EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multi-centre study

Health-related quality of life (HRQoL) scores assess symptom burden in pulmonary arterial hypertension (PAH) but data regarding their role in prognostication and risk stratification are limited. We assessed these relationships using the emPHasis-10 HRQoL measure. 1745 patients with idiopathic or connective tissue disease-associated PAH who had completed emPHasis-10 questionnaires between 2014–17 at 6 UK referral centres were identified. Correlations with exercise capacity and WHO functional class (FC) were assessed, and exploratory risk stratification thresholds were tested. Moderate correlations were seen between emPHasis-10 scores and 6-minute walk distance (r=−0.546), incremental shuttle walking distance (r=−0.504) and WHO FC (r=0.497; p all <0.0001). Distribution of emPHasis-10 differed significantly between each WHO FC (p all <0.0001). At multivariate analysis, emPHasis-10, but not WHO FC, was an independent predictor of mortality. In a risk stratification approach, scores of 0–16, 17–33 and 34–50 identified incident patients with one-year mortality of 5%, 10% and 23%, respectively. Survival of patients in WHO FC III could be further stratified using an emPHasis-10 score ≥34 (p<0.01). At follow-up, patients with improved emPHasis-10 had improved exercise capacity (p<0.0001), and patients who transitioned risk groups demonstrated similar survival to patients originally in those risk groups. The emPHasis-10 score is an independent prognostic marker in patients with idiopathic or connective tissue disease-associated PAH. It has utility in risk stratification in addition to currently used parameters. Improvement in emPHasis-10 score is associated with improved exercise capacity

Validity of a food frequency questionnaire to assess intake of seafood in adults in three European countries

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe aim of the study was to validate a food frequency questionnaire (FFQ) measuring seafood intake among young adults in Europe. Participants from Iceland, Spain and Ireland (n = 56), aged 20–40, filled out a pre-coded FFQ on seafood. One week after filling out the questionnaire, the participants started a 7–14-day food record (FR). The FFQ was found suitable to rank young adults according to their customary intake of fish and fish oil, but it overestimated the amount consumed. The FFQ could be used as a tool to identify high- and low-fish consumers

Preoperative splenic artery embolization in klippel-Trenaunay syndrome with massive splenomegaly: A case report

Gross primary productivity (GPP) is the largest and most variable component of the global terrestrial carbon cycle. Repeatable and accurate monitoring of terrestrial GPP is therefore critical for quantifying dynamics in regional-to-global carbon budgets. Remote sensing provides high frequency observations of terrestrial ecosystems and is widely used to monitor and model spatiotemporal variability in ecosystem properties and processes that affect terrestrial GPP. We used data from the Moderate Resolution Imaging Spectroradiometer (MODIS) and FLUXNET to assess how well four metrics derived from remotely sensed vegetation indices (hereafter referred to as proxies) and six remote sensing-based models capture spatial and temporal variations in annual GPP. Specifically, we used the FLUXNET "La Thuile" data set, which includes several times more sites (144) and site years (422) than previous efforts have used. Our results show that remotely sensed proxies and modeled GPP are able to capture statistically significant amounts of spatial variation in mean annual GPP in every biome except croplands, but that the total variance explained differed substantially across biomes (R2 ≈ 0.1−0.8). The ability of remotely sensed proxies and models to explain interannual variability GPP was even more limited. Remotely sensed proxies explained 40–60% of interannual variance in annual GPP in moisture-limited biomes including grasslands and shrublands. However, none of the models or remotely sensed proxies explained statistically significant amounts of interannual variation in GPP in croplands, evergreen needleleaf forests, and deciduous broadleaf forests. Because important factors that affect year-to-year variation in GPP are not explicitly captured or included in the remote sensing proxies and models we examined (e.g., interactions between biotic and abiotic conditions, and lagged ecosystems responses to environmental process), our results are not surprising. Nevertheless, robust and repeatable characterization of interannual variability in carbon budgets is critically important and the carbon cycle science community is increasingly relying on remotely sensing data. As larger and more comprehensive data sets derived from the FLUXNET community become available, additional systematic assessment and refinement of remote sensing-based methods for monitoring annual GPP is warrante

The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable

Objectives: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24–40% of hormone receptor+/HER2− patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. Methods: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. Results: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)—more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT—more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. Conclusion: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions

Improving the performance of remote sensing models for capturing intra- and inter-annual variations in daily GPP: an analysis using global FLUXNET tower data

Accurate and reliable estimates of gross primary productivity (GPP) are required for monitoring the global carbon cycle at different spatial and temporal scales. Because GPP displays high spatial and temporal variation, remote sensing plays a major role in producing gridded estimates of GPP across spatiotemporal scales. In this context, understanding the strengths and weaknesses of remote sensing-based models of GPP and improving their performance is a key contemporary scientific activity. We used measurements from 157 research sites (∼470 site-years) in the FLUXNET “La Thuile” data and compared the skills of 11 different remote sensing models in capturing intra- and inter-annual variations in daily GPP in seven different biomes. Results show that the models were able to capture significant intra-annual variation in GPP (Index of Agreement = 0.4–0.80) in all biomes. However, the models’ ability to track inter-annual variation in daily GPP was significantly weaker (IoA < 0.45). We examined whether the inclusion of different mechanisms that are missing in the models could improve their predictive power. The mechanisms included the effect of sub-daily variation in environmental variables on daily GPP, factoring-in differential rates of GPP conversion efficiency for direct and diffuse incident radiation, lagged effects of environmental variables, better representation of soil-moisture dynamics, and allowing spatial variation in model parameters. Our analyses suggest that the next generation remote sensing models need better representation of soil-moisture, but other mechanisms that have been found to influence GPP in site-level studies may not have significant bearing on model performance at continental and global scales. Understanding the relative controls of biotic vis-a-vis abiotic factors on GPP and accurately scaling up leaf level processes to the ecosystem scale are likely to be important for recognizing the limitations of remote sensing model and improving their formulatio