Prospectus, September 2, 1974

FACULTY, STUDENTS CONQUER REGISTRATION; Enrollment Procedures Eased By Mail; Dr. Staerkel Welcomes Student Body; Lonnie & The Lugnutz Top Activities; All-College Cookout And Activity Day Schedule; Meeting Set For Prospectus Jobs; Campus Artist Needed For Cartoon Series; StuGo Prexy, Karen Coleman, Offers Welcome; Adjusting To College Life; Parking Regulations; Convocations Plans Activities; Debaters Defend Championships; Music Director Ernie Hoffman Looking For Interested Students; Athletic Season Review; Fast Freddy\u27s Football Forecast; Kirby Wins Babe Ruth Scholarship; Don Grothe New Links Coach; Classified Ads; Here Are Your P/C Student Officers; SIMS Lecture Sept. 10; P/C Bridge Club Opens Season In Sunday Session; Prospectus Staff Salary Increase; M*A*S*H Headlines Film Season; StuGo Works Through Summer; Theatre Troupe To Hold Auditionshttps://spark.parkland.edu/prospectus_1974/1011/thumbnail.jp

B-type natriuretic peptide-guided treatment for heart failure

Background Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B‐type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. Objectives To assess whether treatment guided by serial BNP or NT‐proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Search methods Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We included randomised controlled trials of NP‐guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow‐up. Adults treated for heart failure, in both in‐hospital and out‐of‐hospital settings, and trials reporting a clinical outcome were included. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data and evaluated risk of bias. Risk ratios (RR) were calculated for dichotomous data, and pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated for continuous data. We contacted trial authors to obtain missing data. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table. Main results We included 18 randomised controlled trials with 3660 participants (range of mean age: 57 to 80 years) comparing NP‐guided treatment with clinical assessment alone. The evidence for all‐cause mortality using NP‐guided treatment showed uncertainty (RR 0.87, 95% CI 0.76 to 1.01; patients = 3169; studies = 15; low quality of the evidence), and for heart failure mortality (RR 0.84, 95% CI 0.54 to 1.30; patients = 853; studies = 6; low quality of evidence). The evidence suggested heart failure admission was reduced by NP‐guided treatment (38% versus 26%, RR 0.70, 95% CI 0.61 to 0.80; patients = 1928; studies = 10; low quality of evidence), but the evidence showed uncertainty for all‐cause admission (57% versus 53%, RR 0.93, 95% CI 0.84 to 1.03; patients = 1142; studies = 6; low quality of evidence). Six studies reported on adverse events, however the results could not be pooled (patients = 1144; low quality of evidence). Only four studies provided cost of treatment results, three of these studies reported a lower cost for NP‐guided treatment, whilst one reported a higher cost (results were not pooled; patients = 931, low quality of evidence). The evidence showed uncertainty for quality of life data (MD ‐0.03, 95% CI ‐1.18 to 1.13; patients = 1812; studies = 8; very low quality of evidence). We completed a 'Risk of bias' assessment for all studies. The impact of risk of bias from lack of blinding of outcome assessment and high attrition levels was examined by restricting analyses to only low 'Risk of bias' studies. Authors' conclusions In patients with heart failure low‐quality evidence showed a reduction in heart failure admission with NP‐guided treatment while low‐quality evidence showed uncertainty in the effect of NP‐guided treatment for all‐cause mortality, heart failure mortality, and all‐cause admission. Uncertainty in the effect was further shown by very low‐quality evidence for patient's quality of life. The evidence for adverse events and cost of treatment was low quality and we were unable to pool results.</p

Effectiveness of private land conservation areas in maintaining natural land cover and biodiversity intactness

CITATION: Shumba, T. et al. 2020. Effectiveness of private land conservation areas in maintaining natural land cover and biodiversity intactness. Global Ecology and Conservation, 22:e00935, doi:10.1016/j.gecco.2020.e00935.The original publication is available at https://www.journals.elsevier.com/global-ecology-and-conservationPrivate land conservation areas (PLCAs) are increasingly looked to for meeting the deficit left by state-owned protected areas in reaching global conservation targets. However, despite the increasing extent and recognition of PLCAs as a complementary conservation strategy, little research has been done to quantify their effectiveness; a critical consideration if they are to be counted towards international biodiversity conservation targets. The long history of PLCAs in South Africa provides an interesting case study to address this knowledge gap. Here, we quantified the effectiveness of South African PLCAs by comparing losses in natural land cover and biodiversity intactness within PLCAs with different levels of protection to that of unprotected control points. Points within PLCAs were matched with unprotected control points to test the prediction that if PLCAs offer effective protection, losses in natural land cover and biodiversity intactness would be significantly lower within their boundaries in comparison to unprotected controls exposed to similar conditions. Consequences of natural land cover loss on biodiversity intactness were thus assessed, thus advancing standard approaches for quantifying effectiveness. Between 1990 and 2013, PLCAs lost significantly less natural land cover (3%) and biodiversity intactness (2%) than matched unprotected areas (6% and 4%, respectively). Of the natural land cover lost within PLCAs, most was converted to cultivated land. Farms can support more species than other land uses (e.g. mines), a likely explanation for why losses in biodiversity intactness were less than losses in natural land cover. Contrary to the predicted pattern, effectiveness did not increase with level of protection; informal PLCAs with no legal protection had comparable natural land cover and biodiversity intactness retention to strictly protected PLCAs, with most losses recorded among PLCAs with moderate protection. This study provides the first national-scale evidence that PLCAs can be an effective mechanism for conserving natural land cover and biodiversity intactness, which is highly relevant given current discussions around their likely long-term biodiversity conservation capacity.Publisher's versio

Uptake of Direct Acting Antivirals for Hepatitis C Virus in a New England Medicaid Population, 2014-2017

Introduction Introduction of the direct acting antiviral (DAA) sofosbuvir (SOV) in 2013 offered significant improvement over previous options for hepatitis C virus (HCV) treatment. Initial uptake was low in Medicaid and other populations, perhaps in part due to high drug cost and prior authorization (PA) restrictions related to fibrosis stage, prescribing provider specialty, and sobriety. Both the subsequent introduction of ledipasvir/sofosbuvir (LDV/SOV), an all-oral regimen for most genotypes, and lifting of PA restrictions were expected to increase overall uptake, but little is known about recent prescribing patterns. We examined trends in DAA uptake in a Medicaid population and identified the effect of these two events on treatment initiation. Study Design An interrupted time series (ITS) design utilized enrollment, medical, and pharmacy claims from Medicaid enrollees in three New England states, 12/2013-12/2017. Trends in treatment uptake, defined as 1+ pharmacy claim for a DAA, were examined overall, by demographic characteristics, and prior to and after two time points: 10/2014 (LDV/SOV approval date) and 7/2016 (date PA restrictions affecting two-thirds of members were lifted). Chi-square evaluated demographic differences, segmented regression models examined trends. Study Population The population included members ages 18-64 years with HCV (2+ claims with ICD-9/10 code for HCV or 1+ claim for chronic HCV). Eligible individuals remained in the sample until treatment initiation or Medicaid disenrollment. Findings The analytic sample averaged 30,433 members with HCV per month, mean age 42.9 years, 60% male. In 2014 3.3% of eligible members initiated treatment, increasing to 7.7% in 2017 (p = Conclusion While initial uptake of DAAs was low in this multi-state Medicaid population, treatment initiation among eligible members increased through 2017. Introduction of new medications and lifting of PA restrictions led to an immediate increase in uptake followed by relatively flat monthly utilization. Policy implications Sharp increases in uptake after LDV/SOV introduction may indicate warehousing of members in anticipation of LDV/SOV approval; increases after PA restrictions were lifted indicates demand for treatment among those affected by restrictions. As a large percentage of the Medicaid HCV population remains untreated, planned provider interviews will help to understand barriers and facilitators of treatment for HCV

Impact of a Pilot Outreach Program upon Provider Awareness and Prescribing of a Concerning Opioid Combination Regimen

This pilot program was developed in response to a drug utilization review within a large Medicaid population that revealed some hazardous practices. Co-prescribing of opioids with benzodiazepines, gabapentin, and other stimulants occurred in more than 500 members, putting them at risk for additive central nervous system depression, misuse, abuse, and death from overdose. The poster presentation outlines the objectives, methods, and results of a telephonic outreach program that addressed these safety concerns. It captures prescriber awareness of the presence and risks of potentially deadly medication combinations among members in their care, with some intriguing results. Our experts provide health plans with framework and support to address the opioid epidemic head on with robust opioid medication management programs, evidence-based clinical guidelines, and prescriber outreach. Our interdisciplinary team’s innovative approach helps health plans decrease inappropriate opioid usage and while ensuring members maintain access to appropriate pain management. This presentation was given at the American Drug Utilization Review Society (ADURS) conference February 22-24, 2018 in Scottsdale, Arizona

A Chandra HETGS observation of the Narrow-line Seyfert 1 galaxy Ark 564

We present results from a 50 ks observation of the narrow-line Seyfert 1 galaxy Ark 564 with the Chandra HETGS. The spectra above 2 keV are modeled by a power-law with a photon-index of 2.56+/-0.06. We confirm the presence of the soft excess below about 1.5 keV. If we fit the excess with blackbody model, the best-fit temperature is 0.124 keV. Ark 564 has been reported to show a peculiar emission line-like feature at 1 keV in various observations using lower resolution detectors, and the Chandra grating spectroscopy rules out an origin of blends of several narrow emission lines. We detect an edge-like feature at 0.712 keV in the source rest frame. The preferred interpretation of this feature is combination of the O VII K-edge and a number of L-absorption lines from slightly ionized iron, which suggests a warm absorber with ionization parameter xi~1 and N_H ~ 10^21 cm^-2. These properties are roughly consistent with those of the UV absorber. We also detect narrow absorption lines of O VII, O VIII, Ne IX, Ne X, and Mg XI at the systemic velocity. From these lines, a second warm absorber having log xi ~ 2 and N_H ~ 10^21 cm^-2 is required.Comment: 22 pages, including 5 figures and 2 tables. Accepted for publication in Ap

Evaluating the Impact of Interventions by a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup on Medication Prescribing Trends in a Medicaid Population

In 2011, the U.S. Government Accountability Office (GAO) reported foster and non-foster children in the MassHealth, Massachusetts Medicaid program, exhibited the highest rate of behavioral health medication (BHM) utilization, with 49.3% of all Medicaid children being prescribed a psychotropic medication, and 39.1% of children in foster care prescribed these medications. The MassHealth Pharmacy Program, which is managed by UMass Medical School, implemented a PBHMI Workgroup in November 2014 with the collaboration of the Department of Children and Families and the Department of Mental Health. The workgroup proactively requires prior authorization (PA) for specific medications or combinations of BHMs prescribed to members less than 18 years of age. Interventions include telephonic prescriber outreach by a child/adolescent psychiatrist to discuss opportunities for regimen simplification, drug interactions or toxicity, and to encourage evidence-based practices. An analysis of the workgroup suggests a peer-to-peer outreach program is associated with increased awareness and implementation of evidence based medicine in a pediatric population treated with behavioral health medications

Effectiveness of Ledipasvir/Sofosbuvir and Predictors of Treatment Failure in Members with Hepatitis C Genotype 1: A Retrospective Cohort Study in a Medicaid Population

An evaluation of the effectiveness of HCV genotype 1 treatment with Harvoni® (ledipasvir/sofosbuvir) as measured by a sustained virological response (SVR) of 12 weeks in the MassHealth fee-for-service and Primary Care Clinician plan population. The analysis concluded that treatment was associated with a a high rate of SVR12, which means that Hepatitis C is not detected in the blood after 12 weeks

Does Type of Tumor Histology Impact Survival among Patients with Stage IIIB/IV Non-Small Cell Lung Cancer Treated with First-Line Doublet Chemotherapy?

Chemotherapy regimens may have differential efficacy by histology in nonsmall cell lung cancer (NSCLC). We examined the impact of histology on survival of patients (N = 2,644) with stage IIIB/IV NSCLC who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G) and cisplatin/carboplatin plus a taxane (C/C+T) identified retrospectively in the SEER cancer registry (1997–2002). Patients with squamous and nonsquamous cell carcinoma survived 8.5 months and 8.1 months, respectively (P = .018). No statistically significant difference was observed in survival between C/C+G and C/C+T in both histologies. Adjusting for clinical and demographic characteristics, the effect of treatment regimen on survival did not differ by histology (P for interaction = .257). There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC

Breast screening atypia and subsequent development of cancer: protocol for an observational analysis of the Sloane database in England (Sloane atypia cohort study).

INTRODUCTION: The National Health Service (NHS) Breast Screening Programme aims to detect cancer earlier when treatment is more effective but can harm women by over diagnosing and overtreating cancers which would never have become symptomatic. As well as breast cancer, a spectrum of atypical epithelial proliferations (atypia) can also be detected as part of screening. This spectrum of changes, while not cancer, may mean that a woman is more likely to develop breast cancer in the future. Follow-up of atypia is not evidence based. We currently do not know which atypia should be detected to avoid future cancer. This study will explore how atypia develops into breast cancer in terms of number of women, time of cancer development, cancer type and severity, and whether this varies for different types of atypia. METHODS AND ANALYSIS: The Sloane cohort study began in April 2003 with ongoing data collection including atypia diagnosed through screening at screening units in the UK. The database for England has 3645 cases (24 September 2020) of epithelial atypia, with follow-up from 1 to 15 years. The outcomes include subsequent invasive breast cancer and the nature of subsequent cancer. Descriptive statistics will be produced. The observed rates of breast cancer at 1, 3 and 6 years for types of atypia will be reported with CIs, to enable comparison to women in the general population. Time to event methods will be used to describe the time to breast cancer diagnosis for the types of atypia, including flexible parametric modelling if appropriate. Patient representatives from Independent Cancer Patients' Voice are included at every stage of the research. ETHICS AND DISSEMINATION: The study has received research ethics approval from the University of Warwick Biomedical and Scientific Research Ethics Committee (BSREC 10/20-21, 8 October 2020), Public Health England office for data release approvals (ODR1718_313) and approval from the English Breast Research Advisory Committee (BSPRAC_031). The findings will be disseminated to breast screening clinicians (via journal publication and conference presentation), to the NHS Breast Screening Programme to update their guidelines on how women with atypia should be followed up, and to the general public