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The direct current bias for photovoltaic (PV) modules interconnected in series‐strings may include both high voltage negative ("HV−") and positive ("HV+") polarity with respect to the electrical ground. Multiple degradation modes, resulting in quantifiable optical loss, were found to occur during HV−/HV+ sequential stress, including corrosion of the external glass surface, encapsulant delamination (at its interfaces with the glass and the PV cell), internal haze formation (resulting from a chemical interaction between the glass and the encapsulant), corrosion and migration of the gridlines, and corrosion of the silicon nitride (SixNy) antireflective coating on the cell. The effects of these separate modes were examined using monolithic (e.g., glass or PV cell) and laminated‐coupon (glass/encapsulant/glass or glass/encapsulant/cell/encapsulant/backsheet) specimens. Characterizations during and after unbiased accelerated testing at 85°C/85% relative humidity included spectrophotometry, optical microscopy, electron microscopy, and ellipsometry. For some module components (i.e., the glass and the SixNy coating), the optical performance was determined through iterative analysis of empirical measurements. Concentrating on just their spectral effect, a novel model was then developed to estimate the transfer of light to the PV cell and the return of light from the PV module with simultaneous degradation mechanisms, which was compared with a mini‐module previously subjected to HV−/HV+ stress. The model suggests that one third of the current loss observed for the mini‐module can be attributed to the optical degradation of the packaging materials. The dominant degradation modes include encapsulant delamination and corrosion of the SixNy coating. Recommendations are given so that the optical model may be improved relative to accelerated testing and validated relative to field aging. [ABSTRACT FROM AUTHOR]

Combined‐accelerated stress testing (C‐AST) is developed to establish the durability of photovoltaic (PV) products, including for degradation modes that are not a priori known or examined in standardized tests. C‐AST aims to comprehensively represent the sample, stress factors, and their combinations using levels at the statistical tails of the natural environment. Acceleration factors for relevant climate sequences within the C‐AST cycle with respect to the Florida USA climate are estimated for selected degradation mechanisms. It is found that for degradation of the outer backsheet polymer layer, the acceleration factor of the tropical climate sequence (the longest of the climate sequences) is f (T, G) = 17.3 with ultraviolet photodegradation; for polyethylene terephthalate hydrolysis (backsheets), f (T, RH) = 426; for electrochemical corrosion (PV cell), f (I) = 14.1; and for PbSn solder fatigue f (ΔT, r (T)) = 17.3. Here, T is the module temperature, G is the broadband spectrum irradiance on the plane of array of the module, RH is the relative humidity on the module surface, I is the leakage current through the module packaging, and r(T), the number of temperature reversals. The methods discussed herein are generally applicable for evaluating acceleration factors in other accelerated test methods. [ABSTRACT FROM AUTHOR]

Degradation from ultraviolet (UV) radiation has become prevalent in the front of solar cells due to the introduction of UV‐transmitting encapsulants in photovoltaic (PV) module construction. Here, we examine UV‐induced degradation (UVID) in various commercial, unencapsulated crystalline silicon cell technologies, including bifacial silicon heterojunction (HJ), interdigitated back contact (IBC), passivated emitter and rear contact (PERC), and passivated emitter rear totally diffused (PERT) solar cells. We performed UV exposure tests using UVA‐340 fluorescent lamps at 1.24 W·m−2 (at 340 nm) and 45°C through 4.02 MJ·m−2 (2000 h). Our results showed that modern cell architectures are more vulnerable to UVID, leading to a significant power decrease (−3.6% on average; −11.8% maximum) compared with the conventional aluminum back surface field (Al‐BSF) cells (<−1% on average). The power degradation is largely caused by the decrease in short‐circuit current and open‐circuit voltage. A greater power decrease is observed in bifacial cells with rear‐side exposure compared with those with front‐side exposure, indicating that the rear side is more susceptible to UV damage. Secondary ion mass spectroscopy (SIMS) confirmed an increase in hydrogen concentration near the Si/passivation interface in HJ and IBC cells after UV exposure; the excess of hydrogen could result in hydrogen‐induced degradation and subsequently cause higher recombination losses. Additionally, surface oxidation and hot‐carrier damage were identified in PERT cells. Using a spectral‐based analysis, we obtained an acceleration factor of 5× between unpackaged cells (containing a silicon nitride antireflective coating on the front) in the UV test and an encapsulated module (with the front glass and encapsulant blocking 90% of the UV at 294 nm and 353 nm, respectively) in outdoor conditions. From the analytical calculations, we show that a UV‐blocking encapsulant can reduce UV transmission in the module by an additional factor of ~50. [ABSTRACT FROM AUTHOR]

Accurate thermodynamic properties of electrolyte systems are critical for the design and operation of many chemical processes. A comprehensive description of the thermodynamic framework for multielectrolyte mixed solvent systems is presented, where the parameter structure of the symmetric electrolyte‐non‐random two liquid (e‐NRTL) model is reformulated and a thermodynamically consistent and analytically derived formulation for the excess enthalpy is developed from the e‐NRTL model. The refined parameter structure of the e‐NRTL model avoids numerical singularities of the analytical formulation for the excess enthalpy in the absence of ionic species and extends the derived excess enthalpy formulation to non‐electrolyte systems. The thermodynamic framework is demonstrated for the MEA‐H2O‐CO2 case study using experimental data on thermodynamic quantities for the binary MEA‐H2O system and the ternary MEA‐H2O‐CO2 system. The model is implemented in Pyomo and will be available for release in the Institute for the Design of Advanced Energy Systems (IDAES) computational platform. [ABSTRACT FROM AUTHOR]

Accurate, predictive reaction models are critical for the design and optimization of chemical looping combustion (CLC) reactors. The formulation and estimation of kinetic parameters for these reaction models using a first‐principles equation‐oriented (EO) approach is particularly beneficial as large amounts of experimental data spanning process‐relevant conditions can be used to estimate parameters in a computationally tractable way. This work demonstrates the application of a novel EO framework to develop reduction reaction kinetic models of an iron‐based CLC oxygen carrier (OC). An optimization problem is formulated to estimate kinetic parameters that provide the best fit to the experimental data. The model predicts the state of the OC with mean square error values of 2.5%–4.4% across the full range of validation data, including multiple reduction cycles. [ABSTRACT FROM AUTHOR]

The optical degradation of encapsulants from ultraviolet (UV) radiation has historically resulted in a significant loss in performance throughout the life of a photovoltaic (PV) module. International Electrotechnical Commission (IEC) test methods have recently been developed to screen for PV encapsulants prone to loss in optical performance. The present study was performed to benchmark polymeric packaging materials relative to IEC 62788‐1‐4 (covering the measurement of optical transmittance) and IEC 62788‐1‐7 (on the durability of transmittance), provide feedback toward improvement of the methods, and develop insight regarding optical degradation. Contemporary materials were examined, including poly(ethylene‐co‐vinyl acetate) (EVA), thermoplastic polyolefin (TPO), polyolefin elastomer (POE), and polyvinyl butyral (PVB) encapsulants; a poly(ethene‐co‐tetrafluoroethene)/poly(ethylene terephthalate) (ETFE/PET) transparent backsheet; and a polystyrene (PS) working reference material. The use of silica‐, specialty‐, and rolled‐glass was also compared in laminated coupons. Specimen size was separately examined from 2.5 to 12.5 cm. Weathering was performed with a xenon source, using IEC TS 62788‐7‐2 methods A2, A3, A4, and A5 (chamber temperature of 55°C, 65°C, 75°C, or 85°C), respectively. Characterizations were made using a UV–visible–near‐infrared (UV–VIS–NIR) spectrophotometer (transmittance and reflectance, with and without an integrating sphere), a UV–VIS fluorescence spectrophotometer, a camera, and an optical microscope. Performance was analyzed, including solar weighted transmittance, yellowness index, UV cut‐off wavelength, and haze (scattering). Separate Arrhenius analyses were performed to assess retention of transmittance and changes in yellowness index. The activation energy for both characteristics was found to range from 15–80 kJ·mol−1, with an average of 48 kJ·mol−1, similar to the average of 45 kJ·mol−1 identified in the previous international PV Quality Assurance Task Force (PVQAT) Task Group 5 (TG5) study of more traditional encapsulants. The separate degradation modes of discoloration and scattering were distinguished in the encapsulants using a comprehensive spectral characterization. Based on these results, the IEC 62788‐1‐7 pass/fail criteria of 5% change in transmittance was confirmed to identify a known bad encapsulant. [ABSTRACT FROM AUTHOR]

Background: Dual‐eligible beneficiaries, who qualify for Medicare and Medicaid, are a vulnerable population with much to gain from efforts to improve quality. Integrated delivery networks and cancer centers, with their emphasis on care coordination and communication, may improve quality of care for dual‐eligible patients with cancer at the end of life. Methods: This study used Surveillance, Epidemiology, and End Results registry data linked with Medicare claims to evaluate quality for beneficiaries who died of cancer and were diagnosed from 2009 to 2014. High‐intensity care was evaluated with 7 end‐of‐life quality measures according to dual‐eligible status with multivariable logistic regression models. Regression‐based techniques were used to assess the effect of delivery system affiliation (ie, cancer center or integrated delivery network vs no affiliation). Results: Among 100,549 beneficiaries who died during the study interval, 22% were dually eligible. Inferior outcomes were identified for dual‐eligible beneficiaries in comparison with nondual beneficiaries across nearly every quality measure assessed, including >1 hospitalization in the last 30 days (12.6% vs 11.3%; P <.001) and a greater proportion of deaths occurring in a hospital setting (30.2% vs 26.2%; P <.001). Receipt of care in an affiliated delivery system was associated with reduced deaths in a hospital setting and increased hospice utilization for dual‐eligible beneficiaries. Conclusions: Dual‐eligible status is associated with higher intensity care at the end of life. Delivery system affiliation has a modest impact on quality at the end of life, and this suggests that targeted efforts may be needed to optimize quality for this group of vulnerable patients. Dual‐eligible beneficiaries dying of cancer have higher utilization at the end of life in comparison with nondual beneficiaries across most end‐of‐life quality measures. Some of these differences in utilization are mitigated in part by receipt of care at an affiliated delivery system such as a cancer center or an integrated delivery network. [ABSTRACT FROM AUTHOR]

Energy systems and manufacturing processes of the 21st century are becoming increasingly dynamic and interconnected, which require new capabilities to effectively model and optimize their design and operations. Such next generation computational tools must leverage state‐of‐the‐art techniques in optimization and be able to rapidly incorporate new advances. To address these requirements, we have developed the Institute for the Design of Advanced Energy Systems (IDAES) Integrated Platform, which builds on the strengths of both process simulators (model libraries) and algebraic modeling languages (advanced solvers). This paper specifically presents the IDAES Core Modeling Framework (IDAES‐CMF), along with a case study demonstrating the application of the framework to solve process optimization problems. Capabilities provided by this framework include a flexible, modifiable, open‐source platform for optimization of process flowsheets utilizing state‐of‐the‐art solvers and solution techniques, fully open and extensible libraries of dynamic unit operations models and thermophysical property models, and integrated support for superstructure‐based conceptual design and optimization under uncertainty. [ABSTRACT FROM AUTHOR]

We propose a novel computational framework for the robust optimization of highly nonlinear, non‐convex models that possess uncertainty in their parameter data. The proposed method is a generalization of the robust cutting‐set algorithm that can handle models containing irremovable equality constraints, as is often the case with models in the process systems engineering domain. Additionally, we accommodate general forms of decision rules to facilitate recourse in second‐stage (control) variables. In particular, we compare and contrast the use of various types of decision rules, including quadratic ones, which we show in certain examples to be able to decrease the overall price of robustness. Our proposed approach is demonstrated on three process flow sheet models, including a relatively complex model for amine‐based CO2 capture. We thus verify that the generalization of the robust cutting‐set algorithm allows for the facile identification of robust feasible designs for process systems of practical relevance. [ABSTRACT FROM AUTHOR]

Previously undiscovered failure modes in photovoltaic (PV) modules continue to emerge in field installations despite passing protocols for design qualification and quality assurance. Failure to detect these modes prior to widespread use could be attributed to the limitations of present‐day standard accelerated stress tests (ASTs), which are primarily designed to identify known degradation or failure modes at the time of development by applying simultaneous or sequential stress factors (usually two at most). Here, we introduce an accelerated testing method known as the combined‐accelerated stress test (C‐AST), which simultaneously combines multiple stress factors of the natural environment. Simultaneous combination of multiple stress factors allows for improved identification of failure modes with better ability to detect modes not known a priori. A demonstration experiment was conducted that reproduced the field‐observed cracking of polyamide‐ (PA‐) and polyvinylidene fluoride (PVDF)–based backsheet films, a failure mode that was not detected by current design qualification and quality assurance testing requirements. In this work, a two‐phase testing protocol was implemented. The first cycle ("Tropical") is a predominantly high‐humidity and high‐temperature test designed to replicate harsh tropical climates. The second cycle ("Multi‐season") was designed to replicate drier and more temperate conditions found in continental or desert climates. Testing was conducted on 2 × 2‐cell crystalline‐silicon cell miniature modules constructed with both ultraviolet (UV)–transmitting and UV‐blocking encapsulants. Cracking failures were observed within a cumulative 120 days of the Tropical condition for one of the PA‐based backsheets and after 84 days of Tropical cycle followed by 42 days of the Multi‐season cycle for the PVDF‐based backsheet, which are both consistent with failures seen in fielded modules. In addition to backsheet cracking, degradation modes were observed including solder/interconnect fatigue, various light‐induced degradation modes, backsheet delamination, discoloration, corrosion, and cell cracking. The ability to simultaneously apply multiple stress factors may allow many of the test sequences within the standardized design qualification procedure to be performed using a single test setup. [ABSTRACT FROM AUTHOR]

Delamination of the encapsulant in photovoltaic (PV) module technology results in immediate optical loss and may enable subsequent corrosion or mechanical damage. The effects of artificial weathering were not previously known; therefore, an empirical study was performed to survey the factors most affecting adhesion, including the ultraviolet (UV) source (ie, Xe or fluorescent lamp[s]), the optical filters for the lamp, the chamber temperature, and the relative humidity. Natural weathering was also performed at locations, including the following: Golden, Colorado; Miami, Florida; Phoenix, Arizona; QiongHai, China; Riyadh, Saudi Arabia; and Turpan, China. Specimens were constructed using a laminated glass/poly (ethylene‐co‐vinyl acetate)/glass geometry. The compressive shear test (CST) was used to quantify the mechanical strength of attachment, taken as a proxy for adhesion. The fractography of select specimens (including cross‐sectional optical microscopy) was used to verify the failure mode (delamination or decohesion). Additional analysis of the local solar spectrum as well as the specimen temperature was performed to interpret the results of natural weathering. The goals of this study include to identify the most significant stressors, clarify where strong coupling may occur between stressors, and validate accelerated test results relative to natural weathering. The importance of specimen conditioning (for moisture) and hygrometric degradation as well as the effects of UV degradation are identified in this study. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between National Comprehensive Cancer Network (NCCN) risk, number of positive biopsy cores, age, and early confirmatory test results on pathological upgrading at radical prostatectomy (RP), in order to better understand whether early confirmatory testing and better risk stratification are necessary for all men with Grade Group (GG) 1 cancers who are considering active surveillance (AS). Patients and Methods: We identified men in Michigan initially diagnosed with GG1 prostate cancer, from January 2012 to November 2017, who had a RP within 1 year of diagnosis. Our endpoints were: (i) ≥GG2 cancer at RP and (ii) adverse pathology (≥GG3 and/or ≥pT3a). We compared upgrading according to NCCN risk, number of positive biopsy cores, and age. Last, we examined if confirmatory test results were associated with upgrading or adverse pathology at RP. Results: Amongst 1966 patients with GG1 cancer at diagnosis, the rates of upgrading to ≥GG2 and adverse pathology were 40% and 59% (P < 0.001), and 10% and 17% (P = 0.003) for patients with very‐low‐ and low‐risk cancers, respectively. Upgrading by volume ranged from 49% to 67% for ≥GG2, and 16% to 23% for adverse pathology. Generally, more patients aged ≥70 vs <70 years had adverse pathology. Unreassuring confirmatory test results had a higher likelihood of adverse pathology than reassuring tests (35% vs 18%, P = 0.017). Conclusions: Upgrading and adverse pathology are common amongst patients initially diagnosed with GG1 prostate cancer. Early use of confirmatory testing may facilitate the identification of patients with more aggressive disease ensuring improved risk classification and safer selection of patients for AS. [ABSTRACT FROM AUTHOR]

Reduced optical transmittance of encapsulants resulting from ultraviolet (UV) degradation is frequently identified as a cause of decreased performance through the service life of photovoltaic modules. However, the present module safety and qualification standards apply short UV doses, only capable of examining design robustness and "infant mortality" failures. Furthermore, essential information remains unknown that might be used to screen encapsulants through product lifetime. We conducted an interlaboratory study to provide the understanding that will be used toward developing a higher‐fidelity, more‐rigorous UV weathering test. Five representative known formulations of poly (ethylene‐co‐vinyl acetate) were studied, in addition to one thermoplastic polyurethane material. Replicate laminated silica/polymer/silica specimens were examined at seven institutions using a variety of indoor chambers (including xenon, UVA‐340, and metal‐halide light sources). Specimens were artificially weathered for 180 cumulative days at steady‐state accelerated test conditions, predesignated relative to the default irradiance of 1.0 W·m−2·nm−1 at 340 nm, chamber temperature of 60°C, and chamber relative humidity of 30%. The solar‐weighted transmittance, yellowness index, and the UV cut‐off wavelength—each determined from the measured hemispherical transmittance—are examined to provide understanding and guidance for the UV light source (type lamp and filters), temperature, and humidity used in accelerated UV aging tests. The relative efficacy of xenon‐arc and UVA‐340 fluorescent sources and the typical range of activation energy for degradation is quantified from the experiments. A variety of ultraviolet (UV) light sources, optical filters, temperatures, and humidity conditions were explored to help prescribe test conditions for accelerated aging.The activation energy for photodegradation, attributed to interaction between the formulation additives, was quantified for the six materials examined.An alternate weathering regime, attributed to the loss of the UV absorber additive, was identified for the hottest experiments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accountable care organizations (ACOs) have been shown to reduce prostate cancer treatment among men unlikely to benefit because of competing risks (ie, potential overtreatment). This study assessed whether the level of engagement in ACOs by urologists affected rates of treatment, overtreatment, and spending. METHODS: A 20% sample of national Medicare data was used to identify men diagnosed with prostate cancer between 2012 and 2014. The extent of urologist engagement in an ACO, as measured by the proportion of patients in an ACO managed by an ACO‐participating urologist, served as the exposure. The use of treatment, potential overtreatment (ie, treatment in men with a ≥75% risk of 10‐year noncancer mortality), and average payments in the year after diagnosis for each ACO were modeled. RESULTS: Among 2822 men with newly diagnosed prostate cancer, the median rates of treatment and potential overtreatment by an ACO were 71.3% (range, 23.6%‐79.5%) and 53.6% (range, 12.4%‐76.9%), respectively. Average Medicare payments among ACOs in the year after diagnosis ranged from $16,523.52 to $34,766.33. Stronger urologist‐ACO engagement was not associated with treatment (odds ratio, 0.87; 95% confidence interval, 0.6‐1.2; P = .4) or spending (9.7% decrease in spending; P = .08). However, urologist engagement was associated with a lower likelihood of potential overtreatment (odds ratio, 0.29; 95% confidence interval, 0.1‐0.86; P = .03). CONCLUSIONS: ACOs vary widely in treatment, potential overtreatment, and spending for prostate cancer. ACOs with stronger urologist engagement are less likely to treat men with a high risk of noncancer mortality, and this suggests that organizations that better engage specialists may be able to improve the value of specialty care. Cancer 2018. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)‐guided prostate biopsy is associated with lower rates of infection‐related hospitalisation. Patients and Methods: We conducted a retrospective analysis of all TRUS‐guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection‐related hospitalisations based on whether or not a needle disinfectant technique was used. The disinfectant technique was an intra‐procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection‐related hospitalisations within 30 days of biopsy. Generalised estimating equation models were fit to adjust for potential confounders. Results: During the evaluated period, 17 954 TRUS‐guided prostate biopsies were taken with 5 321 (29.6%) including a disinfectant step. The observed rate of infection‐related hospitalisation was lower when a disinfectant technique was used during biopsy (0.60% vs 0.90%; P = 0.04). After accounting for differences between groups the adjusted hospitalisation rate in the disinfectant group was 0.85% vs 1.12% in the no disinfectant group (adjusted odds ratio 0.76, 95% confidence interval 0.50–1.15; P = 0.19). Conclusions: In this observational analysis, hospitalisations for infectious complications were less common when the TRUS‐guided prostate biopsy included a needle disinfection step. However, after adjusting for potential confounders the effect of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimise infectious complications. [ABSTRACT FROM AUTHOR]

Background: Active surveillance (AS) for prostate cancer includes follow-up with serial prostate biopsies. The optimal biopsy frequency during follow-up has not been determined. The goal of this investigation was to use longitudinal AS biopsy data to assess whether the frequency of biopsy could be reduced without substantially prolonging the time to the detection of disease with a Gleason score ≥ 7.Methods: With data from 1375 men with low-risk prostate cancer enrolled in AS at Johns Hopkins, a hidden Markov model was developed to estimate the probability of undersampling at diagnosis, the annual probability of grade progression, and the 10-year cumulative probability of reclassification or progression to Gleason score ≥ 7. It simulated 1024 potential AS biopsy strategies for the 10 years after diagnosis. For each of these strategies, the model predicted the mean delay in the detection of disease with a Gleason score ≥ 7.Results: The model estimated the 10-year cumulative probability of reclassification from a Gleason score of 6 to a Gleason score ≥ 7 to be 40.0%. The probability of undersampling at diagnosis was 9.8%, and the annual progression probability for men with a Gleason score of 6 was 4.0%. On the basis of these estimates, a simulation of an annual biopsy strategy estimated the mean time to the detection of disease with a Gleason score ≥ 7 to be 14.1 months; however, several strategies eliminated biopsies with only small delays (<12 months) in detecting grade progression.Conclusions: Although annual biopsy for low-risk men on AS is associated with the shortest time to the detection of disease with a Gleason score ≥ 7, several alternative strategies may allow less frequent biopsying without sizable delays in detecting grade progression. Cancer 2018;124:698-705. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Accountable care organizations (ACOs) can improve prostate cancer care by decreasing treatment variations (ie, avoidance of treatment in low-value settings). Herein, the authors performed a study to understand the effect of Medicare Shared Savings Program ACOs on prostate cancer care.Methods: Using a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer from 2010 through 2013. Rates of treatment, potential overtreatment (ie, treatment in men with a ≥75% chance of 10-year mortality from competing risks), and Medicare payments were measured using regression models. The impact of ACO participation was assessed using difference-in-differences analyses.Results: Before implementation of ACOs, the treatment rate was 71.8% (95% confidence interval [95% CI], 70.2%-73.3%) for ACO-aligned beneficiaries and 72.3% (95% CI, 71.7%-73.0% [P = .51]) for non-ACO-aligned beneficiaries. After implementation, this rate declined to 68.4% (95% CI, 66.1%-70.7% [P = .017]) for ACO-aligned beneficiaries and 69.3% (95% CI, 68.5%-70.1% [P<.001]) for non-ACO-aligned beneficiaries. There was no differential effect noted for ACO participation. The rate of potential overtreatment decreased from 48.2% (95% CI, 43.1%-53.3%) to 40.2% (95% CI, 32.4%-48.0% [P = .087]) for ACO-aligned beneficiaries and increased from 44.3% (95% CI, 42.1%-46.5%) to 47.0% (95% CI, 44.5%-49.5% [P = .11]) for non-ACO-aligned beneficiaries. These changes resulted in a significant relative decrease in overtreatment of 17% for ACO-aligned beneficiaries (difference-in-differences, 10.8%; P = .031). Payments were not found to be differentially affected by ACO alignment.Conclusions: The treatment of prostate cancer and annual payments decreased significantly between 2010 and 2013, but ACO participation did not appear to impact these trends. Among men least likely to benefit, Medicare Shared Savings Program ACO alignment was associated with a significant decline in prostate cancer treatment. Cancer 2018;124:563-70. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery.Methods: National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes.Results: This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P < .001). However, both the star rating and surgical volume were correlated with 4 short-term cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay.Conclusions: In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can supplant surgical volume as a measure of surgical quality. Cancer 2017;123:4259-4267. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for AS. To determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance, PubMed searches of 'family history and prostate cancer', 'family history and prostate cancer progression' and 'factors of prostate cancer progression' were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis. Review of the six publications suggests that family history does not increase the risk of prostate cancer progression, whilst a subgroup analysis in one study found that family history increases the risk of prostate cancer progression only in African-Americans. A family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for AS. Further studies are needed to better understand the relationship between race, family history, and eligibility for AS. [ABSTRACT FROM AUTHOR]

Objectives To characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT). Patients and Methods A multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months. Results The median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% ( P < 0.01), and PCSS were 78%, 68%, and 56% ( P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively. Conclusions We demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation. [ABSTRACT FROM AUTHOR]

Objective To report the independent prognostic impact of the new prostate cancer grade-grouping system in a large external validation cohort of patients treated with radical prostatectomy ( RP). Patients and methods Between 1994 and 2013, 3 694 consecutive men were treated with RP at a single institution. To investigate the performance of and validate the grade-grouping system, biochemical recurrence-free survival (bRFS) rates were assessed using Kaplan-Meier tests, Cox-regression modelling, and discriminatory comparison analyses. Separate analyses were performed based on biopsy and RP grade. Results The median follow-up was 52.7 months. The 5-year actuarial bRFS for biopsy grade groups 1-5 were 94.2%, 89.2%, 73.1%, 63.1%, and 54.7%, respectively ( P < 0.001). Similarly, the 5-year actuarial bRFS based on RP grade groups was 96.1%, 93.0%, 74.0%, 64.4%, and 49.9% for grade groups 1-5, respectively ( P < 0.001). The adjusted hazard ratios for bRFS relative to biopsy grade group 1 were 1.98, 4.20, 5.57, and 9.32 for groups 2, 3, 4, and 5, respectively ( P < 0.001), and for RP grade groups were 2.09, 5.27, 5.86, and 10.42 ( P < 0.001). The five-grade-group system had a higher prognostic discrimination compared with the commonly used three-tier system (Gleason score 6 vs 7 vs 8-10). Conclusions In an independent surgical cohort, we have validated the prognostic benefit of the new prostate cancer grade-grouping system for bRFS, and shown that the benefit is maintained after adjusting for important clinicopathological variables. The greater predictive accuracy of the new system will improve risk stratification in the clinical setting and aid in patient counselling. [ABSTRACT FROM AUTHOR]

The durability of polymeric encapsulation materials was examined using outdoor exposure at the nominal geometric concentration of 500 suns. The results for 36-month cumulative field deployment are presented for materials including: poly(ethylene-co-vinyl acetate), (EVA); polyvinyl butyral (PVB); ionomer; polyethylene/polyoctene copolymer (PO); thermoplastic polyurethane (TPU); poly(dimethylsiloxane) (PDMS); poly(diphenyl dimethyl siloxane) (PDPDMS); and poly(phenyl-methyl siloxane) (PPMS). Measurements of the field conditions including ambient temperature and ultraviolet (UV) dose were recorded at the test site during the experiment. Measurements for the experiment included optical transmittance (with subsequent analysis of solar-weighted transmittance, UV cut-off wavelength, and yellowness index), mass, visual photography, photoelastic imaging, and fluorescence spectroscopy. While the results to date for EVA are presented and discussed, examination here focuses more on the siloxane materials. A specimen recently observed to fail by thermal decomposition is discussed in terms of the implementation of the experiment as well as its fluorescence signature, which was observed to become more pronounced with age. Modulated thermogravimetry (allowing determination of the activation energy of thermal decomposition) was performed on a subset of the siloxanes to quantify the propensity for decomposition at elevated temperatures. Supplemental, Pt-catalyst- and primer-solutions as well as peroxide-cured PDMS specimens were examined to assess the source of the luminescence. The results of the study including the change in optical transmittance, observed failure modes, and subsequent analyses of the failure modes are described in the conclusions. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A mathematical model for a moving bed reactor with embedded heat exchanger has been developed for application to solid sorbent-based capture of carbon dioxide from flue gas emitted by coal-fired power plants. The reactor model is one-dimensional, non-isothermal, and pressure-driven. The two-phase (gas and solids) model includes rigorous kinetics and heat and mass transfer between the two phases. Flow characteristics of the gas and solids in the moving bed are obtained by analogy with correlations for fixed and fluidized bed systems. From the steady-state perspective, this work presents the impact of key design variables that can be used for optimization. From the dynamic perspective, the article shows transient profiles of key outputs that should be taken into account while designing an effective control system. In addition, the article also presents performance of a model predictive controller for the moving bed regenerator under process constraints. © 2016 American Institute of Chemical Engineers AIChE J, 62: 3899-3914, 2016 [ABSTRACT FROM AUTHOR]

Background: Accountable care organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. The objective of this study was to evaluate the association between hospital ACO participation and the outcomes of major surgical oncology procedures.Methods: This was a retrospective cohort study of Medicare beneficiaries older than 65 years who were undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer from 2011 through 2013. A difference-in-differences analysis was implemented to compare the postimplementation period (January 2013 through December 2013) with the baseline period (January 2011 through December 2012) to assess the impact of hospital ACO participation on 30-day mortality, complications, readmissions, and length of stay (LOS).Results: Among 384,519 patients undergoing major cancer surgery at 106 ACO hospitals and 2561 control hospitals, this study found a 30-day mortality rate of 3.4%, a readmission rate of 12.5%, a complication rate of 43.8%, and a prolonged LOS rate of 10.0% in control hospitals and similar rates in ACO hospitals. Secular trends were noted, with reductions in perioperative adverse events in control hospitals between the baseline and postimplementation periods: mortality (percentage-point reduction, 0.1%; P = .19), readmissions (percentage-point reduction, 0.4%; P = .001), complications (percentage-point reduction, 1.0%; P < .001), and prolonged LOS (percentage-point reduction, 1.1%; P < .001). After accounting for these secular trends, this study identified no significant effect of hospital participation in an ACO on the frequency of perioperative outcomes (difference-in-differences estimator P values, .24-.72).Conclusions: Early hospital participation in the Medicare Shared Savings Program ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer surgery in comparison with control hospitals. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2739-2746. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Debonding of photovoltaic (PV) encapsulation in moist environments is frequently reported but presently not well understood or quantified. Temperature cycling, moisture, and mechanical loads often cause loss of encapsulation adhesion and interfacial debonding, initially facilitating back-reflectance and reduced electrical current, but ultimately leading to internal corrosion and loss of module functionality. To investigate the effects of temperature ( T) and relative humidity (RH) on the kinetics of encapsulation debonding, we developed a mechanics-based technique to measure encapsulation debond energy and debond growth rates in a chamber of controlled environment. The debond energy decreased from 2.15 to 1.75 kJ m−2 in poly(ethylene-co-vinyl acetate) (EVA) and from 0.67 to 0.52 kJ m−2 in polyvinyl butyral when T increased from 25 to 50°C and 20 to 40°C, respectively. The debond growth rates of EVA increased up to 1000-fold with small increases of T (10°C) and RH (15%). To elucidate the mechanisms of environmental debonding, we developed a fracture-kinetics model, where the viscoelastic relaxation processes at the debonding-tip are used to predict debond growth. The model and techniques constitute the fundamental basis for developing accelerated aging tests and long-term reliability predictions for PV encapsulation. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We examined the overall survival of a population-based cohort of black and white patients with renal cell carcinoma ( RCC) to better understand the paradox of poorer RCC survival despite more frequent diagnosis at lower stage among blacks. Renal cell carcinoma patients (699 white, 252 black) diagnosed between 2002 and 2007 in metropolitan Detroit were followed for vital status in the Detroit Surveillance, Epidemiology and End Results ( SEER) registry. Hazard ratios ( HR) of death for black versus white race and 95% confidence intervals ( CIs) were calculated using Cox proportional hazard models stratified by demographic and prognostic factors, and in models successively adjusted for clinical factors, comorbidities, and socioeconomic factors. Mean follow-up time was 88.4 months for white patients and 89.6 months for black patients ( P = 0.49), with 202 white deaths and 89 black deaths ( P = 0.06). While black race was weakly associated with poorer overall survival ( P = 0.053), black patients <65 years at diagnosis or with tumors <4 cm in size had significantly poorer survival than their white counterparts ( HR = 1.46, 95% CI 1.06-2.01 and HR = 2.15, 95% CI 1.51-3.06, respectively). The racial disparities within these two subgroups were minimally affected by adjustment for clinical/treatment factors ( HR = 1.49, 95% CI 1.01-2.19 and HR = 1.95, 95% CI 1.27-2.99), but were substantially reduced when renal-relevant comorbidities were added ( HR = 1.30, 95% CI 0.89-1.91 and HR = 1.76, 95% CI 1.16-2.66). After further adjustment for socioeconomic factors, the survival disparities were essentially null ( HR = 1.14, 95% CI 0.71-1.85 and HR = 1.15, 95% CI 0.67-1.98). In this population-based sample of RCC patients, younger black patients and those with small tumors had poorer overall survival than whites. The disparity was explained primarily by racial differences in renal-relevant comorbidities, particularly chronic renal failure, and socioeconomic deprivation. Future research should focus on younger patients and those with smaller tumors to better understand how these factors may contribute to the survival disparity. [ABSTRACT FROM AUTHOR]

As creep of polymeric materials is potentially a safety concern for photovoltaic modules, the potential for module creep has become a significant topic of discussion in the development of IEC 61730 and IEC 61215. To investigate the possibility of creep, modules were constructed, using several thermoplastic encapsulant materials, into thin-film mock modules and deployed in Mesa, Arizona. The materials examined included poly(ethylene)-co-vinyl acetate (EVA, including formulations both cross-linked and with no curing agent), polyethylene/polyoctene copolymer (PO), poly(dimethylsiloxane) (PDMS), polyvinyl butyral (PVB), and thermoplastic polyurethane (TPU). The absence of creep in this experiment is attributable to several factors of which the most notable one was the unexpected cross-linking of an EVA formulation without a cross-linking agent. It was also found that some materials experienced both chain scission and cross-linking reactions, sometimes with a significant dependence on location within a module. The TPU and EVA samples were found to degrade with cross-linking reactions dominating over chain scission. In contrast, the PO materials degraded with chain scission dominating over cross-linking reactions. Although we found no significant indications that viscous creep is likely to occur in fielded modules capable of passing the qualification tests, we note that one should consider how a polymer degrades, chain scission or cross-linking, in assessing the suitability of a thermoplastic polymer in terrestrial photovoltaic applications. [ABSTRACT FROM AUTHOR]

The article reports on the transformational carbon capture systems. Topics discussed include carbon capture and storage (CCS), adoption of greenhouse gas (GHG), and cost of electricity (COE). Also being discussed are integrated gasification combined cycle (IGCC), pulverized coal (PC), and enhanced oil recovery (EOR).

Recently there has been increased interest in using thermoplastic encapsulant materials in photovoltaic modules, but concerns have been raised about whether these would be mechanically stable at high temperatures in the field. Recently, this has become a significant topic of discussion in the development of IEC 61730 and IEC 61215. We constructed eight pairs of crystalline-silicon modules and eight pairs of glass/encapsulation/glass thin-film mock modules using different encapsulant materials, of which only two were formulated to chemically crosslink. One module set was exposed outdoors with thermal insulation on the back side in Mesa, Arizona, in the summer (hot-dry), and an identical module set was exposed in environmental chambers. High-precision creep measurements (±20 µm) and electrical performance measurements indicate that despite many of these polymeric materials operating in the melt or rubbery state during outdoor deployment, no significant creep was seen because of their high viscosity, lower operating temperature at the edges, and/or the formation of chemical crosslinks in many of the encapsulants with age despite the absence of a crosslink-ing agent. Only an ethylene-vinyl acetate (EVA) encapsulant formulated without a peroxide crosslinking agent crept significantly. In the case of the crystalline-silicon modules, the physical restraint of the backsheet reduced creep further and was not detectable even for the EVA without peroxide. Because of the propensity of some polymeric materials to crosslink as they age, typical thermoplastic encapsulants would be unlikely to result in creep in the vast majority of installations. [ABSTRACT FROM AUTHOR]

Uncertainties in property models can significantly affect the results obtained from process simulations. If these uncertainties are not quantified, optimal plant designs based on such models can be misleading. With this incentive, a systematic, generalized uncertainty quantification (UQ) methodology for property models is developed. Starting with prior beliefs about parametric uncertainties, a Bayesian method is used to derive informed posteriors using the experimental data. To reduce the computational expense, surrogate response surface models are developed. For downselecting the parameter space, a sensitivity matrix-based approach is developed. The methodology is then deployed to the property models for an MEA-CO2-H2O system. The UQ analysis is found to provide interesting information about uncertainties in the parameter space. The sensitivity matrix approach is also found to be a valuable tool for reducing computational expense. Finally, the effect of the estimated parametric uncertainty on CO2 absorption and monoethanolamine (MEA) regeneration is analyzed. © 2015 American Institute of Chemical Engineers AIChE J, 61: 1822-1839, 2015 [ABSTRACT FROM AUTHOR]

BACKGROUND Integrating quality-of-life (QOL) outcomes into clinics may assist providers in identifying and responding to problems experienced by cancer survivors. To date, however, patient-reported outcomes (PROs) such as QOL are used infrequently to guide care. We integrated QOL assessments into a prostate cancer survivorship clinic and compared recovery and satisfaction among men managed in the survivorship clinic with those followed with more routine care. METHODS We conducted a before-after study comparing 235 men treated surgically for prostate cancer who received routine follow-up care with 102 men managed in a survivorship clinic characterized by point-of-care QOL reporting and integration of QOL scores (EPIC) following radical prostatectomy. We then assessed baseline and postprostatectomy QOL at 6 and 12 months, as well as patient satisfaction, and compared outcomes between groups. RESULTS Although baseline QOL was comparable, scores were generally higher among the survivorship group at 6 months and 1 year compared with those followed with routine care. In particular, sexual function scores were significantly higher among patients managed in the survivorship clinic (52.2 vs 33.6 at 1 year, P < .01). Satisfaction scores were consistently higher in the survivorship clinic group compared with the routine-care group (all P < .05). CONCLUSIONS Patient QOL and satisfaction were higher among men managed in a survivorship program, suggesting that disease-specific survivorship clinics that integrate QOL reporting into care pathways may yield better outcomes compared with less tailored approaches to patient care following cancer therapy. Cancer 2015;121:1484-1491. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

The article offers information on prostate cancer guidelines considers life expectancy (LE) to be an important factor for patients making decisions to undergo screening or treatment. Topics discussed include selection of patients for prostate biopsy with the help of LE calculator in clinical practice; impact of comorbidity points on survival; and pragmatic tool to facilitate clinical decisions incorporating LE for men undergoing prostate cancer screening or treatment.

A central problem in modeling, namely that of learning an algebraic model from data obtained from simulations or experiments is addressed. A methodology that uses a small number of simulations or experiments to learn models that are as accurate and as simple as possible is proposed. The approach begins by building a low-complexity surrogate model. The model is built using a best subset technique that leverages an integer programming formulation to allow for the efficient consideration of a large number of possible functional components in the model. The model is then improved systematically through the use of derivative-free optimization solvers to adaptively sample new simulation or experimental points. Automated learning of algebraic models for optimization (ALAMO), the computational implementation of the proposed methodology, along with examples and extensive computational comparisons between ALAMO and a variety of machine learning techniques, including Latin hypercube sampling, simple least-squares regression, and the lasso is described. © 2014 American Institute of Chemical Engineers AIChE J, 60: 2211-2227, 2014 [ABSTRACT FROM AUTHOR]

Objective To evaluate the predictive value of the Radius, Exophytic, Nearness, Anterior, Location nephrometry scoring system and to investigate the influence of its individual components on perioperative outcomes of minimally invasive partial nephrectomy. Methods Consecutive laparoscopic partial nephrectomy ( n = 189) and robotic partial nephrectomy ( n = 109) cases from 2007 through 2011 were retrospectively reviewed from our prospectively maintained database. Urological surgeons assigned nephrometry scores, excluding cases without images available for review. The association of nephrometry score categories and individual components of the score to perioperative outcomes were assessed. Results No differences were observed in preoperative characteristics of low ( n = 135), intermediate ( n = 155) and high ( n = 8) nephrometry groups. Higher nephrometry score was associated with an increased length of stay, estimated blood loss and warm ischemia time. Higher nephrometry scores were also associated with a greater proportion of major complications ( P < 0.001). Distance to the renal sinus had the greatest impact on perioperative outcomes including operative and ischemic times, estimated blood loss, complications and length of stay. Conclusions The Radius, Exophytic, Nearness, Anterior, Location nephrometry score has value as a predictive tool for perioperative outcomes of minimally invasive partial nephrectomy. Distance to the renal sinus seems to have the greatest association with outcomes. Using these findings, clinicians will be better able to counsel patients regarding anticipated perioperative outcomes of minimally invasive partial nephrectomy. [ABSTRACT FROM AUTHOR]

ABSTRACT The durability of polymeric encapsulation materials was examined using outdoor exposure at the nominal optical concentration of 500 suns. The results for 12 months' cumulative field deployment are presented for materials including ethylene- co-vinyl acetate, polyvinyl butyral (PVB), ionomer, polyethylene/polyoctene copolymer, thermoplastic polyurethane, poly(dimethylsiloxane), and poly(phenyl-methyl siloxane). Measurements during the experiment included optical transmittance (direct and hemispherical), mass, visual appearance, and fluorescence spectroscopy in addition to the initial thermogravimetry of the materials. Measurements of the field conditions and ultraviolet dose at the test site were facilitated by numerous laboratory instruments; characterization of the specimen temperature was performed using thermography. Discovery experiments identified the importance of a secondary homogenizer optic and the importance of contamination control. To date, the formal experiment verified a thermal-runaway-motivated combustion failure mechanism for one of the PVB formulations and identified densification, cracking, and haze-formation behaviors in some of the silicone specimens. The behaviors observed for the silicone specimens may be facilitated by their greater thickness. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Thermogravimetric analysis is used to study the adsorption kinetics, equilibrium, and thermodynamics of CO2 on immobilized polyethylenimine sorbent impregnated on a mesoporous silica over the range of 300-390 K and 5-100% CO2 concentration. Adsorption isotherm models were fitted to the experimental data indicating that a change in adsorption mechanism occurred near 70°C. Below this temperature, the adsorption data followed the heterogeneous isotherms, while data taken at higher-temperatures followed isotherms for homogeneous surfaces. Heat of sorption was estimated to be 130 kJ/mole for the low-temperature regime, but this decreased to 48 kJ/mole above 70°C. The rate of CO2 fractional uptake decreased as temperature increased. A phenomenological kinetic model was derived from the Weibull distribution function using a nucleation growth theory to describe the two-step process. The kinetic model was used to predict the uptake at different operating conditions and resulted in good agreement with experimental data. Published 2012 American Institute of Chemical Engineers AIChE J, 2013 [ABSTRACT FROM AUTHOR]

Objective. We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D. Methods. We present a clinical case and a summary of literature search. Results. A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0mg/mL He also had five small right lung nodules with a negative bone scan. Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL. The patient's calcium was normalized after hydration, and he underwent radical nephrectomy. On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1mg/dL. Pathology showed a 6 cmhigh-grade urothelial carcinoma with divergent differentiation. We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English. No cases have a documented elevated 1,25-dihydroxyvitamin D level. Conclusion. This clinical course suggests that hypercalcemia in this case is from the patient's tumor, which was likely producing 1,25-dihydroxyvitamin D. Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D. [ABSTRACT FROM AUTHOR]

Objective. To determine the proportion of physician practices in the United States that currently meets medical home criteria. Data Source/Study Setting. 2007 and 2008 National Ambulatory Medical Care Survey. Study Design. We mapped survey items to the National Committee on Quality Assurance's ( NCQA's) medical home standards. After awarding points for each 'passed' element, we calculated a practice's infrastructure score, dividing its cumulative total by the number of available points. We identified practices that would be recognized as a medical home (Level 1 [25-49 percent], Level 2 [50-74 percent], or Level 3 [infrastructure score ≥75 percent]) and examined characteristics associated with NCQA recognition. Results. Forty-six percent (95 percent confidence interval [ CI], 42.5-50.2) of all practices lack sufficient medical home infrastructure. While 72.3 percent (95 percent CI, 64.0-80.7 percent) of multi-specialty groups would achieve recognition, only 49.8 percent (95 percent CI, 45.2-54.5 percent) of solo/partnership practices meet NCQA standards. Although better prepared than specialists, 40 percent of primary care practices would not qualify as a medical home under present criteria. Conclusion. Almost half of all practices fail to meet NCQA standards for medical home recognition. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of ≤4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN ( P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P = .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]

The article discusses a study on the relationship between delay in diagnosis and outcomes in patients with bladder cancer. The study identified patients with bladder cancer using the Surveillance, Epidemiology and End Results-Medicare linked database from 1992 to 2002. It suggests that patients with more protracted delays in the diagnosis of bladder cancer had significantly higher rates of mortality from the disease and are likely to undergo a major intervention such as radical cystectomy.

The article presents a cohort study that evaluates the treatments received by disadvantaged prostate cancer patients from private practitioners and county hospitals. The study sought 554 low-income participants with prostate cancer, in which 244 were treated in country hospitals and 315 were treated by private practitioners. It concludes that the disadvantaged patients received different prostate cancer treatments by county hospitals and private providers.

The article discusses a study which investigates the cancer-specific survival outcomes among patients with renal cell carcinoma (RCC) who were treated during the cytokine era from 1989-2005. It reveals that most patients with localized RCC have improved with surgery alone, however, effective adjuvant therapy is required for patients who were at high risk for recurrence. Moreover, less toxic treatments should be at least effective like surgical resection and immunotherapy for advanced disease.

Background: Despite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon-attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.Methods: By using linked Surveillance, Epidemiology, and End Results-Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon- and patient-level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.Results: Of the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon-attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.Conclusions: For many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early-stage kidney cancer. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the benefits of nephron-sparing surgery in patients diagnosed with early-stage kidney cancer. The study included 10,886 cancer patients who underwent partial or radical nephrectomy between 1991 and 2002. It found that patients who underwent partial nephrectomy have had fewer renal outcomes. It concluded that partial nephrectomy is linked with less renal morbidity compared with radical nephrectomy.

The article deals with a study that assessed adherence with the College of American Pathologists (CAP) radical prostatectomy (RP) practice protocol in a sample of men who underwent RP for early-stage prostate cancer in the U.S. The study subjects were chosen using the National Cancer Data Base. Composite measures and all-or-none measures of quality indicator compliance were calculated by the researchers for several analytic categories, including a broad subset of CAP category I factors.

The article presents a study which examined patient survival after surgery for kidney cancer using a population-based cohort. According to the study, kidney cancer's rising incidence is largely attributable to the increased detection of small renal masses. Patients who participated in the study were sorted into 20 age-tumor size categories and the numbers of patients that were alive, dead from kidney cancer, and dead from other causes were tabulated. It was found that patients with the smallest tumors enjoyed the lowest cancer-specific mortality.

In Streptococcus pneumoniae, the first four genes of the capsule locus (cpsA to cpsD) are common to most serotypes. By analysis of various in-frame deletion and site-directed mutants, the function of their gene products in capsular polysaccharide (CPS) biosynthesis was investigated. We found that while CpsB, C and D are essential for encapsulation, CpsA is not. CpsC and CpsD have similarity to the amino-terminal and carboxy-terminal regions, respectively, of the autophosphorylating protein-tyrosine kinase Wzc from Escherichia coli. Alignment of CpsD with Wzc and other related proteins identified conserved Walker A and B sequence motifs and a tyrosine rich domain close to the carboxy-terminus. We have shown that CpsD is also an autophosphorylating protein-tyrosine kinase and that point mutations in cpsD affecting either the ATP-binding domain (Walker A motif) or the carboxy-terminal [YGX]4 repeat domain eliminated tyrosine phosphorylation of CpsD. We describe, for the first time, the phenotypic impact of these two mutations on polysaccharide production and show that they affect CPS production differently. Whereas a mutation in the Walker A motif resulted in loss of encapsulation, mutation of the tyrosines in the [YGX]4 repeat domain resulted in an apparent increase in encapsulation and a mucoid phenotype. These data suggest that autophosphorylation of CpsD at tyrosine attenuates its activity and reduces the level of encapsulation. Additionally, we demonstrated that CpsC is required for CpsD tyrosine phosphorylation and that CpsB influences dephosphorylation of CpsD. These results are consistent with CpsD tyrosine phosphorylation acting to negatively regulate CPS production. This has implications for the function of CpsC/CpsD homologues in both Gram-positive and Gram-negative bacteria and provides a mechanism to explain regulation of CPS production during pathogenesis. [ABSTRACT FROM AUTHOR]

Provides information on studies which determined the extent to which feedback could improve the decision-making of adolescents and adults. Methods; Results and discussion.