPEC report confirming a sizable cut due to bearishness related to rising United States production and inventories.




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Oil prices fall on rising U.S. rigs, fading Venezuelan risk

Oil prices fell Monday as the number of rigs in the United States saw a weekly rise, analysts said




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U.S. fuel prices near last month's levels, unlikely to change

Average fuel prices in the United States started the week at $2.26 per gallon, showing little change from the last month or last week, and may remain flat.




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Crude oil prices rise amid renewed Venezuela concerns

Oil prices were higher early Tuesday amid renewed concern about Venezuelan supplies but market worries about China-U.S. trade issues prevented higher gains.




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Oil prices rise amid ongoing concern about Venezuela

Oil prices rose Wednesday amid expectations that Venezuelan oil shipments would see some disruption following U.S. sanctions.




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Crude oil prices rise early Friday amid supply concerns

Oil prices rose early Friday amid supply concerns following reports of smaller-than-expected stocks, and amid reduced expectation of interest rate hikes.




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2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents With Type 1 Diabetes

OBJECTIVE

In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 guideline on prevalence of HTN in children with type 1 diabetes mellitus (T1DM).

RESEARCH DESIGN AND METHODS

Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5–20 years) with T1DM have been documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years and 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004).

RESULTS

Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys but only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively.

CONCLUSIONS

Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.




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Police arrest two men in shooting death of Ahmaud Arbery

More than two months after Ahmaud Arbery was fatally shot while jogging near Brunswick, Georgia police arrested two men for the shooting, authorities said.




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DNA genealogy leads police to James E. Zastawnik in 1987 killing of Ohio teen Barbara Blatnik

Cleveland police say they have used DNA research to solve the 33-year-old strangling of a teenage girl, and arrest her killer.




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Watch: Kelly Clarkson on 'chaos' of filming 'The Voice' remotely

Kelly Clarkson discussed the challenges of filming "The Voice" at home amid the coronavirus pandemic.




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CBS orders first seasons of 'Clarice,' 'Equalizer,' 'B Positive' for 2020-21

CBS said it has ordered first seasons of three new shows -- "Clarice," "The Equalizer" and "B Positive" for the 2020-21 television season.




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How to Stay Sane While Staying Home: Advice from an Introvert

For loners, recluses, and other solitary types such as myself, sheltering-in-place feels natural and normal. However scary other aspects of this pandemic might be, for us, this aspect isn’t. Working...




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Podcast: Police Response to Quarantined Mental Health Crisis

What happens when the police are called to handle a mental health emergency? And is the current coronavirus pandemic affecting their response? In today’s podcast, Gabe interviews Sergeant Matt Harris,...




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[ Yahoo Answers ] Open Question : Nowadays many of legit questions are getting removed without notice. There's no appeal options also. How can I report about these mistakes?

*my legit questions




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[ Singles & Dating ] Open Question : WHAT TO DO, TO MAKE FRIENDS? I NEED ADVICE?




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[ Engineering ] Open Question : How can I determine data rate of wireless device given this information?

802.11n device 20 MHz band 32 QAM 1/2 coding rate What's formula?