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This case study explores the first decade (2002-2012) of the California Senior Leaders Program (CSLP), including participants' creation of a formal advocacy group, the California Senior Leaders Alliance. Grounded in concerns with ageism and invisibility, the CSLP provides recognition and support for diverse California elders engaged in community building and social justice work. This study employs qualitative analysis of data from participant interviews, event evaluations, program documents, video footage, and participant observation. Findings show emotional, learning, and networking benefits for participants, intergenerational influences, collective capacity and coalition building, and contributions to policy. Program challenges are described, and future directions discussed. © 2013 Copyright Taylor and Francis Group, LLC.

Larry E Miller,1 Melissa S Martinson,2 Joseph S Gondusky,3 Atul F Kamath,4 Friedrich Boettner,5 Samir K Bhattacharyya6 1Miller Scientific Consulting, Inc., Asheville, NC 28803, USA; 2Technomics Research, LLC, Long Lake, MN 55356, USA; 3Department of Orthopaedic Surgery, Jordan-Young Institute, Virginia Beach, VA 23462, USA; 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; 5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; 6DePuy Synthes, Raynham, MA 02767, USA Background: While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. Methods: We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. Results: Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210–$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). Conclusion: The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA. Keywords: anterior approach, bundle, cost, hip, Medicare, reimbursement, total hip arthroplasty

James C Ulchaker,1 Melissa S Martinson2 1Department of Urology, Cleveland Clinic, Cleveland, OH, 2Technomics Research, LLC, Minneapolis, MN, USA Objective: To conduct a cost-effectiveness analysis from payers’ perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients.Methods: The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients’ transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses.Results: ComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS.Conclusion: The analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services. Keywords: prostate, benign prostatic hyperplasia, lower urinary tract symptoms, cost-­effectiveness analysis, minimally invasive therapy

Background: Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom., Methods: Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities., Results: Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries., Conclusion: While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the "whys" of health inequalities in a variety of contexts., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This paper examines the relative role of financial inclusion in enhancing households' ability to spend on energy consumption across rural and urban locations. It uses comprehensive household data from Ghana and employs the ordinary least square (OLS) as well as an instrumental variable estimation technique. Endogeneity of financial inclusion is instrumented using distance to the nearest bank. Our findings suggest that a standard deviation increase in financial inclusion contributes to an improvement in residential energy expenditure by 1.2835 standard deviations. This finding is robust to different methods for resolving endogeneity and alternative weighting schemes in the financial inclusion construct. Among the different sources of energy for lighting and cooking, financial inclusion increases expenditure on LPG and electricity more than the others. Financial inclusion increases the ability to spend more on residential energy in urban, poorest, and female-headed dual-parent households. Household net income is a key pathway through which financial inclusion affects residential energy expenditure., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Lower-limb amputation rates in patients with chronic limb-threatening ischemia vary across the United States, with marked disparities in amputation rates by gender, race, and income status. We evaluated the association of patient, hospital, and geographic characteristics with the intensity of vascular care received the year before a major lower-limb amputation and how intensity of care associates with outcomes after amputation., Methods: Using Medicare claims data (2016-2019), beneficiaries diagnosed with chronic limb-threatening ischemia who underwent a major lower-limb amputation were identified. We examined patient, hospital, and geographic characteristics associated with the intensity of vascular care received the year before amputation. Secondary objectives evaluated all-cause mortality and adverse events following amputation., Results: Of 33 036 total Medicare beneficiaries undergoing major amputation, 7885 (23.9%) were due to chronic limb-threatening ischemia; of these, 4988 (63.3%) received low-intensity and 2897 (36.7%) received high-intensity vascular care. Mean age, 76.6 years; women, 38.9%; Black adults, 24.5%; and of low income, 35.2%. After multivariable adjustment, those of low income (odds ratio, 0.65 [95% CI, 0.58-0.72]; P <0.001), and to a lesser extent, men (odds ratio, 0.89 [95% CI, 0.81-0.98]; P =0.019), and those who received care at a safety-net hospital (odds ratio, 0.87 [95% CI, 0.78-0.97]; P =0.012) were most likely to receive low intensity of care before amputation. High-intensity care was associated with a lower risk of all-cause mortality 2 years following amputation (hazard ratio, 0.79 [95% CI, 0.74-0.85]; P <0.001)., Conclusions: Patients who were of low-income status, and to a lesser extent, men, or those cared for at safety-net hospitals were most likely to receive low-intensity vascular care. Low-intensity care was associated with worse long-term event-free survival. These data emphasize the continued disparities that exist in contemporary vascular practice., Competing Interests: Disclosures Dr Quiroga receives personal fees from Boston Scientific and W.L. Gore. Dr Wadhera receives research support from the National Heart, Lung, Blood Institute (NHLBI)/National Institutes of Health (NIH) K23HL148525 and also receives personal fees from CVS Health and Abbott. Dr Secemsky receives research support from NIH/NHLBI K23HL150290, Food and Drug Administration, Harvard Medical School Shore Faculty Development Award, Becton, Dickinson and Company, Boston Scientific, Cook, Cardiovascular Systems, Inc, Laminate Medical, Medtronic, and Philips and receives personal fees from Abbott, Bayer, Becton, Dickinson and Company, Boston Scientific, Cook, Cordis-X, Cardiovascular Systems, Inc, Janssen, Medtronic, Philips, and VentureMed. Dr West, C.M. King, and J.T. Hasegawa are employees of Abbott Vascular. Dr Martinson is a consultant to Abbott Vascular. The other author reports no conflicts.

Green governance and high-quality green development are crucial to the growth of enterprises; therefore, this paper examines how environmental, social, and corporate governance (ESG) disclosure policies affect the value of heavily polluting companies. The study's data is from the new version of the Governance Guidelines for Public Companies promulgated by the China Securities Regulatory Commission in 2018. Thus, the data of China's public companies from 2011 to 2021 is used for the study's analysis. The methods applied for our estimation analysis are the differences-in-differences (DID) and the mediation effect model. The findings depict that ESG information disclosure policies can significantly inhibit the corporate value of heavily polluting enterprises (HPE). Enterprise technological innovation plays a mediating effect in this mechanism; that is, after introducing the policy, it effectively alleviates the information asymmetry and promotes enterprise technological innovation, but it also damages the enterprise value. Further analysis shows that the inhibition effect of ESG information disclosure policy on the value of HPE is heterogeneous, and for non-state-owned enterprises, ESG information disclosure policies have a stronger inhibitory effect. Also, there is little difference between the central and western regions and the eastern region in terms of the inhibitory effect of ESG disclosure policies on the value of HPE. The conclusion of this paper is conducive to improving the information disclosure policy of listed companies and promoting the green development of enterprises., (© 2023 The Authors.)

This study investigates the relationship between rural Ghanaian household food and nutrition security and financial literacy. We used the endogenous treatment regression (ETR) technique to address the analysis's potential selection bias problem. The findings of our study demonstrated a beneficial relationship between food and nutrition security and financial literacy. According to further studies, the relationship between food security and financial literacy is heterogeneous. Our findings may have some ramifications for promoting food and nutritional security while preserving rural development methods., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Agricultural mechanization is an important component of agricultural modernization, as it contributes to the improvement of agricultural technology and the rapid transformation of agricultural development. However, research on the connection between agricultural mechanization and farmers' health status is scarce. Thus, using the 2018 China Health and Retirement Longitudinal Survey (CHARLS) data, this study explored how agricultural mechanization can affect farmers' health. OLS and 2SLS models were used for the study's analysis. Furthermore, we used a PSM model to check the robustness of our analysis. The findings showed that: (1) the current state of agricultural mechanization in western China harms the health of rural residents; (2) agricultural mechanization can mitigate the adverse effects on health by increasing farmers' living expenditure and improving their living environment; and (3) agricultural mechanization's effects on farmers' health are regionally and income-heterogeneous. Agricultural mechanization has a more significant impact on health in Tibetan areas and high-income regions. It has an almost minimal effect in non-Tibetan and low-income areas. This paper suggests approaches that can be used to encourage the rational development of agricultural mechanization and improve rural populations' health.

Prior studies explored the production and technical efficiency of fish farms and farmers from the perspectives of factors such as credit access and cooperative membership. We focused on the chronic non-communicable diseases (NCDs) of household members and their quantitative impacts on fish farm production efficiency, based on data of earthen pond fish farms from two regions (Bono East and Ashanti) in Ghana. A data envelopment analysis (DEA) and the IV Tobit technique were employed for the study's analysis. From the study's observations, we draw the following conclusions. We found that the NCDs of household members indeed reduce farm production efficiency, and the heterogeneous impact of the NCDs of female members on farm production efficiency was more prominent than that of male members. Insights from this study suggest that the national government should provide farmers with the necessary medical care through the provision of subsidized health insurance, which can facilitate access to healthcare services. Moreover, NGOs and governments should encourage health literacy, i.e., organizing programs aimed at educating farmers on NCDs and their impact on agriculture.

Nutritional status plays an indispensable role in enhancing human capital and preventing the return to poverty. In the context of the three-child policy and the aging society in China, intergenerational care will inevitably become a core component of family support. Thus, this paper evaluates the impacts of intergenerational care behavior on nutritional intake in Chinese rural residents from the perspective of household consumption. The study's data is from the China Family Panel Studies (CFPS) (2010-2014), and, the fixed effect model and analyses are applied to achieve the study's objective. The results reveal that rural residents with intergenerational family care behavior have significantly higher food diversity. Thus, Chinese rural residents with intergenerational care consumed 22.4% more food. A possible mechanism is that intergenerational care improves young mothers' labor participation and income, thus optimizing their dietary structure. Moreover, there was heterogeneity concerning the nutrition intake among rural residents in different geographic and family net income groups. Finally, the robust check is consistent with the baseline regression results. In summary, governments should fully affirm the elderly contribution to families to give full play to the elderly family benefit maximization.

Recent progress in targeting KRAS G12C has provided both insight and inspiration for targeting alternative KRAS mutants. In this study, we evaluated the mechanism of action and anti-tumor efficacy of MRTX1133, a potent, selective and non-covalent KRAS G12D inhibitor. MRTX1133 demonstrated a high-affinity interaction with GDP-loaded KRAS G12D with K D and IC 50 values of ~0.2 pM and <2 nM, respectively, and ~700-fold selectivity for binding to KRAS G12D as compared to KRAS WT . MRTX1133 also demonstrated potent inhibition of activated KRAS G12D based on biochemical and co-crystal structural analyses. MRTX1133 inhibited ERK1/2 phosphorylation and cell viability in KRAS G12D -mutant cell lines, with median IC 50 values of ~5 nM, and demonstrated >1,000-fold selectivity compared to KRAS WT cell lines. MRTX1133 exhibited dose-dependent inhibition of KRAS-mediated signal transduction and marked tumor regression (≥30%) in a subset of KRAS G12D -mutant cell-line-derived and patient-derived xenograft models, including eight of 11 (73%) pancreatic ductal adenocarcinoma (PDAC) models. Pharmacological and CRISPR-based screens demonstrated that co-targeting KRAS G12D with putative feedback or bypass pathways, including EGFR or PI3Kα, led to enhanced anti-tumor activity. Together, these data indicate the feasibility of selectively targeting KRAS mutants with non-covalent, high-affinity small molecules and illustrate the therapeutic susceptibility and broad dependence of KRAS G12D mutation-positive tumors on mutant KRAS for tumor cell growth and survival., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The current study examines the long-run effects of climatic factors on wheat production in China's top three wheat-producing provinces (Hebei, Henan, and Shandong). The data set consists of observations from 1992 to 2020 on which several techniques, namely, fully modified OLS (FMOLS), dynamic OLS (DOLS), and canonical co-integrating regression (CCR) estimators, and Granger causality, are applied. The results reveal that climatic factors, such as temperature and rainfall, negatively influenced wheat production in Henan Province. This means that Henan Province is more vulnerable to climate change. In contrast, it is observed that climatic conditions (via temperature and rainfall) positively contributed to wheat production in Hebei Province. Moreover, temperature negatively influenced wheat production in Shandong Province, while rainfall contributed positively to wheat production. Further, the results of Granger causality reveal that climatic factors and other determinants significantly influenced wheat production in the selected provinces.

In recent years, the changing climate has become a major global concern, and it poses a higher threat to the agricultural sector around the world. Consequently, this study examines the impact of changing climate and technological progress on soybean yield in the 13 major provinces of China, and considers the role of agricultural credit, farming size, public investment, and power of agricultural machinery from 2000 to 2020. Fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) are applied to assess the long-run effect, while Dumitrescu and Hurlin's (2012) causality test is used to explore the short-run causalities among the studied variables. The results revealed that an increase in the annual mean temperature negatively and significantly affects soybean yield, while precipitation expressively helps augment soybean yield. Furthermore, technological factors such as chemical fertilizers accelerate soybean yield significantly, whereas pesticides negatively influence soybean yield. In addition, farming size, public investment, and power of agricultural machinery contribute remarkably to soybean yield. The causality results endorse that chemical fertilizers, pesticides used, agricultural credit, public investment, and power of agricultural machinery have bidirectional causality links with soybean yield. This study suggests several fruitful policy implications for sustainable soybean production in China.

The present article overviews the current state-of-the-art and future prospects for the use of diatomaceous earth (DE) in the continuously expanding sector of energy science and technology. An eco-friendly direct source of silica and the production of silicon, diatomaceous earth possesses a desirable nano- to micro-structure that offers inherent advantages for optimum performance in existing and new applications in electrochemistry, catalysis, optoelectronics, and biomedical engineering. Silica, silicon and silicon-based materials have proven useful for energy harvesting and storage applications. However, they often encounter setbacks to their commercialization due to the limited capability for the production of materials possessing fascinating microstructures to deliver optimum performance. Despite many current research trends focusing on the means to create the required nano- to micro-structures, the high cost and complex, potentially environmentally harmful chemical synthesis techniques remain a considerable challenge. The present review examines the advances made using diatomaceous earth as a source of silica, silicon-based materials and templates for energy related applications. The main synthesis routes aimed at preserving the highly desirable naturally formed neat nanostructure of diatomaceous earth are assessed in this review that culminates with the discussion of recently developed pathways to achieving the best properties. The trend analysis establishes a clear roadmap for diatomaceous earth as a source material of choice for current and future energy applications., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: Diabetes prevalence has become a global crisis. Due to the substantial rise in smartphone use, a variety of mobile interventions have been developed to help improve the clinical outcomes of diabetes patients., Objectives: This study seeks to examine specific behavior change theories and techniques used in the design of self-management mobile app-based interventions aimed at achieving glycemic control in type 1 and type 2 diabetes., Methods: A meta-analysis of randomized control trials published in PubMed/Medline and Web of Science between January 2010 and October 2020 was conducted using studies that included diabetes patients, reported on well-described mobile app-based interventions, compared mHealth to usual care, and evaluated glycated hemoglobin (HbA1c) at baseline and follow-up., Results: We reported on 21 studies with a total of 1,920 diabetes patients. Our findings show that mHealth apps led to statistically significant clinical outcomes as compared to standard care for glycemic control (-0.38, 95% CI = -0.50 to -0.25, p < 0.0001) indicating that such interventions result in a reduction in HbA1c. Interventions that used behavior theory for developing mHealth apps were not statistically different from those that did not (p = 0.18). However, increased use of behavior change techniques (BCTs) may result in slightly higher HbA1c reduction. Among all BCTs, the most effective ones appear to be "Action planning" and "Self-monitoring of outcome(s) of behavior., Conclusions: The current meta-analysis provides evidence that mHealth is likely to be beneficial for diabetes patients when the right behavior change techniques are applied to realize the full advantage of the intervention. Further investigation of the role of theory in the design of mHealth app-based interventions is warranted., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50-69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management., (Copyright © 2020 Harat, Harat and Martinson.)

A new energy dispersive X-ray absorption spectroscopy (EDXAS) method is presented for simultaneous wide-field imaging and transmission X-ray absorption spectroscopy (XAS) to enable rapid imaging and speciation of elements. Based on spectral K-Edge Subtraction imaging (sKES), a bent Laue imaging system diffracting in the vertical plane was developed on a bend magnet beamline for selenium speciation. The high flux and small vertical focus, forming a wide horizontal line beam for projection imaging and computed tomography applications, is achieved by precise matching of lattice plane orientation and crystal surface (asymmetry angle). The condition generating a small vertical focus for imaging also provides good energy dispersion. Details for achieving sufficient energy and spatial resolution are demonstrated for both full field imaging and computed tomography in quantifying selenium chemical species. While this system has lower sensitivity as it uses transmission and may lack the flux and spatial resolution of a dedicated focused beamline system, it has significant potential in rapid screening of heterogeneous biomedical or environmental systems to correlate metal speciation with function.

Background: A range of studies report a robust association between family socioeconomic position and the prevalence of child overweight/obesity. On average, children from poorer backgrounds are more likely to be overweight/obese than children from more advantaged families. However, a small number of US studies have shown that, for ethnic minority children, the association is either nonexistent or reversed., Objective: We test if the link between socioeconomic position and child overweight/obesity at age 7 is heterogeneous in the United Kingdom where rates of obesity are particularly high for some groups of ethnic minority children., Methods: We use nationally representative data from the UK Millennium Cohort Study as well as descriptive analyses and logistic regression models., Results: Poorer White children are at higher risk of overweight/obesity than higher income White children. However, socioeconomic disparities are reversed for Black African/Caribbean children and nonexistent for children of Indian and Pakistani/Bangladeshi origin. Moreover, the health behaviours that explain socioeconomic disparities in child overweight/obesity for the White group appear to be irrelevant in explaining differences by socioeconomic position for the Black Caribbean and African groups., Conclusions: We should be careful in assuming that higher socioeconomic position is protective against child overweight/obesity for all groups of the population., Contribution: This study shows for the first time important variation by ethnicity in the link between socioeconomic position and child overweight/obesity - and in the underlying mechanisms linking them - in the United Kingdom.

A bent Laue double-crystal monochromator system has been designed for vertically expanding the X-ray beam at the Canadian Light Source's BioMedical Imaging and Therapy beamlines. Expansion by a factor of 12 has been achieved without deteriorating the transverse coherence of the beam, allowing phase-based imaging techniques to be performed with high flux and a large field of view. However, preliminary studies revealed a lack of uniformity in the beam, presumed to be caused by imperfect bending of the silicon crystal wafers used in the system. Results from finite-element analysis of the system predicted that the second crystal would be most severely affected and has been shown experimentally. It has been determined that the majority of the distortion occurs in the second crystal and is likely caused by an imperfection in the surface of the bending frame. Measurements were then taken to characterize the bending of the crystal using both mechanical and diffraction techniques. In particular, two techniques commonly used to map dislocations in crystal structures have been adapted to map local curvature of the bent crystals. One of these, a variation of Berg-Berrett topography, has been used to quantify the diffraction effects caused by the distortion of the crystal wafer. This technique produces a global mapping of the deviation of the diffraction angle relative to a perfect cylinder. This information is critical for improving bending and measuring tolerances of imperfections by correlating this mapping to areas of missing intensity in the beam.

Aims: Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study., Methods and Results: An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality-adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5-year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost-effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non-HF hospitalizations, physician visits, prescription drugs, long-term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY., Conclusions: Standard economic modelling suggests that pulmonary artery pressure-guided management of HF using the CardioMEMS™ HF System is cost-effective from the US-payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures., (© 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Minimally invasive sacroiliac joint arthrodesis ("MI SIJ fusion") received a Category I CPT ® code (27279) effective January 1, 2015 and was assigned a work relative value unit ("RVU") of 9.03. The International Society for the Advancement of Spine Surgery ("ISASS") conducted a study consisting of a Rasch analysis of two separate surveys of surgeons to assess the accuracy of the assigned work RVU., Methods: A survey was developed and sent to ninety-three ISASS surgeon committee members. Respondents were asked to compare CPT ® 27279 to ten other comparator CPT ® codes reflective of common spine surgeries. The survey presented each comparator CPT ® code with its code descriptor as well as the description of CPT ® 27279 and asked respondents to indicate whether CPT ® 27279 was greater, equal, or less in terms of work effort than the comparator code. A second survey was sent to 557 U.S.-based spine surgeon members of ISASS and 241 spine surgeon members of the Society for Minimally Invasive Spine Surgery ("SMISS"). The design of the second survey mirrored that of the first survey except for the use of a broader set of comparator CPT ® codes (27 vs. 10). Using the work RVUs of the comparator codes, a Rasch analysis was performed to estimate the relative difficulty of CPT ® 27279, after which the work RVU of CPT ® 27279 was estimated by regression analysis., Results: Twenty surgeons responded to the first survey and thirty-four surgeons responded to the second survey. The results of the regression analysis of the first survey indicate a work RVU for CPT ® 27279 of 14.36 and the results of the regression analysis of the second survey indicate a work RVU for CPT ® 27279 of 14.1., Conclusion: The Rasch analysis indicates that the current work RVU assigned to CPT ® 27279 is undervalued at 9.03. Averaging the results of the regression analyses of the two surveys indicates a work RVU for CPT ® 27279 of 14.23., Competing Interests: This study was funded by the International Society for the Advancement of Spine Surgery (ISASS) and contributions by Globus, SI Bone, and Zyga. Melissa Martinson has a consulting arrangement with ISASS and is a paid consultant on this project.

It has been established that for cylindrically bent crystals the optimal beam characteristics occur when the geometric and single-ray foci are matched. In the beam-expanding monochromator developed for the BioMedical Imaging and Therapy beamlines at the Canadian Light Source, it was unclear how critical this `magic condition' was for preserving the transverse coherence of the beam. A study was conducted to determine whether misalignments away from the ideal conditions would severely affect the transverse coherence of the beam, thereby limiting phase-based imaging techniques. The results were that the magic condition has enough flexibility to accommodate deviations of about ±1° or ±5 keV.

High-resolution computed tomography (CT) imaging of a live animal within a lead-lined synchrotron light hutch presents several unique challenges. In order to confirm that the animal is under a stable plane of anaesthesia, several physiological parameters (e.g. heart rate, arterial oxygen saturation, core body temperature and respiratory rate) must be remotely monitored from outside the imaging hutch. In addition, to properly scan the thoracic region using CT, the animal needs to be held in a vertical position perpendicular to the fixed angle of the X-ray beam and free to rotate 180°-360°. A new X-ray transparent mouse restraint designed and fabricated using computer-aided design software and three-dimensional rapid prototype printing has been successfully tested at the Biomedical Imaging and Therapy bending-magnet (BMIT-BM) beamline at the Canadian Light Source.

The stability of the photon beam position on synchrotron beamlines is critical for most if not all synchrotron radiation experiments. The position of the beam at the experiment or optical element location is set by the position and angle of the electron beam source as it traverses the magnetic field of the bend-magnet or insertion device. Thus an ideal photon beam monitor would be able to simultaneously measure the photon beam's position and angle, and thus infer the electron beam's position in phase space. X-ray diffraction is commonly used to prepare monochromatic beams on X-ray beamlines usually in the form of a double-crystal monochromator. Diffraction couples the photon wavelength or energy to the incident angle on the lattice planes within the crystal. The beam from such a monochromator will contain a spread of energies due to the vertical divergence of the photon beam from the source. This range of energies can easily cover the absorption edge of a filter element such as iodine at 33.17 keV. A vertical profile measurement of the photon beam footprint with and without the filter can be used to determine the vertical centroid position and angle of the photon beam. In the measurements described here an imaging detector is used to measure these vertical profiles with an iodine filter that horizontally covers part of the monochromatic beam. The goal was to investigate the use of a combined monochromator, filter and detector as a phase-space beam position monitor. The system was tested for sensitivity to position and angle under a number of synchrotron operating conditions, such as normal operations and special operating modes where the photon beam is intentionally altered in position and angle at the source point. The results are comparable with other methods of beam position measurement and indicate that such a system is feasible in situations where part of the synchrotron beam can be used for the phase-space measurement.

The BioMedical Imaging and Therapy beamlines at the Canadian Light Source are used by many researchers to capture phase-based imaging data. These experiments have so far been limited by the small vertical beam size, requiring vertical scanning of biological samples in order to image their full vertical extent. Previous work has been carried out to develop a bent Laue beam-expanding monochromator for use at these beamlines. However, the first attempts exhibited significant distortion in the diffraction plane, increasing the beam divergence and eliminating the usefulness of the monochromator for phase-related imaging techniques. Recent work has been carried out to more carefully match the polychromatic and geometric focal lengths in a so-called `magic condition' that preserves the divergence of the beam and enables full-field phase-based imaging techniques. The new experimental parameters, namely asymmetry and Bragg angles, were evaluated by analysing knife-edge and in-line phase images to determine the effect on beam divergence in both vertical and horizontal directions, using the flat Bragg double-crystal monochromator at the beamline as a baseline. The results show that by using the magic condition, the difference between the two monochromator types is less than 10% in the diffraction plane. Phase fringes visible in test images of a biological sample demonstrate that this difference is small enough to enable in-line phase imaging, despite operating at a sub-optimal energy for the wafer and asymmetry angle that was used.

Non-adherence to stroke prevention medications is a risk factor for first-ever and recurrent stroke. As of yet, there are no guidelines for processes to recognize and address medication non-adherence in stroke patients. We developed a new model of post-discharge prevention care that measures and addresses medication-taking (transition coaching for stroke or TRACS). TRACS includes personalized education about risk factors and medications prior to discharge, follow-up telephone calls, and appointments with a stroke nurse practitioner (NP). The stroke NP asks about medication use (persistence) and whether doses are missed (adherence), and helps to solve problems with access to medications or side effects. In an analysis of 142 patients enrolled in TRACS from October 2012 to February 2014, medication persistence (use of medications from discharge to the time of measurement) was about 80%. Medication persistence at NP visit was higher in those patients with a first-ever stroke (78.9%) vs. those with recurrent stroke (60.7%; p = 0.045). Concerted efforts with 2-day RN follow-up calls and earlier NP appointments to improve medication-taking behaviors are underway.

Background and Objectives: Modifiable factors, such as body size and body composition, could influence physical function and quality of life in patients undergoing maintenance hemodialysis (MHD)., Design, Setting, Participants, & Measurements: From January 2008 to June 2012, in body mass index (BMI), waist circumference (WC), and magnetic resonance imaging measurements of midthigh muscle area (MTMA) and intra-abdominal fat area (IAFA) were obtained at baseline in 105 MHD patients. Six-minute walk distances and physical and mental component scores (PCS and MCS) from the Short Form-12 questionnaire were obtained at baseline and 6 and 12 months. Separate mixed-effects regression models were used to relate baseline BMI, WC, and IAFA with baseline and the average of follow-up 6-minute walk distances and PCS and MCS after adjustment for baseline covariates and MTMA., Results: for baseline covariates and baseline MTMA, each SD increase in baseline BMI was inversely associated with baseline (-31.5 m; 95% confidence interval [95% CI], -53.0 to -10.0 m) and follow-up (-36.9 m; 95% CI, -54.6 to -19.2 m) 6-minute walk distances. Results were similar for WC and IAFA. In each of these models, each SD increase in MTMA had a strong positive association with 6-minute walk distance. Adiposity measures were not associated with baseline or follow-up PCS and MCS. After adjustment for baseline BMI, each SD increase in baseline MTMA was associated with higher baseline PCS score (3.78; 95% CI, 0.73 to 6.82) and MCS (3.75; 95% CI, 0.44 to 7.05) but had weaker associations with follow-up PCS and MCS., Conclusions: Body size and composition are significantly associated with physical functioning and quality of life. Interventions that improve muscle mass and decrease obesity might improve these measures in patients undergoing MHD., (Copyright © 2014 by the American Society of Nephrology.)

The Biomedical Imaging and Therapy (BMIT) beamline at the Canadian Light Source has produced some excellent biological imaging data. However, the disadvantage of a small vertical beam limits its usability in some applications. Micro-computed tomography (micro-CT) imaging requires multiple scans to produce a full projection, and certain dynamic imaging experiments are not possible. A larger vertical beam is desirable. It was cost-prohibitive to build a longer beamline that would have produced a large vertical beam. Instead, it was proposed to develop a beam expander that would create a beam appearing to originate at a source much farther away. This was accomplished using a bent Laue double-crystal monochromator in a non-dispersive divergent geometry. The design and implementation of this beam expander is presented along with results from the micro-CT and dynamic imaging tests conducted with this beam. Flux (photons per unit area per unit time) has been measured and found to be comparable with the existing flat Bragg double-crystal monochromator in use at BMIT. This increase in overall photon count is due to the enhanced bandwidth of the bent Laue configuration. Whilst the expanded beam quality is suitable for dynamic imaging and micro-CT, further work is required to improve its phase and coherence properties.

We examined the prevalence and the in vitro susceptibility to antifungal drugs of Candida spp isolated from clinical specimens at our university hospital in São Paulo, Brazil. Among 6,417 samples studied, positive cultures, were obtained from 222 (3.5%) most of them (68%) from the pediatric unit and nursery. Candida albicans and Candida parapsilosis were the most frequent species and the susceptibility patterns of a panel of 130 isolates to amphotericin B, ketoconazole and fluconazole, showed that the order of antifungal efficacy was amphotericin B > ketoconazole > fluconazole.

Eosinophil differentiation factor (EDF) is a recently described regulator affecting eosinophil growth and activation. cDNA clones for murine EDF were isolated by direct expression from libraries prepared from the T cell hybrid NIMP-TH1. The longest cDNA clone obtained was 1534 bp in length encoding a polypeptide of 133 amino acids. Two variant cDNAs suggesting alternative RNA processing events were detected. The EDF gene was cloned from a genomic lambda library and a region of 6727 bp encompassing the gene was sequenced. The gene contains three introns 829, 1875 and 79 bases in length and has numerous repetitive sequences. A common, possible regulatory element, including a conserved decamer, lies adjacent to the TATA boxes of the EDF and granulocyte-macrophage colony-stimulating factor (GM-CSF) genes and similar sequences are present in some other lymphokine genes. Recombinant EDF produced in monkey COS cells strongly stimulated the eosinophil lineage and also showed B-cell-growth factor II (BCGFII) activity whereas recombinant murine interleukin-3 and GM-CSF showed much broader activity towards the different myeloid lineages, were less active on eosinophils and had no BCGFII activity. The BCGFII activity of recombinant EDF together with a comparison of the BCGFII (interleukin-5) cDNA sequence with that of the EDF cDNA establishes that these two activities are the properties of a single polypeptide.

The human genes for the hematopoietic growth factors interleukin-3 (IL-3), IL-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF) have been mapped to 5q23-31. We present in situ hybridization evidence that the human IL-4 gene is located at 5q23.3-31.2, suggesting that the four cytokine genes may be closely linked. We used pulsed-field gel electrophoresis to prepare subchromosomal restriction maps surrounding these genes to define this possible linkage more precisely. The IL-4 and IL-5 genes are tightly linked, being 90 to 240 kilobases (kb) apart, as has been shown for the IL-3 and GM-CSF genes, which are only 9 kb apart. Possible overlap of the map containing the IL-4 and IL-5 genes with restriction sites 5' to the IL-3 gene suggests that the four cytokine genes may be localized within 500 kb of each other. The endothelial cell growth factor gene (ECGF), which has also been localized to the 5q31 region, did not appear to be close to the cytokine genes. Linkage of the IL-3, IL-4, IL-5, and GM-CSF genes has important implications in the evolutionary origin and regulation of expression of these genes. The four cytokine genes are located in the region of the long arm of chromosome 5, which is deleted in the 5q- anomaly. The present study provides a basis for further investigations of this disorder.

The feasibility of limb salvage with bypasses to the infrapopliteal arterial tree has been established. In this review, our experience with bypasses to the peroneal artery is compared with that to the tibial arteries. Autogenous saphenous veins were employed in 164 limb salvage arterial revascularizations because of gangrene, ischemic ulceration, or rest pain. These were retrospectively analyzed by the life-table method. Femorotibial (137) or femoroperoneal (27) bypasses were performed on the basis of adequate preoperative arteriograms demonstrating the distal arterial tree, but with no popliteal runoff. Overall operative mortality was 6.1%. Initial limb salvage was 71.2 +/- 3.9% following femorotibial bypass and 51.9 +/- 9.6% after femoroperoneal bypass. Five and seven year cumulative limb salvage rates for femorotibial bypass were 48.5 +/5.2% and 43.4 +/- 6.7%; those for femoroperoneal were equivalent at 38.2 +/- 9.9%. Since long-term limb salvage can be realized in a large number of patients by revascularization of the distal arterial tree, primary amputation is seldom indicated. Operative approach to the ischemic limb must be based on a thorough preoperative arteriogram which demonstrates contrast within vessels down to the distal foot. This is almost always seen and arterial reconstruction is usually feasible. Therefore, limb salvage should be attempted in lieu of primary amputation whether tibial or peroneal arteries are visualized on preoperative arteriogram.

A prospective study was undertaken of the prognostic significance of quantitative signal-averaged electrocardiographic (ECG) variables relative to clinical variables, site of myocardial infarction, left ventricular ejection fraction and characteristics of ventricular premature beats in 115 patients (mean age 62 +/- 12 years) studied 10 +/- 6 days after myocardial infarction. Signal-averaged variables included the root mean square voltage of the terminal 40 ms, the duration of the filtered signal-averaged QRS complex and low amplitude signals less than 40 microV determined at 25 and 40 Hz high pass filtering in all patients. Of the 115 patients, 51 (44%) had an abnormal signal-averaged ECG (one or more abnormal signal-averaged variables), 51 (44%) at 25 Hz and 48 (42%) at 40 Hz high pass filtering. A higher proportion of patients with an inferior wall infarction had an abnormal signal-averaged ECG as compared with patients with anterior wall infarction (58% versus 31%). Over a 14 +/- 8 month follow-up period 16 patients (14%) had an arrhythmic event. An abnormal signal-averaged ECG at 40 Hz high pass filtering had a higher sensitivity (81% versus 75%) and specificity (65% versus 61%) than at 25 Hz high pass filtering. The predictive value of the signal-averaged ECG was superior to that of the ejection fraction (40% versus 20%) in anterior wall myocardial infarction, whereas in patients with inferior wall infarction, the predictive values of the two tests were equivalent. The prognostic power of 27 clinical and noninvasive variables was determined with the Cox proportional hazards regression model.(ABSTRACT TRUNCATED AT 250 WORDS)

Human bone marrow cells cultured for 21 days in the presence of recombinant human interleukin-3 (IL-3) produced up to 28 times more colony-forming cells (CFC) than could be obtained from cultures stimulated with granulocyte colony stimulating factor (G-CSF) or granulocyte-macrophage CSF (GM-CSF). IL-3-cultured cells retained a multipotent response to IL-3 in colony assays but were restricted to formation of granulocyte colonies in G-CSF and granulocyte or macrophage colonies in GM-CSF. Culture of bone marrow cells in IL-3 also led to accumulation of large numbers of eosinophils and basophils. These data contrast with the effects of G-CSF, GM-CSF, and IL-3 in seven-day cultures. Here both GM-CSF and IL-3 amplified total CFC that had similar multipotential colony-forming capability in either factor. G-CSF, on the other hand, depleted IL-3-responsive colony-forming cells dramatically, apparently by causing these cells to mature into granulocytes. The data suggest that a large proportion of IL-3-responsive cells in human bone marrow express receptors for G-CSF and can respond to this factor, the majority becoming neutrophils. Furthermore, the CFC maintained for 21 days in IL-3 may be a functionally distinct population from that produced after seven days culture of bone marrow cells in either IL-3 or GM-CSF.