Improving Osteoporosis Screening Rates in a Primary Care Practice Using an EMR-based Intervention

Objective Osteoporosis is defined as a T-score ≤ -2.5 on DEXA or history of fragility fracture Affects a significant proportion of our population over 65 with an estimated annual cost burden of $22 billion Only 46% of females over 65 years of age had been screened for osteoporosis at JHAP Our study aims to increase that percentage between July 2019 and July 2020 from 46% to 60

An EPID-based method for comprehensive verification of gantry, EPID and the MLC carriage positional accuracy in Varian linacs during arc treatments

BACKGROUND: In modern radiotherapy, it is crucial to monitor the performance of all linac components including gantry, collimation system and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method has been introduced in conjunction with an algorithm to investigate the stability of these systems during arc treatments with the aim of ensuring the accuracy of linac mechanical performance. METHODS: The Varian EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt, and the sag in MLC carriages as a result of linac rotation were separately investigated by acquisition of EPID images of a simple phantom comprised of 5 ball-bearings during arc delivery. A fast and robust software package was developed for automated analysis of image data. Twelve Varian linacs of different models were investigated. RESULTS: The average EPID sag was within 1 mm for all tested linacs. All machines showed less than 1 mm gantry sag. Changes in SDD values were within 1.7 mm except for three linacs of one centre which were within 9 mm. Values of EPID skewness and tilt were negligible in all tested linacs. The maximum sag in MLC leaf bank assemblies was around 1 mm. The EPID sag showed a considerable improvement in TrueBeam linacs. CONCLUSION: The methodology and software developed in this study provide a simple tool for effective investigation of the behaviour of linac components with gantry rotation. It is reproducible and accurate and can be easily performed as a routine test in clinics

Heterogeneity

This entry discusses heterogeneity in the context of ecological landscapes and how the heterogeneity impacts the resilience of the system. Heterogeneity is closely linked to the scale of measurement, both spatially and temporally. We will walk through a simple example that highlights how the scale of observation can impact the heterogeneity of the system. The differences between functional and measured heterogeneity will also be explained. Finally, heterogeneity will be discussed in the context of its utility to management and how it can be used to understand the resilience of agro-ecosystems. Overview - What Will You Learn In This Lesson? This lesson discusses what heterogeneity is and how it relates to understanding and interpreting natural phenomena. Objectives This lesson covers the concept of heterogeneity. At the end of this module you should be able to: Define heterogeneity in the context of environmental management Explain the relationship between heterogeneity and ecological resilience Differentiate between functional and measured heterogeneity in ecology Understand the importance and usefulness of heterogeneity in resource management Modules Lesson home Overview and Objectives Introduction - What Is Heterogeneity? Measures of Heterogeneity Heterogeneity in Management - How Does This Concept Impact Real-World Management? Example - Heterogeneity of Zoning in Cities Summary - What Did We Learn? Quiz Questions References and Further Reading Glossar

Fourteen propositions for resilience, fourteen years later

In 2006, Walker et al. published an article titled, “A Handful of Heuristics and Some Propositions for Understanding Resilience in Social-ecological Systems.” The article was incorporated into the Ecology and Society special feature, Exploring Resilience in Social-Ecological Systems. Walker et al. identified five heuristics and posed 14 propositions for understanding resilience in social-ecological systems. At the time, the authors hoped the paper would promote experimentation, critique, and application of these ideas in resilience and social-ecological systems research. To determine the extent to which these propositions have achieved the authors’ hopes, we reviewed the scientific literature on socialecological systems since the article was published. Using Scopus, we identified 627 articles that cited the Walker et al. article. We then identified and assessed the articles relative to each proposition. In addition, we conducted a more general Scopus review for articles that did not cite the Walker et al. article specifically but incorporated a proposition’s concepts. Overall, articles often cite Walker et al. as a reference for a definition of a heuristic or ecological resilience generally and not to reference a specific proposition. Nonetheless, every proposition was at least mentioned in the literature and used to advance resilience scholarship on social-ecological systems. Eleven propositions were tested by multiple articles through application of case studies or other research, and 7 of the 11 propositions were substantially discussed and advanced. Finally, three propositions were heavily critiqued either as concepts in resilience literature or in their application

Anti-schistosomal activities of quinoxaline-containing compounds:From hit identification to lead optimisation

Schistosomiasis is a neglected disease of poverty that is caused by infection with blood fluke species contained within the genus Schistosoma. For the last 40 years, control of schistosomiasis in endemic regions has predominantly been facilitated by administration of a single drug, praziquantel. Due to limitations in this mono-chemotherapeutic approach for sustaining schistosomiasis control into the future, alternative anti-schistosomal compounds are increasingly being sought by the drug discovery community. Herein, we describe a multi-pronged, integrated strategy that led to the identification and further exploration of the quinoxaline core as a promising anti-schistosomal scaffold

Cytochrome P450 20A1 in zebrafish: Cloning, regulation and potential involvement in hyperactivity disorders

Cytochrome P450 (CYP) enzymes for which there is no functional information are considered "orphan" CYPs. Previous studies showed that CYP20A1, an orphan, is expressed in human hippocampus and substantia nigra, and in zebrafish (Danio rerio) CYP20A1 maternal transcript occurs in eggs, suggesting involvement in brain and in early development. Moreover, hyperactivity is reported in humans with chromosome 2 microdeletions including CYP20A1. We examined CYP20A1 in zebrafish, including impacts of chemical exposure on expression. Zebrafish CYP20A1 cDNA was cloned, sequenced, and aligned with cloned human CYP20A1 and predicted vertebrate orthologs. CYP20A1s share a highly conserved N-terminal region and unusual sequences in the I-helix and the heme-binding CYP signature motifs. CYP20A1 mRNA expression was observed in adult zebrafish organs including the liver, heart, gonads, spleen and brain, as well as the eye and optic nerve. Putative binding sites in proximal promoter regions of CYP20A1s, and response of zebrafish CYP20A1 to selected nuclear and xenobiotic receptor agonists, point to up-regulation by agents involved in steroid hormone response, cholesterol and lipid metabolism. There also was a dose-dependent reduction of CYP20A1 expression in embryos exposed to environmentally relevant levels of methylmercury. Morpholino knockdown of CYP20A1 in developing zebrafish resulted in behavioral effects, including hyperactivity and a slowing of the optomotor response in larvae. The results suggest that altered expression of CYP20A1 might be part of a mechanism linking methylmercury exposure to neurobehavioral deficits. The expanded information on CYP20A1 brings us closer to "deorphanization" CYP20A1 functions and its roles in health and disease

The Ninth Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the SDSS-III Baryon Oscillation Spectroscopic Survey

The Sloan Digital Sky Survey III (SDSS-III) presents the first spectroscopic data from the Baryon Oscillation Spectroscopic Survey (BOSS). This ninth data release (DR9) of the SDSS project includes 535,995 new galaxy spectra (median z=0.52), 102,100 new quasar spectra (median z=2.32), and 90,897 new stellar spectra, along with the data presented in previous data releases. These spectra were obtained with the new BOSS spectrograph and were taken between 2009 December and 2011 July. In addition, the stellar parameters pipeline, which determines radial velocities, surface temperatures, surface gravities, and metallicities of stars, has been updated and refined with improvements in temperature estimates for stars with T_eff<5000 K and in metallicity estimates for stars with [Fe/H]>-0.5. DR9 includes new stellar parameters for all stars presented in DR8, including stars from SDSS-I and II, as well as those observed as part of the SDSS-III Sloan Extension for Galactic Understanding and Exploration-2 (SEGUE-2). The astrometry error introduced in the DR8 imaging catalogs has been corrected in the DR9 data products. The next data release for SDSS-III will be in Summer 2013, which will present the first data from the Apache Point Observatory Galactic Evolution Experiment (APOGEE) along with another year of data from BOSS, followed by the final SDSS-III data release in December 2014.Comment: 9 figures; 2 tables. Submitted to ApJS. DR9 is available at http://www.sdss3.org/dr

Food System Resilience: Concepts, Issues, and Challenges

Food system resilience has multiple dimensions. We draw on food system and resilience concepts and review resilience framings of different communities. We present four questions to frame food system resilience (Resilience of what? Resilience to what? Resilience from whose perspective? Resilience for how long?) and three approaches to enhancing resilience (robustness, recovery, and reorientation—the three “Rs”). We focus on enhancing resilience of food system outcomes and argue this will require food system actors adapting their activities, noting that activities do not change spontaneously but in response to a change in drivers: an opportunity or a threat. However, operationalizing resilience enhancement involves normative choices and will result in decisions having to be negotiated about trade-offs among food system outcomes for different stakeholders. New approaches to including different food system actors’ perceptions and goals are needed to build food systems that are better positioned to address challenges of the future. Expected final online publication date for the Annual Review of Environment and Resources, Volume 47 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial