Search

Hospital readmission is a key metric of hospital quality, such as for comparing Veterans Affairs (VA) hospitals to private sector hospitals. To calculate readmission rates, one must first identify individual hospitalizations. However, in the VA Corporate Data Warehouse (CDW), data are organized by “bedded stays,” that is, any stay in a healthcare facility where a patient is provided a bed, not hospitalizations. Thus, CDW data poses several challenges to identifying hospitalizations including: (1) bedded stays include both non-acute inpatient stays (i.e. nursing home, mental health) and acute inpatient hospital care; (2) transfers between VA facilities appear as separate bedded stays; and (3) VA care may also be fragmented by non-VA care. Thus, we sought to develop a rigorous method to identify acute hospitalizations using the VA CDW. We examined all VA bedded stays with an admission date in 2009. Non-acute portions of a stay were dropped. VA to VA transfers were merged when consecutive discharge and admission dates were within one calendar day. Finally, hospitalizations that occurred in a non-VA facility were merged. The 30-day readmission rate was calculated at each step of the algorithm to demonstrate the impact. The total number of VA medical hospitalizations in 2009 with live discharges was 505,861. The 30-day readmission rate after adjusting for VA to VA transfers and incorporating non-VA care was 18.3% (95% confidence interval (CI): 18.2, 18.4%).

BACKGROUND AND OBJECTIVES Drug courts provide an array of substance use treatments and community-based services for probationers struggling with substance use disorders. We assessed substance use treatment services utilization and related expenditures and relapse and recidivism outcomes and identified predictors of cost of provision of substance use treatment services in a matched cohort of Massachusetts probationers in drug courts and traditional courts. METHODS This was an observational quasi-experimental study with 542 propensity-score-matched probationers initiating drug court between August 1, 2015 and February 28, 2018 and a minimum 6-month follow-up period. RESULTS A significantly greater proportion of probationers in drug courts were female, self-reported opioids as their primary drug of choice, had a history of substance use treatment, and a high and very high risk of recidivism than their counterparts in traditional courts. We estimated that the provision of substance use treatment services was $1498 more expensive for probationers in drug courts than traditional courts (p = .054). There were no statistically significant differences in relapse or recidivism rates between court systems. DISCUSSION AND CONCLUSIONS Probationer's age, gender, risk of recidivism at court intake, and enrollment length were strong predictors of expenditures on substance use treatment services. SCIENTIFIC SIGNIFICANCE This was the first study to assess substance use treatment services utilization and outcomes among probationers in drug courts and traditional courts. Drug courts served the needs of probationers disproportionally impacted by nonserious drug-related offenses struggling with substance use disorders who were at a high and very high risk of recidivism at court intake.

Next-generation sequencing (NGS) technologies are now established in clinical laboratories as a primary testing modality in genomic medicine. These technologies have reduced the cost of large-scale sequencing by several orders of magnitude. It is now cost-effective to analyze an individual with disease-targeted gene panels, exome sequencing, or genome sequencing to assist in the diagnosis of a wide array of clinical scenarios. While clinical validation and use of NGS in many settings is established, there are continuing challenges as technologies and the associated informatics evolve. To assist clinical laboratories with the validation of NGS methods and platforms, the ongoing monitoring of NGS testing to ensure quality results, and the interpretation and reporting of variants found using these technologies, the American College of Medical Genetics and Genomics (ACMG) has developed the following technical standards.

Summary We simulate pathways for achieving up to 100% renewable energy (RE) electric power systems for the contiguous United States. Under base conditions, the least-cost buildout has RE penetration growing up to 57% in 2050. Relative to this base scenario, average CO2 abatement costs of achieving 80%, 90%, 95%, and 100% RE are $25, $33, $40, and $61/ton, respectively, with system costs growing from $30 to $36/MWh at 95% (achieved in 2040) and $39/MWh at 100%. Incremental abatement costs from 99% to 100% RE reach $930/ton, driven primarily by the need for firm RE capacity. In addition to the base conditions, we also examined 22 alternative conditions for a buildout of up to 100%. These sensitivities capture different technology trajectories, compliance requirements, requirement timing, electrification, and transmission availability. Nonlinear marginal costs for the last few percent approaching 100% RE were found for all sensitivities, which might motivate alternative nonelectric-sector abatement opportunities.

Objective:The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection.Methods:All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020.Results:Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%–6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67–7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection.Conclusions:The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19–positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.

Klawitter, L, Vincent, BM, Choi, BJ, Smith, J, Hammer, KD, Jurivich, DA, Dahl, LJ, and McGrath, R. Handgrip strength asymmetry and weakness are associated with future morbidity accumulation in americans. J Strength Cond Res 36(1): 106-112, 2022-Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006-2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength10% between hands had HGS asymmetry. Men with HGS26 kg and women with HGS16 kg were considered as weak. Subjects reported the presence of healthcare provider-diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04-1.14) and 1.27 (CI: 1.11-1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29-1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk.

BACKGROUND Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings. OBJECTIVE The objective of this study was to test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) health care system and determine power to detect greater-than-expected 30-day mortality. RESEARCH DESIGN Observational cohort study with hospital-specific template matching assessment. For each VA hospital, the 30-day mortality of a representative subset of hospitalizations was compared with the pooled mortality from matched hospitalizations at a set of comparison VA hospitals treating sufficiently similar patients. The simulation was used to determine power to detect greater-than-expected mortality. SUBJECTS A total of 556,266 hospitalizations at 122 VA hospitals in 2017. MEASURES A number of comparison hospitals identified per hospital; 30-day mortality. RESULTS Each hospital had a median of 38 comparison hospitals (interquartile range: 33, 44) identified, and 116 (95.1%) had at least 20 comparison hospitals. In total, 8 hospitals (6.6%) had a significantly lower 30-day mortality than their benchmark, 5 hospitals (4.1%) had a significantly higher 30-day mortality, and the remaining 109 hospitals (89.3%) were similar to their benchmark. Power to detect a standardized mortality ratio of 2.0 ranged from 72.5% to 79.4% for a hospital with the fewest (6) versus most (64) comparison hospitals. CONCLUSIONS Hospital-specific template matching may be feasible for assessing hospital performance in the diverse VA health care system, but further refinements are needed to optimize the approach before operational use. Our findings are likely applicable to other large and diverse multihospital systems.

Hatfield, DL, Stranieri, AM, Vincent, LM, and Earp, JE. Effect of a neoprene knee sleeve on performance and muscle activity in men and women during high-intensity, high-volume resistance training. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this study was to assess the effects of a commercially available neoprene knee sleeve (KS) on exercise performance and muscle activity during an exhaustive leg press exercise. Twenty resistance-trained individuals, 11 men {21.0 ± 2.2 years; 77.7 ± 8.7 kg; 1 repetition maximum (1RM/body mass [BM]): 0.30 ± 0.04} and 9 women (22.0 ± 3.5 years; 66.1 ± 9.1 kg; 1RM/BM: 0.30 ± 0.04), all subjects (21.5 ± 2.8 years; 72.5 ± 10.5 kg; 1RM/BM: 0.30 ± 0.04), participated in 3 testing sessions. The second and third sessions were performed using a counterbalanced and randomized design in which subjects exercised with (WS) or without (NS) KSs and performed 6 sets of leg press exercise at 80% of 1RM until failure with a 3-minute rest between sets. Number of repetitions, blood lactate (BL), heart rate (HR), rating of perceived exertion (RPE), and peak and average power were recorded after each set. Surface electromyography (EMG) of the right and left vastus lateralis muscles was also recorded to compare muscle activity between conditions. Significance was set at p ≤ 0.05, and values are presented as mean ± SD. No significant differences were observed in the total number of repetitions for all sets (p = 0.3; WS 75.3 ± 33.7, NS 79.8 ± 34.3) and the number of repetitions per set between conditions (p ≤ 0.05) or between men and women. Similarly, no significance differences (p ≤ 0.05) were observed for BL, HR, RPE, or EMG per set between conditions or between men and women. These results suggest that wearing compressive neoprene KSs has no effect on improving performance and associated variables during high-load, high-volume lower-body resistance training.

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%−93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1–90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1–91.4%). DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

The semiconductor industry is witnessing a nascent security paradigm shift in the rise of Confidential Computing. Driven by the need to protect computations delegated to co-tenanted machines operated by Cloud Computing services, mainstream instruction set architectures are gradually introducing novel features that can be used to establish protected isolates offering strong integrity and confidentiality guarantees to code and data contained within. Coupled with a Remote Attestation protocol, a third-party may request the launch of an isolate on an otherwise untrusted machine and know—with a high degree of assurance—that a payload of code and data was indeed loaded into a legitimate isolate with a particular configuration.We argue that this ability to reliably establish a safe “beach-head” on an untrusted third-party’s machine has far-reaching consequences with applications beyond protecting workloads delegated to Cloud Computing services. In a future world where facilities for Confidential Computing are widely deployed and used, we imagine a utopia where inadvertent data leakage is a curiosity of a bygone age, with encrypted data moving from isolate to isolate and never resting in plaintext. Moreover, data is only released in explicitly delimited ways for processing, with systems and individuals exhibiting fine-grained control over data.We report on recent activities within Arm in attempting to realize this vision, and hope that this paper acts as a “call to arms” to others to join with us in fully exploring the potential of these emerging technologies.

Background: HIV is a worldwide disease and affects all systems of the body. Despite the high burden of Paediatric HIV in Nigeria, few studies have been done on Otolaryngological disorders in children living with HIV. This study aimed to determine the pattern and prevalence of Otorhinolaryngological disorders among HIV positive paediatric patients and to compare them with age and sex-matched control. Methods: This was a descriptive cross-sectional case-control study carried out among 130 HIV positive and 130 HIV negative children aged 6 to 15 years at the University of Port Harcourt Teaching Hospital (UPTH). Eligible patients were recruited via a systematic sampling method and matched with HIV negative controls and an interviewer-administered questionnaire was used to extract relevant information. All patients had Otorhinolaryngological examination and CD4 count determination, while children with tonsillar enlargement underwent X-ray of the post nasal space. HIV patients were graded for severity using WHO clinical Staging. Results: A higher proportion of the HIV positive patients had allergic rhinitis (66.9% vs.30.8%, p=0.01), pharyngitis (40.8% vs.18.5%, p=0.01), tonsillitis (34.6% vs.20.8%, p=0.013), adenotonsilar disease (24.6% vs. 13.8%, p=0.028), cervical lymphadenopathy (15.4% vs. 5.4%, p=0.001) and otitis media (5.4% vs. 0.8%, p=0.031). There was a significantly higher prevalence of ORL disorders among HIV positive children (95.4%) compared to HIV negative children (78.5%). (P=0.001). Conclusion: Pattern of ORL disorder appeared similar in both HIV-positive and -negative children. However, the overall high prevalence of the findings among the HIV-positive children required regular ORL assessment in these children.

Summary With rapid declines in solar photovoltaic (PV) and energy storage costs, futures with PV penetrations approaching or exceeding 50% of total annual US generation are becoming conceivable. The operational merits of such a national-scale system have not been evaluated sufficiently. Here, we analyze in detail the operational impacts of a future US power system with very high annual levels of PV (>50%) with storage. We show that load and operating reserve requirements can be met for all hours while considering key generator operational constraints. Storage plays an active role in maintaining the balance of supply and demand during sunset hours. Under the highest PV penetration scenario, hours with >90% PV penetration are relatively common, which require rapid transitions between predominately conventional synchronous generation and mostly inverter-based generation. We observe hours with almost 400 GW (over 40%) of economic curtailment and frequent (up to 36%) hours with very low energy prices., Graphical Abstract, Highlights • Load and operating reserves can be met in US grid with up to 55% PV with storage • Power system must rapidly transition between synchronous and inverter-based generation • Significant curtailment is seen, with hours of >40% economic curtailment • Hours with very low energy prices become more frequent, up to 36% of hours, Energy Policy; Energy Engineering; Energy Flexibility

Handgrip strength is considered a biomarker of nutritional status and strength capacity, which are both linked to heart complications. However, it is not well understood how weakness, as measured by handgrip strength, factors into common heart conditions seen in aging adults such as chronic heart failure (CHF). The purpose of this study was to determine the association between weakness and incident CHF for aging Americans. Longitudinal-Panel. Physical measures were completed during enhanced face-to-face interviews. The core interview was typically conducted over the telephone. Data from 17,431 adults aged at least 50 years who identified as Black or White, completed interviews without a proxy, and participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were included. Handgrip strength was measured with a hand-held dynamometer. Healthcare provider diagnosed CHF was self-reported at each wave. Sex- and race-specific maximal handgrip strength cut-points were used for determining weakness (Black men

Discovering how certain health factors contribute to functional declines may help to promote successful aging. To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans. Data from 18,391 adults aged 50 years and over who participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses. Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57–1.84), 1.97 (CI 1.74–2.23), and 3.13 (CI 2.73–3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03–2.51), 1.26 (CI 1.05–1.51), and 4.48 (CI 3.72–5.39) greater odds for ADL disability decline, respectively. HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone. Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity.

Even though risk assessment tools are often intended to inform case planning, they do not provide much direct guidance. As such, we developed an intervention-planning tool called the Adolescent Risk Reduction and Resilient Outcomes Work-Plan (ARROW) to accompany the Structured Assessment of Violence Risk in Youth. The ARROW includes a decision support system, guide, and training, and is one of the first tools of its kind. To evaluate the ARROW, we conducted two studies: (a) a vignette study with 178 professionals and (b) a field study with 320 propensity-score matched adolescents. Most professionals (>98%) rated the ARROW as useful. Moreover, compared with (a) unstructured plans and (b) a simple form, ARROW plans were more likely to include supported interventions, adhere to best practices, and integrate culturally tailored approaches for Indigenous adolescents. Formulations also showed improvements. However, further research is needed on strategies to bridge risk assessment and risk management.

Background To study patient physiology throughout a period of acute hospitalization, we sought to create accessible, standardized nationwide data at the level of the individual patient-facility-day. This methodology paper summarizes the development, organization, and characteristics of the Veterans Affairs Patient Database 2014–2017 (VAPD 2014–2017). The VAPD 2014–2017 contains acute hospitalizations from all parts of the nationwide VA healthcare system with daily physiology including clinical data (labs, vitals, medications, risk scores, etc.), intensive care unit (ICU) indicators, facility, patient, and hospitalization characteristics. Methods The VA data structure and database organization represents a complex multi-hospital system. We define a single-site hospitalization as one or more consecutive stays with an acute treating specialty at a single facility. The VAPD 2014–2017 is structured at the patient-facility-day level, where every patient-day in a hospital is a row with separate identification variables for facility, patient, and hospitalization. The VAPD 2014–2017 includes daily laboratory, vital signs, and inpatient medication. Such data were validated and verified through lab value range and comparison with patient charts. Sepsis, risk scores, and organ dysfunction definitions were standardized and calculated. Results We identified 565,242 single-site hospitalizations (SSHs) in 2014; 558,060 SSHs in 2015; 553,961 SSHs in 2016; and 550,236 SSHs in 2017 at 141 VA hospitals. The average length of stay was four days for all study years. In-hospital mortality decreased from 2014 to 2017 (1.7 to 1.4%), 30-day readmission rates increased from 15.3% in 2014 to 15.6% in 2017; 30-day mortality also decreased from 4.4% in 2014 to 4.1% in 2017. From 2014 to 2017, there were 107,512 (4.8%) of SSHs that met the Center for Disease Control and Prevention’s Electronic Health Record-based retrospective definition of sepsis. Conclusion The VAPD 2014–2017 represents a large, standardized collection of granular data from a heterogeneous nationwide healthcare system. It is also a direct resource for studying the evolution of inpatient physiology during both acute and critical illness. Electronic supplementary material The online version of this article (10.1186/s12874-019-0740-x) contains supplementary material, which is available to authorized users.

Background: Dementia screening is an important step for appropriate dementia-related referrals to diagnosis and treat possible dementia. Objective: We sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally representative sample of older Americans with a cognitive impairment consistent with dementia (CICD). Methods: The weighted analytical sample included 6,036,224 Americans aged at least 65 years old that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 Health and Retirement Study. The adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores≤6 were considered as having a CICD. Healthcare provider dementia-related diagnosis was self-reported. Age, sex, educational achievement, and race and ethnicity were also self-reported. Results: The overall estimated prevalence of no reported dementia-related diagnosis for older Americans with a CICD was 91.4%(95%confidence interval (CI): 87.7%–94.1%). Persons with a CICD who identified as non-Hispanic black had a high prevalence of no reported dementia-related diagnosis (93.3%; CI: 89.8%–95.6%). The estimated prevalence of no reported dementia-related diagnosis was greater in males with a CICD (99.7%; CI: 99.6%–99.8%) than females (90.2%; CI: 85.6%–93.4%). Moreover, the estimated prevalence of no reported dementia-related diagnosis for non-high school graduates with a CICD was 93.5%(CI: 89.3%–96.1%), but 90.9%(CI: 84.7%–94.7%) for those with at least a high school education. Conclusion: Dementia screening should be encouraged during routine geriatric health assessments. Continued research that evaluates the utility of self-reported dementia-related measures is also warranted.

Background Desoxycorticosterone pivalate (DOCP) is a commonly used mineralocorticoid replacement for dogs with primary hypoadrenocorticism (HA), but manufacturer-recommended dosing protocols can be cost-prohibitive. Recent reports also have raised concerns that label dose protocols could be excessive. Objective To investigate the relative efficacy and adverse effects of 2 DOCP dosages in dogs with primary glucocorticoid and mineralocorticoid deficient HA. Animals Thirty-seven dogs, including 19 test population dogs and 18 controls. Methods Randomized controlled double-blinded clinical trial. Dogs with newly diagnosed primary HA were assigned to standard (2.2 mg/kg q30d, control population) or low-dose (1.1 mg/kg q30d, test population) DOCP treatment. Clinical and laboratory variables were assessed 10 to 14 days and approximately 30 days after each DOCP treatment for 90 days. Results Mean serum sodium to potassium ratios at reevaluations were ≥32 in both populations throughout the study. No dog developed electrolyte abnormalities warranting medical treatment, although hypokalemia occurred on at least 1 occasion in 9 controls and 6 test population dogs. Urine specific gravities (median, interquartile range) were lower in control dogs (1.022, 1.016-1.029) as compared to test population dogs (1.033, 1.023-1.039; P = .006). Plasma renin activity was overly suppressed on 84 of 104 (80.8%) assessments in control dogs whereas increased renin activity occurred on 23 of 112 (20.5%) assessments in test population dogs. Conclusions and clinical importance Low-dose DOCP protocols appear to be safe and effective for treatment of HA in most dogs. Standard-dose protocols are more likely to result in biochemical evidence of overtreatment.

Objective To examine associations between local and systemic symptoms and the wear of the tin weld of Essure implants. Design study of a series of cases. Settings Two French hospitals. Participants Eighteen patients explanted by hysterectomy and salpingectomy for removal of their Essure implants between September 2019 and July 2020, have had a common anatomopathological process. Main outcome measures anatomopathological examination by optical microscopy and mineralogical analysis of the fallopian tube or uterine horn with scanning electron microscopy coupled with energy dispersive X-ray (SEM-EDX). Evaluation of local and systemic symptoms with a questionnaire. Examination of blood metal assays (nickel, chromium, and tin). Results anatomopathological examination highlights foreign body granulomas, fibrosis, adenomyosis, nonspecific inflammation, cysts and myomas in the Fallopian tubes, uterine horns, or both and mentions the presence of foreign bodies in seven cases. SEM-EDX analyses showed, systematically, the presence of tin particles integrated in the wall near the weld, generally in clusters, and with a size ranging from about one micron to several dozen microns. The questionnaire shows that the most frequent local symptoms were pelvic pain, urinary disorders, bleeding, and pains during intercourse. The most common systemic symptoms were: asthenia, visual disturbances, amnesia, giddiness, dorsal pains, headaches, and joint pains. The majority of local and systemic symptoms decreased after explantation, but sometimes incompletely. Before explantation, high levels of nickel, tin and chromium were observed in 11/17, 1/7 and 2/17 patients. After explantation, tin levels were high in 3/11 patients. Conclusions our new anatomopathological process systematically demonstrates the presence of tin particles in tissue near the weld. These particles could be responsible for granulomatous inflammations as well as local symptoms. Many of the systemic symptoms are consistent with chronic organotin poisoning but further studies are needed to find out whether tin from the solder can be converted to organotin in the patients' bodies.

OBJECTIVES To evaluate biomarkers of oxidative stress in dogs with copper-associated hepatitis (CAH) as compared with healthy controls, and to evaluate if these markers correlate with hepatic copper concentrations and hepatic histopathologic features. MATERIALS AND METHODS Prospective study. Plasma reactive metabolite concentrations, plasma antioxidant potential, and plasma and urine isoprostane concentrations were determined in Labrador retrievers with copper-associated hepatitis (n=9) as well as in breed- and sex-matched (n=9) and age- and sex-matched (n=9) healthy control populations. Possible correlations between markers of oxidative stress and hepatic histopathological features also were investigated. RESULTS Reactive metabolites (median, range) were over twofold greater in dogs with copper-associated hepatitis (87.2 RFU/μL, 60.9 to 185.6 RFU/μL) as compared to breed- and sex-matched (38.2 RFU/μL, 22.4 to 116.8 RFU/μL) and age- and sex-matched controls (32.0 RFU/μL, 18.5 to 127.4 RFU/μL). Antioxidant potential was decreased in copper-associated hepatitis dogs (6.5 TE/μL, 5.1 to 7.7 TE/μL) as compared to breed- and sex-matched controls (8.2 TE/μL, 5.3 to 11.8 TE/μL). Both reactive metabolite concentrations and the reactive metabolite to antioxidant potential ratio were positively correlated with hepatic copper concentrations. Plasma and urine isoprostanes were variable and not significantly different between populations. CLINICAL SIGNIFICANCE Labrador retrievers with copper-associated hepatitis have altered oxidant status. Plasma reactive metabolite concentrations and the reactive metabolite to antioxidant potential ratio could be useful biomarkers. However, neither plasma nor urine isoprostanes were useful biomarkers for copper-associated hepatitis.

Related metabolites can be grouped into sets in many ways, e.g., by their participation in series of chemical reactions (forming metabolic pathways), or based on fragmentation spectral similarities or shared chemical substructures. Understanding how such metabolite sets change in relation to experimental factors can be incredibly useful in the interpretation and understanding of complex metabolomics data sets. However, many of the available tools that are used to perform this analysis are not entirely suitable for the analysis of untargeted metabolomics measurements. Here, we present PALS (Pathway Activity Level Scoring), a Python library, command line tool, and Web application that performs the ranking of significantly changing metabolite sets over different experimental conditions. The main algorithm in PALS is based on the pathway level analysis of gene expression (PLAGE) factorisation method and is denoted as mPLAGE (PLAGE for metabolomics). As an example of an application, PALS is used to analyse metabolites grouped as metabolic pathways and by shared tandem mass spectrometry fragmentation patterns. A comparison of mPLAGE with two other commonly used methods (overrepresentation analysis (ORA) and gene set enrichment analysis (GSEA)) is also given and reveals that mPLAGE is more robust to missing features and noisy data than the alternatives. As further examples, PALS is also applied to human African trypanosomiasis, Rhamnaceae, and American Gut Project data. In addition, normalisation can have a significant impact on pathway analysis results, and PALS offers a framework to further investigate this. PALS is freely available from our project Web site.

Background: Engaging in healthy behaviors may help to preserve function during aging; however, it is not well understood how sleeping time is associated with functional capacity in older adults.Aims We sought to determine the association of sleeping time on functional limitation in a national sample of older Americans. Methods: The analytical sample included 6020 adults aged at least 65 years who participated in the 2007–2016 waves of the National Health and Nutrition Examination Survey. Respondents indicated their hours of sleep/weeknight and were categorized as9 h of sleep/weeknight. Ability to complete 19 functional tasks including basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical activities were also self-reported. A covariate-adjusted logistic model analyzed the associations between each sleeping time category and functional limitation. Results: Relative to those reporting 7–8 h of sleep/weeknight, older Americans reporting9 h of sleep/weeknight had 1.66 [95% confdence interval (CI): 1.05, 2.62], 1.25 (CI: 1.02, 1.52), 1.59 (CI: 1.19, 2.12), and 2.99(CI: 1.96, 4.56) greater odds for functional limitation, respectively. Discussion: Sleep should be recognized as a health factor that may reflect functional capacity in older adults. Health careproviders should discuss the importance of optimal sleep with their older patients and older adults should practice healthy sleeping behaviors for preserving function. Conclusions: Not meeting optimal sleep recommendations is associated with functional limitations in older Americans. Refereed/Peer-reviewed

Background: The PACIFIC trial demonstrated that consolidation durvalumab significantly improved PFS and OS (the primary endpoints) vs. placebo in patients with unresectable, stage III NSCLC whose disease had not progressed after platinum-based, concurrent chemoradiotherapy (CRT). We report exploratory analyses of outcomes from PACIFIC by age. Patients and Methods: Patients were randomized 2:1 (1-42 days post-CRT) to receive 12-months’ durvalumab (10 mg/kg intravenously every-2-weeks) or placebo. We analyzed PFS and OS (unstratified Cox-proportional-hazards models), safety and patient-reported outcomes (PROs: symptoms, functioning, and global-health-status/quality-of-life) in subgroups defined by a post-hoc 70-year age threshold. Data cut-off for PFS was February 13, 2017 and for OS, safety and PROs was March 22, 2018. Results: Overall, 158 of 713 (22.2%) and 555 of 713 (77.8%) randomized patients were aged ?70 and

Background Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans. Methods The analytic sample included 18,468 Americans aged ≥50 years from the 2006–2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS >10% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS >10% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS >10% stronger on their nondominant hand were classified as having nondominant HGS asymmetry. Men with HGS Results Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95% confidence interval [CI]: 1.02–1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, and 1.81 (CI: 1.52–2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13–1.50) for nondominant HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, 1.72 (CI: 1.29–2.29) for both weakness and nondominant HGS asymmetry, and 1.86 (CI: 1.52–2.28) for both weakness and dominant HGS asymmetry. Conclusions HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.

Background Evaluating asymmetries in muscle function could provide important insights for fall risk assessments. We sought to determine the associations of (i) handgrip strength (HGS) asymmetry and (ii) leg extension power (LEP) asymmetry on risk of incident recurrent falls and fractures in older men. Method There were 5 730 men with HGS asymmetry data and 5 347 men with LEP asymmetry data from the Osteoporotic Fractures in Men (MrOS) study. A handgrip dynamometer measured HGS and a Nottingham Power Rig ascertained LEP. Percent difference in maximal HGS between hands was calculated, and asymmetric HGS was defined as men in the highest quartile of dissimilarity for HGS between hands. The same approach was used to determine asymmetric LEP. Participants self-reported falls every 4 months after the baseline exam, and persons with ≥2 falls in the first year were considered recurrent fallers. Fractures and their dates of occurrence were self-reported and confirmed with radiographic reports. Results Older men in the highest HGS asymmetry quartile had a 1.20 (95% confidence interval [CI]: 1.01–1.43) relative risk for incident recurrent falls. Likewise, men in the highest HGS asymmetry quartile had a higher risk for incident fractures: 1.41 (CI: 1.02–1.96) for hip, 1.28 (CI: 1.04–1.58) for major osteoporotic, and 1.24 (CI: 1.06–1.45) for nonspine. There were no significant associations between LEP asymmetry and recurrent falls or fractures. Conclusions Asymmetric HGS could be a novel risk factor for falls and fractures that is more feasible to measure than LEP. Fall risk assessments should consider evaluating muscle function, including HGS asymmetry.

Background Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU). Methods Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 >120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP. Results Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002). Conclusions In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted. Funding Acknowledgement Type of funding source: None

Risk assessment instruments for violence and reoffending are widely used throughout the world. According to researchers, there are many different reasons to use these instruments; for instance, they are thought to reduce violence, save money, and improve treatment-planning. In this paper, we create a taxonomy to classify these risk management outcomes into agency, professional practice, and examinee domains. Through a review of research, we show that instruments do not always achieve their goals. First, agencies encounter problems in successfully implementing instruments. Second, a lack of follow through can occur between risk assessments and the subsequent phases of risk management, such as case planning and intervention delivery. By drawing from the field of implementation science, we create an agenda for research.

Objectives: Examining strength asymmetries in assessments of muscle function may improve screenings for limitations in independent living tasks such as instrumental activities of daily living (IADL). We sought to determine the associations between handgrip strength (HGS) asymmetry and future IADL limitations in aging Americans. Design: Longitudinal panel. Setting and Participants: Secondary analyses of data from participants aged at least 50 years from the 2006-2016 waves of the Health and Retirement Study. The analytic sample included 18,235 Americans who identified hand dominance and had measures of HGS for both hands in a single wave. Methods: Hand dominance was self-reported, and a handgrip dynamometer measured HGS on each hand. The highest HGS values on each hand were used to calculate the HGS asymmetry ratio: (nondominant HGS/dominant HGS). Individuals with HGS asymmetry ratio 1.20 had HGS asymmetry. Persons with HGS asymmetry ratio 1.20 had nondominant HGS asymmetry. Persons with HGS asymmetry ratio

Introduction When a doctor is informed of a patient’s future care preferences if they were to lose capacity, there is an ethical and legal obligation to share this information with the treating medical team. In frail older patients, conversations about treatment preferences often occur during hospital admission. We sought to assess the communication of these preferences to the patient’s GP. Methods Retrospective chart review of consecutive discharges from acute geriatric wards across seven hospitals. Records were excluded if the patient was admitted for less than 48 hours, was under orthogeriatric care, or died in hospital. Results 339 notes were included, 41-50 from each hospital. GPs were informed of the resuscitation status of 28% of all patients. 52% of patients had an inpatient DNACPR, the GP was informed of 54% of these. 36% of patients had an inpatient ceiling of treatment documented, of which GPs were informed of 19%. 53% of hospital DNACPRs were converted into community DNACPRs on discharge: GPs were informed of only 24% of new community DNACRPs. 47% of patients discharged with a new community DNACPR lacked capacity to be involved in that decision; for just 6% of these was the GP asked to review the DNACPR order in the community. Inpatient Advance Care Planning (ACP) discussions were held for 9% of patients, of which the GP was informed in 59% of cases. 49% of ACP conversations involved the next-of-kin but not the patient. Among patients who had a new DNACPR decision made during their admission (n=124), there was documentary evidence in only 25% that the patient or next-of-kin was informed whether this was time-limited or indefinite. Conclusions Communication from hospitals to GPs about resuscitation, ceiling of care and ACP discussions is very limited. For patients who have expressed ongoing future care preferences, there is a legal obligation to share this information with the treating medical team, which on discharge is the GP. There is poor documentary evidence of discussions with patients about whether DNACPR decisions are time-limited or indefinite. Furthermore, many hospitalised frail patients lack capacity to make DNACPR decisions but they may subsequently regain capacity, particularly those with delirium. Despite this, GPs are rarely asked to review new community DNACPRs, including those made for patients without capacity.

ClinVar provides open access to variant classifications shared from many clinical laboratories. While most classifications are consistent across laboratories, classification differences exist. To facilitate resolution of classification differences on a large scale, clinical laboratories were encouraged to reassess outlier classifications of variants with medically significant differences. Outliers were identified by first comparing ClinVar submissions from 41 clinical laboratories to detect variants with medically significant differences between the laboratories (650 variants). Next, medically significant differences were filtered for variants with ≥3 classifications (244 variants), of which 87.6% (213 variants) had a majority consensus in ClinVar, thus allowing for identification of outlier classifications in need of reassessment. Laboratories with outlier classifications were sent a custom report and encouraged to reassess variants. Results were returned for 204 (96%) variants, of which 62.3% (127) were resolved. Of those 127, 64.6% (82) were resolved due to reassessment prompted by this study and 35.4% (45) resolved by a previously completed reassessment. This study demonstrates a scalable approach to classification resolution and capitalizes on the value of data sharing within ClinVar. These activities will help the community move toward more consistent variant classifications which will improve the care of patients with, or at risk for, genetic disorders.

Objectives: The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States. Design: Longitudinal-Panel. Setting: Detailed interviews were completed in person and core interviews were typically completed over the telephone. Participants: A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years. Measurements: A hand-held dynamometer assessed HGS and performance in IADLs were self-reported. Results: Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone. Conclusions: Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.

Purpose We sought to measure inpatient healthcare utilization among U.S. Veteran Affairs beneficiaries surviving sepsis hospitalization, and to examine how post-sepsis utilization varies by select patient characteristics. Materials and methods Retrospective cohort study of 26,561 Veterans who survived sepsis hospitalization in 2009. Using difference-in-differences analysis, we compared changes in healthcare utilization in one year before and one year after sepsis hospitalization by Veteran age, illness severity, and recent nursing facility use. Results Median days in a healthcare facility increased from 5 to 10. Veterans with recent nursing facility use spent a median 65 days (or 86% of days alive) in a healthcare facility in the year after sepsis. Older age, greater illness severity, and recent nursing home use were each associated with spending more days, and a greater proportion of days alive, in a healthcare facility during the year after sepsis. However, none of these characteristics was associated with a greater rise in utilization after sepsis. Conclusions Veterans surviving sepsis experience high rates of post-sepsis mortality and significant increases in healthcare facility use. Recent nursing facility use is strongly predictive of greater post-sepsis healthcare utilization.

McGrath, RP, Kraemer, WJ, Vincent, BM, Hall, OT, and Peterson, MD. Muscle strength is protective against osteoporosis in an ethnically diverse sample of adults. J Strength Cond Res 31(9): 2586-2589, 2017-The odds of developing osteoporosis may be affected by modifiable and nonmodifiable factors such as muscle strength and ethnicity. This study sought to (a) determine whether increased muscle strength was associated with decreased odds of osteoporosis and (b) identify whether the odds of osteoporosis differed by ethnicity. Data from the 2013 to 2014 National Health and Nutrition Examination Survey were analyzed. Muscle strength was measured with a hand-held dynamometer, and dual-energy x-ray absorptiometry was used to assess femoral neck bone mineral density. A T-score of ≤2.5 was used to define osteoporosis. Separate covariate-adjusted logistic regression models were performed on each sex to determine the association between muscle strength and osteoporosis. Odds ratios (ORs) were also generated to identify if the association between muscle strength and osteoporosis differed by ethnicity using non-Hispanic blacks as the reference group. There were 2,861 participants included. Muscle strength was shown to be protective against osteoporosis for men (OR: 0.94; 95% confidence interval [CI]: 0.94-0.94) and women (OR: 0.90; CI: 0.90-0.90). Although ORs varied across ethnicities, non-Hispanic Asian men (OR: 6.62; CI: 6.51-6.72) and women (OR: 6.42; CI: 6.37-6.48) were at highest odds of osteoporosis. Increased muscle strength reduced the odds of osteoporosis among both men and women in a nationally representative, ethnically diverse sample of adults. Non-Hispanic Asians had the highest odds of developing osteoporosis. Irrespective of sex or ethnicity, increased muscle strength may help protect against the odds of developing osteoporosis.

SummaryBackground Several studies document reliable brain health benefits of acute exercise bouts. However, no prior studies have explored such effects among those living with co-morbid overweight/obesity and type 2 diabetes (T2DM), both of which are conditions associated with cognitive performance decrements. Purpose To examine the impact of a 30-min bout of moderate-intensity aerobic exercise on executive function among adults with overweight/obesity and T2DM, employing a widely used experimental paradigm. Methods Thirty adults with overweight/obesity and T2DM were randomly assigned to moderate (30% maximal heart rate reserve) and minimal (r.p.m. 30–50; work load 5) intensity aerobic exercise. Pre-exercise to post-exercise changes in Stroop interference and Go/No-Go scores were compared across conditions. Results Primary analyses revealed no overall effect of exercise condition on changes in Stroop or Go/No-Go performance. Post-hoc moderation analyses indicated that Stroop interference scores were reduced, following moderate exercise among female participants and among those who were more physically active. Conclusion The current study revealed no reliable benefit of acute aerobic exercise for overweight and obese individuals living with T2DM overall. There may be limited benefits for women and more and active subgroups, but the precise nature of such benefits remains unclear.

Aim Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use. Method A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded. Results The protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94–7.61) and 2.3 times less likely to receive treatment (95% CI 1.2–4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70). Conclusion Our ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications.

Objectives: Assessing handgrip strength (HGS) asymmetry may provide insights into HGS as a prognostic assessment of strength capacity and vitality. This study sought to determine the associations of HGS asymmetry and weakness on time to mortality in aging Americans. Design: Longitudinal panel. Setting: Secondary analyses of data from participants aged ≥50 years from the 2006‒2014 waves of the Health and Retirement Study. Participants: The analytic sample included 19,325 Americans who identified hand dominance and had measures of HGS for both hands in a single wave. Measures: A handgrip dynamometer was used to measure HGS. Men and women who were considered weak had HGS 1.10 had any HGS asymmetry. Moreover, participants with HGS ratio 1.10 had nondominant HGS asymmetry. The National Death Index and postmortem interviews verified date of death. Covariate-adjusted Cox models were used for analyses. Results: Those with any HGS asymmetry had a 1.10 [95% confidence interval (CI) 1.03‒1.17] higher hazard for mortality, while those with weakness had a 1.44 (CI 1.32‒1.58) higher hazard for mortality. Likewise, participants with dominant HGS asymmetry had a 1.11 (CI 1.03‒1.18) higher hazard for mortality, and those with weakness had a 1.45 (CI 1.32‒1.58) higher hazard for mortality; however, the association was not significant for those with nondominant HGS asymmetry (hazard ratio: 1.07; CI 0.96‒1.18). Conclusions and Implications: HGS asymmetry and weakness are markers of impaired strength capacity that independently accelerate time to mortality, but the magnitude of these associations was more prominent for weakness. Nevertheless, assessments of asymmetric HGS are a simple adjunct analysis that may show promise for increasing the prognostic value of handgrip dynamometers. Refereed/Peer-reviewed

OBJECTIVES: Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We utilized a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared to control groups with incrementally higher strength capacities. DESIGN: Longitudinal-Panel. SETTING: Detailed interviews that included physical measures were conducted in person, while core interviews were often performed over the telephone. PARTICIPANTS: Data from 19,729 Americans aged at least 50-years from 2006-2014 waves of the Health and Retirement Study were analyzed. MEASURES: A hand-grip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS

International audience; The evaluation of the wear of hip prostheses is regulated by international standards, however, the results of in vitro tests do not allow to predict the effective lifetime once the implants are in place. Our study aims to develop a new method of in vitro testing of implants, more representative of their wear in physiological conditions. We also want to develop a questionnaire that can detect the particular sensitivities of each patient to the constituent materials of the prostheses and thus guide the choice of one's implant to limit the risk of aseptic loosening.

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults. The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans. Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed. Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study. At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative. Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults. Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.

Interior Intrusion Detection System (IIDS) is used to monitor the interior areas of radiological laboratories. Passive infra red sensor is used to monitor the intrusion of people. 16 Passive infra red sensors are connected to one controller. Two controllers are connected to server by LAN. IIDS monitors movement of people in interior areas, raises audible and visual alarm. This paper discusses the System Requirements, System Architecture, Hardware Design and Software aspects of Interior Intrusion Detection System.

Objective Research indicates moderate-to-limited integration of the risk-need-responsivity (RNR) principles in probation case planning. Efforts to improve implementation are important targets for research, policy, and practice. This study examined the ability of two juvenile probation departments to implement RNR principles with fidelity following a comprehensive implementation protocol that included RNR-related policies, creation of a service matrix for criminogenic need-to-service matching, and extensive staff training. Hypotheses The researchers anticipated fidelity to the risk and need principles would be stronger than previous studies. Method This implementation study involved secondary data analysis of services received over 10 months for 254 adolescent offenders (76.80% male, 72.40% White, M age = 16.13 years) from two probation departments following adoption of the Youth Level of Service/Case Management Inventory. Results Probation departments evidenced strong fidelity to the risk principle, such that higher risk youth were assigned more services with higher intensity. Fidelity to the need principle was moderate at best (an average 24.61% to 29.38% need-to-service match) and varied by criminogenic need, overall risk level, and the operational definition of criminogenic need. Conclusions Comprehensive implementation practices are associated with strong fidelity to the risk principle, but it may take longer for probation departments to achieve strong fidelity to the need principle. Researchers should identify more feasible methods for implementing the need principle and strive for a consensus on methods for measuring need-to-service match that are also consistent with probation policies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

We juxtapose 386 prominent contrarians with 386 expert scientists by tracking their digital footprints across ∼200,000 research publications and ∼100,000 English-language digital and print media articles on climate change. Projecting these individuals across the same backdrop facilitates quantifying disparities in media visibility and scientific authority, and identifying organization patterns within their association networks. Here we show via direct comparison that contrarians are featured in 49% more media articles than scientists. Yet when comparing visibility in mainstream media sources only, we observe just a 1% excess visibility, which objectively demonstrates the crowding out of professional mainstream sources by the proliferation of new media sources, many of which contribute to the production and consumption of climate change disinformation at scale. These results demonstrate why climate scientists should increasingly exert their authority in scientific and public discourse, and why professional journalists and editors should adjust the disproportionate attention given to contrarians. The role of climate change (CC) contrarians is neglected in climate change communication studies. Here the authors used a data-driven approach to identify CC contrarians and CC scientists and found that CC scientists have much higher citation impact than those for contrarians but lower media visibility.

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are preferred methods of gathering structural and metabolic information from the body due to their non-invasive approach to obtaining a diagnosis. Dual-tuned radiofrequency (RF) coils can detect signals produced by both hydrogen and a second atomic nuclei of interest. However, undesired electromagnetic coupling often confounds both the design and utilization of RF coils. Coaxial shield currents, also known as common-mode currents, can be induced during MR scans and cause image distortion and reduction in signal-to-noise ratio (SNR); furthermore, the energy dissipated from the cabling can create heat that poses a risk of patient burns if the routed too closely. Thus, common-mode currents must be suppressed in RF coils by employing non-magnetic current traps. In this paper, we present a novel dual-tuned current trap that is fully removable and does not require soldering directly to the cable. The design was manufactured with 3D printing to support rapid fabrication and distribution. Bench measurements at the 3T Larmor frequencies for hydrogen and phosphorous-31 demonstrate common-mode attenuation of −18 dB and −8.4 dB respectively.

Assessment of the clinical benefit of cancer treatments can be highly subjective, influenced by both perspective and context. Such assessments are required in regulatory and policy decision-making, but consistency between jurisdictions is often lacking. Clear and consistent standards for determining when a treatment offers a meaningful benefit, relative to the current standard of care, can help to address issues of equity and transparency in health technology assessment. For metastatic colorectal cancer (MCRC), no standardized Canadian definition of clinically meaningful benefit has yet been proposed. Colorectal Cancer Canada therefore convened a group of medical oncologists expert in colorectal cancer to review the literature about clinical significance. The resulting consensus is intended to apply to any therapeutic agent being considered in the setting of chemotherapy-refractory MCRC. It was agreed that overall survival is the appropriate measure of clinical efficacy in chemorefractory MCRC. As quantitative targets for efficacy, an improvement of 2 months or more in median overall survival or a hazard ratio for survival of 0.75 or lower (or both) are proposed as the threshold for clinically meaningful benefit. That threshold could be influenced by a treatment’s effect on quality of life. Treatment toxicity is also relevant to the assessment of clinical benefit in this setting, specifically when significant differences in treatment tolerability are evident.