Measurement of the pubic portion of the levator ani muscle in women with unilateral defects in 3â D models from MR images

ObjectiveDevelop a method to quantify the crossâ sectional area of the pubic portion of the levator ani muscle, validate the method in women with unilateral muscle defects, and report preliminary findings in those women.MethodMultiâ planar proton density magnetic resonance images of 12 women with a unilateral defect in the pubic portion of their levator ani were selected from a larger study of levator ani muscle anatomy in women with and without genital prolapse. Threeâ dimensional bilateral models of the levator ani were reconstructed (using 3â D Slicer, version 2.1b1) and divided into iliococcygeal and pubic portions. Muscle crossâ sectional areas were calculated at four equally spaced locations perpendicular to a line drawn from the pubic origin to the visceral insertion using the Iâ DEAS® computer modeling software.ResultsThe crossâ sectional area of the muscle on the side with the defect was smaller than the normal side at all the four locations. The average bilateral difference was up to 81% at location 1 (nearest pubic origin). Almost all of the volume difference (13.7%, P = 0.0004) was attributable to a reduction in the pubic portion (24.6%, P < 0.0001), not the iliococcygeal portion (P = 0.64), of the muscle.ConclusionsA method was developed to quantify crossâ sectional area of the pubic portion of the levator ani perpendicular to the intact muscle direction. Significant bilateral crossâ sectional area differences were found between intact and defective muscles in women with a unilateral defect.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135155/1/ijgo234.pd

Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation.

BACKGROUND: There are limited data regarding clinical outcomes and healthcare resource utilization of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) who are morbidly obese (body mass index \u3e40 kg/m METHODS: Using data from 2 US healthcare claims databases, we identified patients initiating rivaroxaban or warfarin who had ≥1 medical claim with an AF diagnosis, a diagnostic code for morbid obesity (ICD-9: 278.01, V85.4%; ICD-10: E66.01%, E66.2%, Z68.4%), and a minimum continuous enrollment of 12 months before and 3 months after treatment initiation. Patients were excluded if they had mitral stenosis, a mechanical heart valve procedure, an organ/tissue transplant, or an oral anticoagulant prescription prior to the index date. Rivaroxaban and warfarin patients were 1:1 propensity score matched. Conditional logistic regression was used to compare ischemic stroke/systemic embolism and major bleeding risk. Generalized linear models were used to compare healthcare resource utilization and costs. RESULTS: A total of 3563 matched pairs of morbidly obese AF patients treated with rivaroxaban or warfarin were identified. The majority (81.4%) of patients in the rivaroxaban cohort were receiving the 20 mg dose. The rivaroxaban and warfarin cohorts were well balanced after propensity score matching. The risks of ischemic stroke/systemic embolism and major bleeding were similar for rivaroxaban and warfarin users (stroke/systemic embolism: 1.5% vs 1.7%; odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.60, 1.28; P = .5028; major bleeding: 2.2% vs 2.7%; OR: 0.80; 95% CI: 0.59, 1.08; P = .1447). Total healthcare costs including medication costs per patient per year (PPPY) were significantly lower with rivaroxaban versus warfarin ($48,552 vs$52,418; P = .0025), which was primarily driven by lower hospitalization rate (50.2% vs 54.1%; P = .0008), shorter length of stay (7.5 vs 9.1 days; P = .0010), and less outpatient service utilization (86 vs 115 visits PPPY; P \u3c .0001). CONCLUSIONS: Morbidly obese AF patients treated with rivaroxaban had comparable risk of ischemic stroke/systemic embolism and major bleeding as those treated with warfarin, but lower healthcare resource utilization and costs

Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: Comparative effectiveness, safety, and costs.

INTRODUCTION: Limited data exist on direct-acting oral anticoagulants in morbidly obese patients with venous thromboembolism (VTE). We compared clinical and health/economic outcomes with rivaroxaban versus warfarin for VTE treatment in morbidly obese patients. MATERIALS AND METHODS: This retrospective 1:1 propensity score matched cohort study analyzed data from 2 US claims databases. VTE patients initiating rivaroxaban or warfarin were identified who had diagnosis codes for morbid obesity (ICD-9:278.01,V85.4; ICD-10:E66.01,E66.2,Z68.4) 12 months pre- or 3 months post-initiation and followed ≥3 months. Intent-to-treat (ITT) and on-treatment (OT) analyses were conducted using conditional logistic regression and generalized linear models to compare recurrent VTE and major bleeding risks, healthcare resource utilization (HRU), and per patient per year (PPPY) costs. RESULTS: In total, 2890 matched pairs of morbidly obese VTE patients initiating rivaroxaban or warfarin were identified. Risks of recurrent VTE (ITT: OR: 0.99; 95% CI: 0.85-1.14) and major bleeding (OT: OR: 0.75; 95% CI: 0.47-1.19) were similar for cohorts. Anti-Factor Xa laboratory measurement was performed on CONCLUSIONS: Morbidly obese VTE patients receiving rivaroxaban had similar risks of recurrent VTE and major bleeding versus warfarin. Rivaroxaban treatment yielded significantly less HRU and total medical costs, with similar total healthcare costs between groups

Statistical Study of Ion Upflow and Downflow Observed by PFISR

Ion upflow in the F region and topside ionosphere can greatly influence the ion density and fluxes at higher altitudes and thus has significant impact on ion outflow. We investigated the statistical characteristics of ion upflow and downflow using a 3‐year (2011–2013) data set from the Poker Flat Incoherent Scatter Radar (PFISR). Ion upflow is twice more likely to occur on the nightside than on the dayside in PFISR observations, while downflow events occur more often in the afternoon sector. Upflow and downflow on the dayside tend to occur at altitudes ~500 km, higher than those on the nightside. Both upflow and downflow occur more frequently as ion convection speed increases. Upflow observed from 16 to 6 magnetic local time through midnight is associated with temperature and density enhancements. Occurrence rates of upflow on the nightside and downflow on the dayside increase with geomagnetic activity level. On the nightside, occurrence rate of ion upflow increases with enhanced solar wind and interplanetary magnetic field (IMF) drivers as well as southwestward local magnetic perturbations. The lack of correlation of upflow on the dayside with the solar wind and IMF parameters is because PFISR is usually equatorward of the dayside auroral zone. Occurrence rate of downflow does not show strong dependence on the solar wind and IMF conditions. However, it occurs much more frequently on the dayside when the IMF By > 10 nT and the IMF Bz < −10 nT, which we suggest is associated with the decaying of the dayside storm‐enhanced density (SED) and the SED plume.Key PointsThe occurrence frequency of ion upflow increases with enhanced geomagnetic activity level and stronger solar wind and IMF drivingIon upflow at PFISR latitude is twice more likely to occur on the nightside than on the daysidePeak ion downflow occurrence rate reaches 30% on the dayside during strongly positive IMF By and negative Bz, associated with SED and plumePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163443/3/jgra56049-sup-0001-2020JA028179-SI.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163443/2/jgra56049.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163443/1/jgra56049_am.pd

Blood-based high sensitivity measurements of beta-amyloid and phosphorylated tau as biomarkers of Alzheimer's disease: a focused review on recent advances

Discovery and development of clinically useful biomarkers for Alzheimer’s disease (AD) and related dementias have been the focus of recent research efforts. While cerebrospinal fluid and positron emission tomography or MRI-based neuroimaging markers have made the in vivo detection of AD pathology and its consequences possible, the high cost and invasiveness have limited their widespread use in the clinical setting. On the other hand, advances in potentially more accessible blood-based biomarkers had been impeded by lack of sensitivity in detecting changes in markers of the hallmarks of AD, including amyloid-β (Aβ) peptides and phosphorylated tau (P-tau). More recently, however, emerging technologies with superior sensitivity and specificity for measuring Aβ and P-tau have reported high concordances with AD severity. In this focused review, we describe several emerging technologies, including immunoprecipitation-mass spectrometry (IP-MS), single molecule array and Meso Scale Discovery immunoassay platforms, and appraise the current literature arising from their use to identify plaques, tangles and other AD-associated pathology. While there is potential clinical utility in adopting these technologies, we also highlight the further studies needed to establish Aβ and P-tau as blood-based biomarkers for AD, including validation with existing large sample sets, new independent cohorts from diverse backgrounds as well as population-based longitudinal studies. In conclusion, the availability of sensitive and reliable measurements of Aβ peptides and P-tau species in blood holds promise for the diagnosis, prognosis and outcome assessments in clinical trials for AD

Using machine learning to derive spatial wave data: A case study for a marine energy site

This is the final version. Available on open access from Elsevier via the DOI in this record.Ocean waves are widely estimated using physics-based computational models, which predict how energy is transferred from the wind, dissipated, and transferred spatially across the ocean. Machine learning methods offer an opportunity to predict these data with significantly reduced data input and computational power. This paper describes a novel surrogate model developed using the random forest method, which replicates the spatial nearshore wave data estimated by a Simulating WAves Nearshore (SWAN) numerical model. By incorporating in-situ buoy observations, outputs were found to match observations at a test location more closely than the corresponding SWAN model. Furthermore, the required computational time reduced by a factor of 100. This methodology can provide accurate spatial wave data in situations where computational power and transmission are limited, such as autonomous marine vehicles or during coastal and offshore operations in remote areas. This represents a significant supplementary service to existing physics-based wave models.Engineering and Physical Sciences Research Council (EPSRC

On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System

Five midsagittal pelvic reference lines have been employed to quantify prolapse using MRI. However, the lack of standardization makes study results difficult to compare. Using MRI scans from 149 women, we demonstrate how use of existing reference lines can systematically affect measurements in three distinct ways: in oblique line systems, distances measured to the reference line vary with antero-posterior location; soft issue-based reference lines can underestimate organ movement relative to the pelvic bones; and systems defined relative to the MR scanner are affected by intra- and interindividual differences in the pelvic inclination angle at rest and strain. Thus, we propose a standardized approach called the Pelvic Inclination Correction System (PICS). Based on bony structures and the body axis, the PICS system corrects for variation in pelvic inclination, at rest of straining, and allows for the standardized measurement of organ displacement in the direction of prolaps

Brain atrophy and white matter hyperintensities are independently associated with plasma neurofilament light chain in an Asian cohort of cognitively impaired patients with concomitant cerebral small vessel disease

Introduction: Plasma neurofilament light chain (NfL) is a potential biomarker for neurodegeneration in Alzheimer's disease (AD), ischemic stroke, and non-dementia cohorts with cerebral small vessel disease (CSVD). However, studies of AD in populations with high prevalence of concomitant CSVD to evaluate associations of brain atrophy, CSVD, and amyloid beta (Aβ) burden on plasma NfL are lacking. Methods: Associations were tested between plasma NfL and brain Aβ, medial temporal lobe atrophy (MTA) as well as neuroimaging features of CSVD, including white matter hyperintensities (WMH), lacunes, and cerebral microbleeds. Results: We found that participants with either MTA (defined as MTA score ≥2; neurodegeneration [N]+WMH−) or WMH (cut-off for log-transformed WMH volume at 50th percentile; N−WMH+) manifested increased plasma NfL levels. Participants with both pathologies (N+WMH+) showed the highest NfL compared to N+WMH−, N−WMH+, and N−WMH− individuals. Discussion: Plasma NfL has potential utility in stratifying individual and combined contributions of AD pathology and CSVD to cognitive impairment

Assessing the Effectiveness of Payments for Ecosystem Services: an Agent-Based Modeling Approach

Payments for ecosystem services (PES) have increasingly been implemented to protect and restore ecosystems worldwide. The effectiveness of conservation investments in PES may differ under alternative policy scenarios and may not be sustainable because of uncertainties in human responses to policies and dynamic human-nature interactions. To assess the impacts of these interactions on the effectiveness of PES programs, we developed a spatially explicit agent-based model: human and natural interactions under policies (HANIP). We used HANIP to study the effectiveness of China’s Natural Forest Conservation Program (NFCP) and alternative policy scenarios in a coupled human-nature system, China’s Wolong Nature Reserve, where indigenous people’s use of fuelwood affects forests. We estimated the effects of the current NFCP, which provides a cash payment, and an alternative payment scenario that provides an electricity payment by comparing forest dynamics under these policies to forest dynamics under a scenario in which no payment is provided. In 2007, there were 337 km² of forests in the study area of 515 km². Under the baseline projection in which no payment is provided, the forest area is expected to be 234 km² in 2030. Under the current NFCP, there are likely to be 379 km² of forests in 2030, or an increase of 145 km² of forests to the baseline projection. If the cash payment is replaced with an electricity payment, there are likely to be 435 km² of forests in 2030, or an increase of 201 km² of forests to the baseline projection. However, the effectiveness of the NFCP may be threatened by the behavior of newly formed households if they are not included in the payment scheme. In addition, the effects of socio-demographic factors on forests will also differ under different policy scenarios. Human and natural interactions under policies (HANIP) and its modeling framework may also be used to assess the effectiveness of many other PES programs around the world