Recruiting patients with advanced malignant and non-malignant disease: lessons learned from a palliative care RCT.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Access to weight reduction interventions for overweight and obese patients in UK primary care: Population-based cohort study

Objectives To investigate access to weight management interventions for overweight and obese patients in primary care. Setting UK primary care electronic health records. Participants A cohort of 91 413 overweight and obese patients aged 30–100 years was sampled from the Clinical Practice Research Datalink (CPRD). Patients with body mass index (BMI) values ≥25 kg/m2 recorded between 2005 and 2012 were included. BMI values were categorised using WHO criteria. Interventions Interventions for body weight management, including advice, referrals and prescription of antiobesity drugs, were evaluated. Primary and secondary outcome measures The rate of body weight management interventions and time to intervention were the main outcomes. Results Data were analysed for 91 413 patients, mean age 56 years, including 55 094 (60%) overweight and 36 319 (40%) obese, including 4099 (5%) with morbid obesity. During the study period, 90% of overweight patients had no weight management intervention recorded. Intervention was more frequent among obese patients, but 59% of patients with morbid obesity had no intervention recorded. Rates of intervention increased with BMI category. In morbid obesity, rates of intervention per 1000 patient years were: advice, 60.2 (95% CI 51.8 to 70.4); referral, 75.7 (95% CI 69.5 to 82.6) and antiobesity drugs 89.9 (95% CI 85.0 to 95.2). Weight management interventions were more often accessed by women, older patients, those with comorbidity and those in deprivation. Follow-up of body weight subsequent to interventions was infrequent. Conclusions Limited evidence of weight management interventions in primary care electronic health records may result from poor recording of advice given, but may indicate a lack of patient access to appropriate body weight management interventions in primary care

Severity of obesity and management of hypertension, hypercholesterolaemia and smoking in primary care: population-based cohort study

Obesity and obesity-associated cardiovascular risk are increasing worldwide. This study aimed to determine how different levels of obesity are associated with the management of smoking, hypertension and hypercholesterolaemia in primary care. We conducted a cohort study of adults aged 30–100 years in England, sampled from the primary care electronic health records in the Clinical Practice Research Datalink. Prevalence, treatment and control were estimated for each risk factor by body mass index (BMI) category. Adjusted odds ratios (AOR) were estimated, allowing for age, gender, comorbidity and socioeconomic status, with normal weight as reference category. Data were analysed for 247 653 patients including 153 308 (62%) with BMI recorded, of whom 46 149 (30%) were obese. Participants were classified into simple (29 257), severe (11 059) and morbid obesity (5833) categories. Smoking declined with the increasing BMI category, but smoking cessation treatment increased. Age-standardised hypertension prevalence was twice as high in morbid obesity (men 78.6%; women 66.0%) compared with normal weight (men 37.3%; women 29.4%). Hypertension treatment was more frequent (AOR 1.75, 1.59–1.92) but hypertension control less frequent (AOR 0.63, 0.59–0.69) in morbid obesity, with similar findings for severe obesity. Hypercholesterolaemia was more frequent in morbid obesity (men 48.2%; women 36.3%) than normal weight (men 25.0%; women 20.0%). Lipid lowering therapy was more frequent in morbid obesity (AOR 1.83, 1.61–2.07) as was cholesterol control (AOR 1.19, 1.06–1.34). Increasing obesity category is associated with elevated risks from hypertension and hypercholesterolaemia. Inadequate hypertension control in obesity emerges as an important target for future interventions

Debris Disks: Probing Planet Formation

Debris disks are the dust disks found around ~20% of nearby main sequence stars in far-IR surveys. They can be considered as descendants of protoplanetary disks or components of planetary systems, providing valuable information on circumstellar disk evolution and the outcome of planet formation. The debris disk population can be explained by the steady collisional erosion of planetesimal belts; population models constrain where (10-100au) and in what quantity (>1Mearth) planetesimals (>10km in size) typically form in protoplanetary disks. Gas is now seen long into the debris disk phase. Some of this is secondary implying planetesimals have a Solar System comet-like composition, but some systems may retain primordial gas. Ongoing planet formation processes are invoked for some debris disks, such as the continued growth of dwarf planets in an unstirred disk, or the growth of terrestrial planets through giant impacts. Planets imprint structure on debris disks in many ways; images of gaps, clumps, warps, eccentricities and other disk asymmetries, are readily explained by planets at >>5au. Hot dust in the region planets are commonly found (<5au) is seen for a growing number of stars. This dust usually originates in an outer belt (e.g., from exocomets), although an asteroid belt or recent collision is sometimes inferred.Comment: Invited review, accepted for publication in the 'Handbook of Exoplanets', eds. H.J. Deeg and J.A. Belmonte, Springer (2018

Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records

Objectives: To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. Methods: A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. Results: In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18–£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123–8,502). Incremental QALYs will increase by 2,142 (range 2,032–2,256). The estimated cost per QALY gained is £7,129 (range £6,775–£7,506). Net monetary benefits will be £49.02 million (range £45.72–£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Conclusions: Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals

A gap in the planetesimal disc around HD 107146 and asymmetric warm dust emission revealed by ALMA

While detecting low mass exoplanets at tens of au is beyond current instrumentation, debris discs provide a unique opportunity to study the outer regions of planetary systems. Here we report new ALMA observations of the 80-200 Myr old Solar analogue HD 107146 that reveal the radial structure of its exo-Kuiper belt at wavelengths of 1.1 and 0.86 mm. We find that the planetesimal disc is broad, extending from 40 to 140 au, and it is characterised by a circular gap extending from 60 to 100 au in which the continuum emission drops by about 50%. We also report the non-detection of the CO J=3-2 emission line, confirming that there is not enough gas to affect the dust distribution. To date, HD 107146 is the only gas-poor system showing multiple rings in the distribution of millimeter sized particles. These rings suggest a similar distribution of the planetesimals producing small dust grains that could be explained invoking the presence of one or more perturbing planets. Because the disk appears axisymmetric, such planets should be on circular orbits. By comparing N-body simulations with the observed visibilities we find that to explain the radial extent and depth of the gap, it would be required the presence of multiple low mass planets or a single planet that migrated through the disc. Interior to HD 107146's exo-Kuiper belt we find extended emission with a peak at ~20 au and consistent with the inner warm belt that was previously predicted based on 22$\mu$m excess as in many other systems. This warm belt is the first to be imaged, although unexpectedly suggesting that it is asymmetric. This could be due to a large belt eccentricity or due to clumpy structure produced by resonant trapping with an additional inner planet

Succinct Data Structures for Families of Interval Graphs

We consider the problem of designing succinct data structures for interval graphs with $n$ vertices while supporting degree, adjacency, neighborhood and shortest path queries in optimal time in the $\Theta(\log n)$-bit word RAM model. The degree query reports the number of incident edges to a given vertex in constant time, the adjacency query returns true if there is an edge between two vertices in constant time, the neighborhood query reports the set of all adjacent vertices in time proportional to the degree of the queried vertex, and the shortest path query returns a shortest path in time proportional to its length, thus the running times of these queries are optimal. Towards showing succinctness, we first show that at least $n\log{n} - 2n\log\log n - O(n)$ bits are necessary to represent any unlabeled interval graph $G$ with $n$ vertices, answering an open problem of Yang and Pippenger [Proc. Amer. Math. Soc. 2017]. This is augmented by a data structure of size $n\log{n} +O(n)$ bits while supporting not only the aforementioned queries optimally but also capable of executing various combinatorial algorithms (like proper coloring, maximum independent set etc.) on the input interval graph efficiently. Finally, we extend our ideas to other variants of interval graphs, for example, proper/unit interval graphs, k-proper and k-improper interval graphs, and circular-arc graphs, and design succinct/compact data structures for these graph classes as well along with supporting queries on them efficiently