bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathologists’ Participation and Performance in the Medicare Physician Quality Reporting System
Authors: Ge Li , Liu Xinliang
Published: September 2019

Objectives

Public reporting of quality metrics has become increasingly important for pathologists to demonstrate excellence of care and to secure value-based payments from both public and private payers. This study evaluated the participation and performance of pathologists in the Medicare Physician Quality Reporting System (PQRS).

Methods

This study conducted a retrospective review of the Physician Compare data files from 2016. Specifically, pathologists enrolled in the Physician Compare Initiative were identified and merged with quality data using uniquely assigned National Provider Identifiers. Descriptive statistics and multiple logistic regression were performed using Stata (version 12.1) statistical software (StataCorp, College Station, TX).

Results

Among the 11,637 pathologists identified in the Physician Compare Initiative, 8,408 pathologists (73.3%) participated in the PQRS. Regression analysis indicated that female gender, foreign medical graduate (FMG), and a larger number of employees in the affiliated organization were associated with a lower likelihood of participating in the PQRS. To protect patient privacy, the Centers for Medicare and Medicaid Services (CMS) only released the quality metrics of 353 pathologists, which were computed based on 20 or more Medicare beneficiaries. The three most commonly reported quality metrics included PQRS#249 Barrett’s Esophagus, PQRS#395 Lung Cancer Reporting (Biopsy/Cytology Specimens), and PQRS#397 Melanoma Reporting. The mean performance rates for the three most common metrics were 98.8% (SD 8.3%), 96.8% (SD 11.9%), and 97.4% (SD 6.9%), respectively.

Conclusion

A majority of pathologists participated in the Medicare PQRS program in 2016. The performance rates of public available quality metrics remained at high levels with significant variations in some metrics. Future research should examine the quality performance of pathologists as they transition from the PQRS to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.
The Utility of Immunohistochemistry in Diagnosing Liver Adenocarcinoma in Patients With Pancreatic Mass
Authors: Katerji Roula , Whitney-Miller Christa
Published: September 2019

Objectives

Biopsies of liver lesions frequently have two goals: confirm malignancy and determine the site of origin. We frequently encounter liver biopsies in patients with pancreatic mass (PM). Given the lack of a specific marker for pancreatic adenocarcinoma, a broad panel of immunohistochemical (IHC) stains is frequently done. In this study, we evaluated the usefulness of IHC staining in the setting of a liver biopsy in the presence of PM.

Methods

Between 2011 and 2017, 85 cases of liver biopsies or segmental resections with a diagnosis of adenocarcinoma in the presence of PM were retrieved from our archives. Clinical history of other malignancies, any other lesions detected by imaging studies, CA19-9 levels, and reevaluation of the available H&E and IHC slides were performed.

Results

The patients were divided into four groups: 74.1% with isolated PM on imaging and no previous history of any malignancy, 12.9% with PM on imaging with previous history-proven adenocarcinoma of the pancreas, 7.0% with PM in association with another lesion shown by imaging studies in other organs, and 5 (5.8%) PM on imaging in association with previous history of cancer somewhere else other than pancreas. At least two IHC stains were performed for each case. CK7 was ordered in all the cases and was positive in 100%; CK20 was positive in 35.8%. Interestingly, TTF-1 was positive in only one case, in the absence of discrete lung mass; the patient was treated for pancreatic adenocarcinoma.

Conclusion

We suggest that in the presence of PM, with liver metastasis of adenocarcinoma morphology on H&E, the metastasis is from the pancreas or upper gastrointestinal primarily and no need for further stains. Although performing IHC is useful sometimes, it should be ordered wisely; this practice will lower costs and result in higher quality care, with more effective use of the lab resources and personnel.
A Network Model of Communication and Test Utilization: A Laboratory Ambassador Program
Authors: Hutson LeAnne
Published: September 2019

Clinical laboratories often have the problem of poor communication between the lab and other health care professions, mainly nursing. This miscommunication can negatively influence employee satisfaction and patient care, requiring specimen recollections when quality is jeopardized. In an effort to improve specimen quality and build relationships between professionals, Parkland Hospital has worked to focus attention on laboratory/nursing communication by implementing the Laboratory Ambassador Program. The initial implementation of the Ambassador Program began in 2008 but ended in 2012 due to staffing issues. Afterward, the clinical laboratory noticed a marked increase in specimen recollections due to the specimen quality. They also found that both the nursing and laboratory staff missed the interactions between each other. As a result, the Ambassador Program restarted in 2018, targeting eight nursing units. A small team of laboratory professionals was assigned to each nursing unit and provided educational and reference material on specimen collections. The Ambassador Program at Parkland Hospital has proven to improve patient care by lessening specimen recollections by nearly 30%, and it has built critical relationships between nursing and the clinical laboratory staff. By working together with nursing, the laboratorians can now see the bigger picture of health care outside of the lab, and nursing now understands the complexities of laboratory testing and resulting.
Test Utilization of Serum Protein Electrophoresis and Immunofixation Electrophoresis
Authors: Katerji Roula , Paczos Tamera , Liu Li
Published: September 2019

Objectives

Serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) are commonly used to screen and monitor monoclonal gammopathies. Currently, there are no consensus guidelines on optimal testing frequency leading to overutilization. Here we examined the testing frequencies of SPE and IFE in our institution to provide an evidence-based perspective on efficient test utilization.

Methods

We retrospectively reviewed all SPE and IFE tests performed in 2018. Ordering patterns and testing frequencies were analyzed. In cases with more than monthly repeats, electronic medical records were reviewed to follow the result changes over time.

Results

There were 10,054 SPE and 4,248 IFE orders in 2018. The 4,248 IFE cases represented 2,439 patients, among whom 104 patients (4.3%) had IFE repeated more frequently than every 2 months and 50 patients (2%) more frequently than monthly. The 10,054 SPE cases represented 5,472 patients; 127 patients (2.3%) had SPE performed more than 12 times. Rare cases (0.1%) had SPE and IFE repeated every 1 to 2 weeks. Most IFE tests were ordered together with SPE (89% of all IFE orders), among which 28% of cases had normal SPE findings. Among the cases with more than monthly SPE and IFE tests, IFE results showed meaningful interpretation changes in a minimum period of 2 to 3 months; 35% cases had no IFE interpretation changes throughout the year. In contrast, during active treatment period of multiple myeloma, SPE detected paraprotein level change weekly.

Conclusion

IFE is overutilized and monthly monitoring does not add value even during active treatment of multiple myeloma. Our results support the need for the development of testing frequency guidelines to avoid overutilization and provide more cost-effective patient care.
Review of Free Prostate-Specific Antigen Assay Utilization at Danbury Hospital
Authors: Nguyen Quoc , Sena Salvador
Published: September 2019

Introduction

Measuring the concentration of free fraction of prostate-specific antigen (fPSA) present in serum in addition to the total PSA (tPSA) concentration has been shown to enhance specificity over tPSA alone in evaluating male patients with mild-moderate elevations of tPSA in the diagnostic “gray zone” (4.0-10.0 ng/mL) and negative findings on digital rectal exam. The clinical utility of fPSA has not been demonstrated outside the tPSA gray zone, as the probability of prostate cancer is very low at tPSA <4.0 and very high at tPSA >10.0. However, many clinicians order tPSA and fPSA concurrently without first knowing the results of the tPSA. This study was to review orders for fPSA and provide suggestions for improving utilization.

Methods

Paired test results for concurrently ordered tPSA and fPSA tests during the time periods of January to February 2018 and January to February 2019 (before and after laboratory information system upgrade) were extracted for quality assurance purposes. No patient identifiers were included. Data were sorted and the percentage of “appropriate” fPSA orders was calculated for each time period.

Results

The number of concurrent total and fPSA tests ordered was 174 for January-February 2018 and 232 for January-February 2019. The number of tPSA within the 4.0 to 10.0 ng/mL range was 78 for January-February 2018 and 148 for January-February 2019. The percentage of “appropriate” fPSA test orders (tPSA 4.0-10.0 ng/mL) was 44.8% for January-February 2018 and 63.8% for January-February 2019.

Conclusion

A high percentage of inappropriate fPSA orders was found during both time periods. Inappropriate fPSA testing is not only unnecessary and wasteful but can lead to diagnostic errors. Options for driving improved utilization include automatic canceling of fPSA orders when tPSA is not within the diagnostic gray zone and offering fPSA as a “reflex” test that is performed only when tPSA is within the diagnostic gray zone.
Comparison Between Integrated Genomic DNA/RNA Profiling and Fluorescence In Situ Hybridization in the Detection of MYC, BCL-2, and BCL-6 Gene Rearrangements in Large B-Cell Lymphomas
Authors: Cassidy Daniel P , Chapman Jennifer R , Lopez Rafael , White Kyle , Fan Yao-Shan , Casas Carmen , Severson Eric A , Vega Francisco
Published: September 2019

Objectives

To compare fluorescence in situ hybridization (FISH) and a commercially available sequencing assay for comprehensive genomic profiling (CGP) to determine the best approach to identify gene rearrangements (GRs) in large B-cell lymphomas (LBCLs).

Methods

Comparison of standard-of-care FISH assays (including a two-probe approach for MYC; break-apart and fusion probes) and an integrated genomic DNA/RNA sequencing CGP approach on a set of 69 consecutive LBCL cases.

Results

CGP detected GRs, including those involving MYC (1), BCL-2 (3), and BCL-6 (3), not detected by FISH. FISH detected non–IgH-MYC (4) and BCL-6 (2) GRs that were not detected by CGP. In four instances, standalone CGP or FISH testing would have missed a double-hit lymphoma.

Conclusions

CGP was superior to FISH in the detection of IgH-MYC rearrangements but was inferior for the detection of non–IgH-MYC rearrangements. Our study demonstrates the rationale for development of a customized approach to identify GRs in LBCLs.
Open-label Study with Nalmefene as Needed Use in Alcohol-Dependent Patients with Evidence of Elevated Liver Stiffness and/or Hepatic Steatosis
Authors: Mueller Sebastian , Luderer Mathias , Zhang Doris , Meulien Didier , Brach Björn Steiniger , Schou Maiken Brix
Published: September 2019

Aims

This open-label study in patients with alcohol dependence and evidence of elevated liver stiffness and/or hepatic steatosis was designed to explore the efficacy of nalmefene (18 mg) in reducing alcohol consumption and its subsequent effects on a variety of clinically relevant liver parameters.

Methods

Adult patients with a diagnosis of alcohol dependence and evidence of elevated liver stiffness and/or hepatic steatosis (liver stiffness >6 kPa or controlled attenuation parameter (CAP) >215 dB/m as measured by transient elastography) were recruited at two study sites in Germany. During the 12-week treatment period, patients were instructed to take nalmefene each day they perceived a risk of drinking alcohol.

Results

All 45 enrolled patients took at least one dose of nalmefene and 39 completed the study. After 12 weeks of study treatment with nalmefene patients showed a reduction in alcohol consumption of −13.5 days/month heavy drinking days and −45.8 g/day total alcohol consumption. Most liver parameters showed modest changes at Week 12; there was a 13% decrease in liver stiffness and 10% reduction in CAP values. Results indicated non-significant negative associations between alcohol consumption and liver stiffness and/or CAP over this 12-week study. Nalmefene was generally well tolerated, and most adverse events were mild or moderate, the most frequent being dizziness.

Conclusions

Patients treated with nalmefene for 12 weeks had reductions in alcohol consumption by ~50% relative to baseline and showed trends to improvement in liver stiffness and CAP.
Development of an Empirical Formula for Describing Human Inhalability of Airborne Particles at Low Wind Speeds and Calm Air
Authors: Cox Alexandra L , Handy Rodney G , Thiese Matthew S , Sleeth Darrah K
Published: September 2019

Based on experiments conducted in low wind speed and calm air environments, the current International Organization for Standardization (ISO) and European Committee for Standardization (CEN) convention modeling human aerosol inhalability (i.e. aspiration efficiency) may not be valid when wind speeds are less than 0.5 ms−1. Additionally, the convention is based primarily on mouth breathing data and aerosols with aerodynamic diameters smaller than 100 µm. Since the convention's development, experimental inhalation data at wind speeds lower than 0.5 ms−1 for nose, mouth, and oronasal breathing have been generated for aerosols in a wider range of sizes (1.5–135 µm). These data were gathered and modeled with the intention of providing a simple convention recommendation for inhalability in low wind speed (>0 to <0.5 ms−1) and calm air (~0 ms−1) conditions to the ISO Technical Committee (TC) 146, Subcommittee 2, Working Group (WG) 1 (‘Particle Size-Selective Sampling and Analysis'), as it relates to standard ISO 7708, and to CEN TC 137/WG 3, as it relates to standard EN 481. This paper presents several equations as possibilities, all relating aspiration efficiency to aerodynamic diameter. The equation AE=1+0.000019dae2−0.009788dae stands out as a possible new convention. This polynomial model balances simplicity and fit while addressing the weakness of the current convention.
A Hypothesis-Generating Study Using Electrophysiology to Examine Cognitive Function in Colon Cancer Patients
Authors: Hung Stanley Hughwa , Mutti Jaswal Sumeet , Neil-Sztramko Sarah Elizabeth , Kam Julia W Y , Niksirat Negin , C Handy Todd , Liu-Ambrose Teresa , Lim Howard J , Hayden Sherri , Gill Sharlene , Campbell Kristin L
Published: September 2019

Introduction

The purpose of this study was to describe the trajectory of cognitive function using neuropsychological tests and electrophysiological measures in individuals receiving 5FU/oxaliplatin chemotherapy for colon cancer.

Methods

A total of 10 participants were tested at baseline (within 3 weeks of starting chemotherapy), 6 months (coinciding with the end of chemotherapy treatment), and 12 months (approximately 6 months post-chemotherapy). Participants completed neuropsychological tests and electrophysiology recordings of P300 event-related potential (ERP) elicited by a sustained attention to response task paired with experience sampling of attentional states (subjective reports of on-task or mind wandering).

Results

No change in mean neuropsychological test performance was observed. Comparison of mean P300 ERP amplitudes as a function of attentional states (on-task vs. mind wandering) revealed no main effect of attentional state observed at baseline or 6 months, but a significant effect of attention was observed at 12 months, consistent with effects observed in healthy individuals.

Conclusions

Future studies can consider sustained attention constructs when studying cognitive function in colon cancer patients.
Optimal multisensory integration
Authors: Munoz Nicole E , Blumstein Daniel T
Published: September 2019

Animals are often confronted with potentially informative stimuli from a variety of sensory modalities. Although there is a large proximate literature demonstrating multisensory integration, no general framework explains why animals integrate. We developed and tested a quantitative model that explains why multisensory integration is not always adaptive and explains why unimodal decision-making might be favored over multisensory integration. We present our model in terms of a prey that must determine the presence or absence of a predator. A greater chance of encountering a predator, a greater benefit of correctly responding to a predator, a lower benefit of correctly foraging, or a greater uncertainty of the second stimulus favors integration. Uncertainty of the first stimulus may either increase or decrease the favorability of integration. In three field studies, we demonstrate how our model can be empirically tested. We evaluated the model with field studies of yellow-bellied marmots (Marmota flaviventer) by presenting marmots with an olfactory-acoustic predator stimulus at a feed station. We found some support for the model's prediction that integration is favored when the second stimulus is less noisy. We hope additional predictions of the model will guide future empirical work that seeks to understand the extent to which multimodal integration might be situation dependent. We suggest that the model is generalizable beyond antipredator contexts and can be applied within or between individuals, populations, or species.

Multisensory integration is often studied from a very proximate view that simply describes the process of integration. We developed a model, the first of its kind, to investigate the situations under which multisensory integration is adaptive. We empirically evaluated the model by investigating the conditions under which yellow-bellied marmots integrated predatory scents and sounds. We found that integration can depend on an animal's situation at a given point in time.
Microhabitat use and body size drive the evolution of colour patterns in snapping shrimps (Decapoda: Alpheidae: Alpheus)
Authors: Elias Marco A M , Anker Arthur , Gawryszewski Felipe M
Published: September 2019

Background matching and disruptive coloration are common strategies used by animals to increase concealment, whereas motion-dazzle may prevent capture after recognition. Studies have related background matching to habitat dependency and survival success, whereas for animals with highly contrasting patterns it has been shown that they are able to explore a broader range of habitats due to disruptive coloration, and possibly via motion-dazzle. However, the effects of these strategies are likely to be influenced by body size and to work better for smaller species. We applied phylogenetic comparative methods to test the hypothesis that smaller snapping shrimps (genus Alpheus) with high-contrast stripes would be able to utilize more microhabitats than non-striped and larger species. We used a published phylogeny of the American species of Alpheus, studies that have described alpheid microhabitats and size, and high-resolution photographs of each species in the phylogeny. Our categorical analysis suggested that generalist snapping shrimps are more likely to have stripes than specialist shrimps, and this effect was stronger in smaller species. Similarly, we found an interacting effect of body size and habitat use on the degree of luminance contrast: smaller generalist species had higher contrast values than average-sized and habitat-specialist species. Therefore, predators, body size and frequency of microhabitats are likely to have influenced the evolution of colour patterns in Alpheus.
TDP-43 cytoplasmic inclusion formation is disrupted in C9orf72-associated amyotrophic lateral sclerosis/frontotemporal lobar degeneration
Authors: Lee Samuel M , Asress Seneshaw , Hales Chadwick M , Gearing Marla , Vizcarra Juan C , Fournier Christina N , Gutman David A , Chin Lih-Shen , Li Lian , Glass Jonathan D
Published: September 2019

The G4C2 hexanucleotide repeat expansion mutation in the C9orf72 gene is the most common genetic cause underlying both amyotrophic lateral sclerosis and frontotemporal dementia. Pathologically, these two neurodegenerative disorders are linked by the common presence of abnormal phosphorylated TDP-43 neuronal cytoplasmic inclusions. We compared the number and size of phosphorylated TDP-43 inclusions and their morphology in hippocampi from patients dying with sporadic versus C9orf72-related amyotrophic lateral sclerosis with pathologically defined frontotemporal lobar degeneration with phosphorylated TDP-43 inclusions, the pathological substrate of clinical frontotemporal dementia in patients with amyotrophic lateral sclerosis. In sporadic cases, there were numerous consolidated phosphorylated TDP-43 inclusions that were variable in size, whereas inclusions in C9orf72 amyotrophic lateral sclerosis/frontotemporal lobar degeneration were quantitatively smaller than those in sporadic cases. Also, C9orf72 amyotrophic lateral sclerosis/frontotemporal lobar degeneration homogenized brain contained soluble cytoplasmic TDP-43 that was largely absent in sporadic cases. To better understand these pathological differences, we modelled TDP-43 inclusion formation in fibroblasts derived from sporadic or C9orf72-related amyotrophic lateral sclerosis/frontotemporal dementia patients. We found that both sporadic and C9orf72 amyotrophic lateral sclerosis/frontotemporal dementia patient fibroblasts showed impairment in TDP-43 degradation by the proteasome, which may explain increased TDP-43 protein levels found in both sporadic and C9orf72 amyotrophic lateral sclerosis/frontotemporal lobar degeneration frontal cortex and hippocampus. Fibroblasts derived from sporadic patients, but not C9orf72 patients, demonstrated the ability to sequester cytoplasmic TDP-43 into aggresomes via microtubule-dependent mechanisms. TDP-43 aggresomes in vitro and TDP-43 neuronal inclusions in vivo were both tightly localized with autophagy markers and, therefore, were likely to function similarly as sites for autophagic degradation. The inability for C9orf72 fibroblasts to form TDP-43 aggresomes, together with the observations that TDP-43 protein was soluble in the cytoplasm and formed smaller inclusions in the C9orf72 brain compared with sporadic disease, suggests a loss of protein quality control response to sequester and degrade TDP-43 in C9orf72-related diseases.
Ultrastructural Evidence for a Role of Astrocytes and Glycogen-Derived Lactate in Learning-Dependent Synaptic Stabilization
Authors: Vezzoli E , Calì C , De Roo M , Ponzoni L , Sogne E , Gagnon N , Francolini M , Braida D , Sala M , Muller D , Falqui A , Magistretti P J
Published: September 2019

Long-term memory formation (LTM) is a process accompanied by energy-demanding structural changes at synapses and increased spine density. Concomitant increases in both spine volume and postsynaptic density (PSD) surface area have been suggested but never quantified in vivo by clear-cut experimental evidence. Using novel object recognition in mice as a learning task followed by 3D electron microscopy analysis, we demonstrate that LTM induced all aforementioned synaptic changes, together with an increase in the size of astrocytic glycogen granules, which are a source of lactate for neurons. The selective inhibition of glycogen metabolism in astrocytes impaired learning, affecting all the related synaptic changes. Intrahippocampal administration of l-lactate rescued the behavioral phenotype, along with spine density within 24 hours. Spine dynamics in hippocampal organotypic slices undergoing theta burst-induced long-term potentiation was similarly affected by inhibition of glycogen metabolism and rescued by l-lactate. These results suggest that learning primes astrocytic energy stores and signaling to sustain synaptic plasticity via l-lactate.
Improving Human Action Recognition Using Hierarchical Features And Multiple Classifier Ensembles
Authors: Bulbul Mohammad Farhad , Islam Saiful , Zhou Yatong , Ali Hazrat
Published: September 2019

This paper presents a simple, fast and efficacious system to promote the human action classification outcome using the depth action sequences. Firstly, the motion history images (MHIs) and static history images (SHIs) are created from the front (XOY), side (YOZ) and top (XOZ) projected scenes of each depth sequence in a 3D Euclidean space through engaging the 3D Motion Trail Model (3DMTM). Then, the Local Binary Patterns (LBPs) algorithm is operated on the MHIs and SHIs to learn motion and static hierarchical features to represent the action sequence. The motion and static hierarchical feature vectors are then fed into a classifier ensemble to classify action classes, where the ensemble comprises of two classifiers. Thus, each ensemble includes a pair of Kernel-based Extreme Learning Machine (KELM) or ${\mathrm{l}}_{\mathrm{2}}$-regularized Collaborative Representation Classifier (${\mathrm{l}}_{\mathrm{2}}$-CRC) or Multi-class Support Vector Machine. To extensively assess the framework, we perform experiments on a couple of standard available datasets such as MSR-Action3D, UTD-MHAD and DHA. Experimental consequences demonstrate that the proposed approach gains a state-of-the-art recognition performance in comparison with other available approaches. Several statistical measurements on recognition results also indicate that the method achieves superiority when the hierarchical features are adopted with the KELM ensemble. In addition, to ensure real-time processing capability of the algorithm, the running time of major components is investigated. Based on machine dependency of the running time, the computational complexity of the system is also shown and compared with other methods. Experimental results and evaluation of the computational time and complexity reflect real-time compatibility and feasibility of the proposed system.
Benchmarking database systems for Genomic Selection implementation
Authors: Nti-Addae Yaw , Matthews Dave , Ulat Victor Jun , Syed Raza , Sempéré Guilhem , Pétel Adrien , Renner Jon , Larmande Pierre , Guignon Valentin , Jones Elizabeth , Robbins Kelly
Published: September 2019

Motivation

With high-throughput genotyping systems now available, it has become feasible to fully integrate genotyping information into breeding programs. To make use of this information effectively requires DNA extraction facilities and marker production facilities that can efficiently deploy the desired set of markers across samples with a rapid turnaround time that allows for selection before crosses needed to be made. In reality, breeders often have a short window of time to make decisions by the time they are able to collect all their phenotyping data and receive corresponding genotyping data. This presents a challenge to organize information and utilize it in downstream analyses to support decisions made by breeders. In order to implement genomic selection routinely as part of breeding programs, one would need an efficient genotyping data storage system. We selected and benchmarked six popular open-source data storage systems, including relational database management and columnar storage systems.

Results

We found that data extract times are greatly influenced by the orientation in which genotype data is stored in a system. HDF5 consistently performed best, in part because it can more efficiently work with both orientations of the allele matrix.

Availability

http://gobiin1.bti.cornell.edu:6083/projects/GBM/repos/benchmarking/browse
Iron deficiency in worsening heart failure is associated with reduced estimated protein intake, fluid retention, inflammation, and antiplatelet use
Authors: van der Wal Haye H , Grote Beverborg Niels , Dickstein Kenneth , Anker Stefan D , Lang Chim C , Ng Leong L , van Veldhuisen Dirk J , Voors Adriaan A , van der Meer Peter
Published: September 2019

Aims

Iron deficiency (ID) is common in heart failure (HF) patients and negatively impacts symptoms and prognosis. The aetiology of ID in HF is largely unknown. We studied determinants and the biomarker profile of ID in a large international HF cohort.

Methods and results

We studied 2357 worsening HF patients from the BIOSTAT-CHF cohort. ID was defined as transferrin saturation <20%. Univariable and multivariable logistic regression models were constructed to identify determinants for ID. We measured 92 cardiovascular markers (Olink Cardiovascular III) to establish a biomarker profile of ID. The primary endpoint was the composite of all-cause mortality and first HF rehospitalization. Mean age (±standard deviation) of all patients was 69 ± 12.0 years, 26.1% were female and median N-terminal pro B-type natriuretic peptide levels (+interquartile range) were 4305 (2360–8329) ng/L. Iron deficiency was present in 1453 patients (61.6%), with highest prevalence in females (71.1% vs. 58.3%; P < 0.001). Independent determinants of ID were female sex, lower estimated protein intake, higher heart rate, presence of peripheral oedema and orthopnoea, chronic kidney disease, lower haemoglobin, higher C-reactive protein levels, lower serum albumin levels, and P2Y12 inhibitor use (all P < 0.05). None of these determinants were sex-specific. The biomarker profile of ID largely consisted of pro-inflammatory markers, including paraoxonase 3 (PON3) and tartrate-resistant acid phosphatase type 5. In multivariable Cox proportional hazard regression analyses, ID was associated to worse outcome, independently of predictors of ID (hazard ratio 1.25, 95% confidence interval 1.06–1.46; P = 0.007).

Conclusion

Our data suggest that the aetiology of ID in worsening HF is complex, multifactorial and seems to consist of a combination of reduced iron uptake (malnutrition, fluid overload), impaired iron storage (inflammation, chronic kidney disease), and iron loss (antiplatelets).
General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study
Authors: Kjellstadli Camilla , Allore Heather , Husebo Bettina S , Flo Elisabeth , Sandvik Hogne , Hunskaar Steinar
Published: September 2019

Background

General practitioners (GPs) may play an important role in providing end-of-life care to community-dwelling people.

Objective

To investigate patients' contacts with GPs, GPs' interdisciplinary collaboration, out-of-hours services and hospitalizations in the last 13 weeks of life and associations with dying at home. Second, investigate whether GP contacts were associated with fewer out-of-hours contacts or days hospitalized.

Methods

Individually linked data from the Norwegian Cause of Death Registry, Norwegian Patient Registry, Statistics Norway and Control and Payment of Reimbursement to Health Service Providers database for all 80 813 deceased people in Norway within 2012–13. Outcomes were analyzed with logistic regression and negative binomial multilevel mixed-effect models.

Results

Overall, 1% of people received GP home visits in Week 13 and 4.6% in the last week before death. During the last 4 weeks of life, 9.2% received one or more GP home visits. Altogether, 6.6% received one or more home visits when the GP had one or more interdisciplinary collaborations during the last 4 weeks, of which <3% died at home. GP office consultations decreased towards the end of life. The likelihood of home death versus another location increased in relation to GP home visits [one home visit odds ratio (OR) 1.92, confidence interval (CI) 1.71–2.15; two or more OR 3.49, CI 3.08–3.96] and GP interdisciplinary collaboration (one contact OR 1.76, CI 1.59–1.96; two or more OR 2.52, CI 2.32–2.74).

Conclusions

GPs play a role in enabling people to die at home by performing home visits and collaborating with other health care personnel. Only a minority received such services in Norway.
Precarity and Aging: A Scoping Review
Authors: Grenier Amanda , Hatzifilalithis Stephanie , Laliberte-Rudman Debbie , Kobayashi Karen , Marier Patrik , Phillipson Chris
Published: September 2019

Background and Objective

The concept of precarity holds the potential to understand insecurities and risks experienced by older people in the contemporary social, economic, political and cultural context. This study maps existing conceptualizations of precarity in relation to aging and later life, identifies key themes, and considers the use of precarity in two subfields.

Research Design and Methods

This article presents the findings of a two-phase scoping study of the international literature on precarity in later life. Phase I involved a review of definitions and understandings of precarity and aging. Phase II explored two emerging subthemes of disability and im/migration as related to aging and late life.

Results

A total of 121 published studies were reviewed across Phase I and Phase II. Findings reveal that the definition of precarity is connected with insecurity, vulnerability, and labor and that particular social locations, trajectories, or conditions may heighten the risk of precarity in late life.

Implications and Discussion

The article concludes by outlining the need for conceptual clarity, research on the unique multidimensional features of aging and precarity, the delineation of allied concepts and emerging applications, and the importance of linking research results with processes of theory building and the development of policy directives for change.
Ground motion simulation and validation of the 2008 Chino Hills earthquake in scattering media
Authors: Savran W H , Olsen K B
Published: September 2019

We simulate 0–2.5 Hz deterministic wave propagation in 3-D velocity models for the 2008 Chino Hills, CA, earthquake using a finite-fault source model and frequency-dependent anelastic attenuation. Small-scale heterogeneities are modeled as 3-D random fields defined using an elliptically anisotropic von Kármán autocorrelation function with its parameters constrained using Los Angeles basin borehole data. We superimpose the heterogeneity models on a leading deterministic community velocity model (CVM) of southern California. We find that models of velocity and density perturbations can have significant effects on the wavefield at frequencies as low as 0.5 Hz, with ensemble median values of various ground motion metrics varying up to ±50 per cent compared to those computed using the deterministic CVM only. In addition, we show that frequency-independent values of the shear-wave quality factor (Qs0) parametrized as Qs0 = 150Vs (Vs in km s–1) provides the best agreement with data when assuming the published moment magnitude (Mw) of 5.4 (M0 = 1.6 × 1017 Nm) for the finite-fault source model. This model for Qs0 trades off with Qs0 = 100Vs assuming Mw = 5.5 (M0 = 2.2 × 1017 Nm), which represents an upper bound of the Mw estimates for this event. We find the addition of small-scale heterogeneities provides limited overall improvement to the misfit between simulations and data for the considered ground motion metrics, because the primary sources of misfit originate from the deterministic CVM and/or the finite-fault source description.
High-frequency seismic wave modelling of the deep Earth based on hybrid methods and spectral-element simulations: a conceptual study
Authors: Lin Chuangxin , Monteiller Vadim , Wang Kai , Liu Tianshi , Tong Ping , Liu Qinya
Published: September 2019

Over the past few decades, seismic studies have revealed complex structural anomalies in the Earth’s deep interior at various scales, such as large low-shear-velocity provinces (LLSVPs) and ultra-low velocity zones (ULVZs) in the lowermost mantle, and small-scale scatterers in the mid-mantle. These structures which are critical for better understanding of the geodynamics and evolution of the deep Earth, need to be further resolved by high-resolution imaging techniques. The spectral-element method (SEM) can be used to accurately simulate seismic wave propagation in heterogeneous Earth models, and its application in full-waveform inversion (FWI) provides a promising high-resolution and high-fidelity imaging technique. But it can be computationally prohibitive when used to model small scale structures in the deep Earth based upon high-frequency seismic waves. The heavy computational cost can be circumvented by using hybrid methods, which restrict the main computation by SEM solver to only a small target region (e.g. above the CMB) encompassing possible 2-D/3-D anomalies, and apply efficient analytical or numerical methods to calculate the wavefield for 1-D background models. These forward modelling tools based on hybrid methods can be then used in the so-called ‘box tomography’ approach to resolve fine-structures in the deep Earth.

In this study, we outline the theory of a hybrid method used to model small scale structures in the deep Earth and present its implementation based on SEM solvers in a three-step workflow. First, the wavefield generated by the source is computed for the 1-D background model with traction and velocity saved for the virtual boundary of the target region, which are then used as boundary inputs to simulate the wavefield in the target region based on absorbing boundary condition in SEM. In the final step, the total wavefield at receivers is reconstructed based upon the total wavefield on the virtual boundary computed in the previous step. As a proof-of-concept study, we demonstrate the workflow of the hybrid method based on a 2-D SEM solver. Examples of the hybrid method applied to a coupled fluid–solid model show that our workflow can accurately recover the scattered waves back to the surface. Furthermore, we benchmark the hybrid method on a realistic heterogeneous Earth model built from AK135-F and show how teleseismic scattered waves can be used to model deep Earth structures. By documenting the theory and SEM implementation of the hybrid method, our study lays the foundation for future two-way coupling of 3-D SEM solver with other efficient analytic or numerical 1-D solvers.
Galectin-8 in the onset of the immune response and inflammation
Authors: Tribulatti María V , Carabelli Julieta , Prato Cecilia A , Campetella Oscar
Published: September 2019

Galectins (Gals), a family of mammalian lectins, have emerged as key regulators of the immune response, being implicated in several physiologic and pathologic conditions. Lately, there is increasing data regarding the participation of Galectin-8 (Gal-8) in both the adaptive and innate immune responses, as well as its high expression in inflammatory disorders. Here, we focus on the pro- and anti-inflammatory properties of Gal-8 and discuss the potential use of this lectin in order to shape the immune response, according to the context.
Is tuberculosis elimination a feasible goal in Colombia by 2050?
Authors: López Lucelly , Keynan Yoav , Marin Diana , Ríos-Hincapie Cielo Yaneth , Montes Fernando , Escudero-Atehortua Ana Cecilia , Rueda Zulma Vanessa
Published: September 2019

Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and the mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015. The aims of this study were: To evaluate whether Colombia will be able to achieve the goals of TB incidence and mortality by 2050, using the current strategies; and whether the implementation of new screening, diagnosis and TB treatment strategies will allow to achieve those WHO targets. An ecological study was conducted using TB case-notification, successful treatment and mortality rates from the last 8 years (2009–17). System dynamics analysis was performed using simulated scenarios: (1) continuation with the same trends following the trajectory of the last 8 years (Status quo) and (2) modification of the targets between 2017 through 2050, assuming the implementation of multimodal strategies to increase the screening, to improve the early diagnosis and to improve the treatment adherence. Following the current strategies, it is projected that Colombia will not achieve the End TB strategy targets. Achieving the goal of TB incidence of 10/100 000 by 2050 will only be possible by implementing combined strategies for increasing screening of people with respiratory symptoms, improving access to rapid diagnostic tests and improving treatment adherence. Therefore, it is necessary to design and implement simultaneous strategies according to the population needs and resources, in order to stride towards the End TB targets.
Community-based men’s health promotion programs: eight lessons learnt and their caveats
Authors: Oliffe John L , Rossnagel Emma , Bottorff Joan L , Chambers Suzanne K , Caperchione Cristina , Rice Simon M
Published: September 2019

Long-standing commentaries about men’s reticence for accessing clinical medical services, along with the more recent recognition of men’s health inequities, has driven work in community-based men’s health promotion. Indeed, the 2000s have seen rapid growth in community-based programs targeting men, and across this expanse of innovative work, experiential and empirical insights afford some important lessons learnt, and caveats to guide existing and future efforts. The current article offers eight lessons learnt regarding the design, content, recruitment, delivery, evaluation and scaling of community-based men’s health promotion programs. Design lessons include the need to address social determinants of health and men’s health inequities, build activity-based programming, garner men’s permission and affirmation to shift masculine norms, and integrate content to advance men’s health literacy. Also detailed are lessons learnt about men-friendly spaces, recruitment and retention strategies, the need to incrementally execute program evaluations, and the limits for program sustainability and scaling. Drawing from diverse community-based programs to illustrate the lessons learnt, caveats are also detailed to contextualize and caution some aspects of the lessons that are shared. The express aim of discussing lessons learnt and their caveats, reflected in the purpose of the current article, is to guide existing and future work in the ever growing field of community-based men’s health promotion.
Hypoxic drive caused type 3 neovascularization in a preclinical model of exudative age-related macular degeneration
Authors: Zhang Lijuan , Cui Xuan , Han Yangjun , Park Karen Sophia , Gao Xiaohong , Zhang Ximei , Yuan Zhigang , Hu Yong , Hsu Chun-Wei , Li Xiaorong , Bassuk Alexander G , Mahajan Vinit B , Wang Nan-Kai , Tsang Stephen H
Published: September 2019

Hypoxia associated with the high metabolic demand of rods has been implicated in the pathology of age-related macular degeneration (AMD), the most common cause of adult blindness in the developed world. The majority of AMD-associated severe vision loss cases are due to exudative AMD, characterized by neovascularization. To further investigate the causes and histopathology of exudative AMD, we conditionally induced hypoxia in a novel preclinical AMD model (Pde6gcreERT2/+;Vhl−/−) by targeting Vhl and used multimodal imaging and immunohistochemistry to track the development of hypoxia-induced neovascularization. In addition to developing a preclinical model that phenocopies exudative AMD, our studies revealed that the photoreceptor hypoxic response initiates and drives type 3 neovascularization, mainly in the outer retina. Activation of the VHL-HIF1a-VEGF-EPO pathway in the adult retina led to long-term neovascularization, retinal hemorrhages and compromised retinal layers. Our novel preclinical model would accelerate the testing of therapies that use metabolomic approaches to ameliorate AMD.
Towards sustainable European seaweed value chains: a triple P perspective
Authors: van den Burg S W K , Dagevos H , Helmes R J K
Published: September 2019

Seaweeds are seen as important future feedstock for Europe, providing biomass for food, feed, and other applications. Seaweeds can contribute to a circular food system a protein transition and bio-based economy. Europe is a minor player in the world market dominated by the Asian producers and processors. According to the FAO, total production of aquatic plants (dominated by seaweed) was 30 million tonnes in 2016, with China (47.9%) and Indonesia (38, 7%) dominating production. This article discusses the challenges to seaweed production and use in Europe and formulates future directions for upscaling the European seaweed sector. From a People, Planet, Profit perspective, there is no need to focus on producing large volumes of seaweed per se. We need to focus on nature-inclusive production systems, producing the right amount of the right seaweeds, based on the carrying capacity of the European seas. The seaweed sector must avoid developing along the “old” economy’s way of cost leadership but develop along the way of the “new” circular economy. Seaweeds should not be seen as a new product “added” to the market but become an integral part of the European food system, being used for human consumption, feed and improving production processes.
Aerodynamic and structural optimization of wind turbine blade with static aeroelastic effects
Authors: Zhu Jie , Ni Xiaohui , Shen Xiaomei
Published: September 2019

With the increasing size of wind turbine blade, the aeroelastic analysis becomes an essential step in the blade design process. The scope of this paper is to investigate the static aeroelastic effects between the fluid–structure interaction and improve the blade performances. First, the rigid and flexible blades are used to analyze the effects of static aeroelasticity on the blade aerodynamic and structural performances through a blade element momentum model coupled with 3D finite element analysis model. Based on this, a multi-objective aerodynamic and structural optimization method is proposed aiming at increasing the annual energy production and reducing blade mass, key parameters of the blade are employed as design variables, and various design requirements including strain, deflection, vibration and buckling limits are considered as constraints. Finally, a commercial 1.5 MW wind turbine blade is applied as a case study, and the optimization results show great improvements for the aerodynamic and structural performances of the blade.
Moving frames and Noether’s finite difference conservation laws II
Authors: Mansfield E L , Rojo-Echeburúa A
Published: September 2019

In this second part of the paper, we consider finite difference Lagrangians that are invariant under linear and projective actions of $SL(2)$, and the linear equi-affine action that preserves area in the plane. We first find the generating invariants, and then use the results of the first part of the paper to write the Euler–Lagrange difference equations and Noether’s difference conservation laws for any invariant Lagrangian, in terms of the invariants and a difference moving frame. We then give the details of the final integration step, assuming the Euler Lagrange equations have been solved for the invariants. This last step relies on understanding the adjoint action of the Lie group on its Lie algebra. We also use methods to integrate Lie group invariant difference equations developed in Part I. Effectively, for all three actions, we show that solutions to the Euler–Lagrange equations, in terms of the original dependent variables, share a common structure for the whole set of Lagrangians invariant under each given group action, once the invariants are known as functions on the lattice.