Comparison of osteoporosis pharmacotherapy fracture rates: Analysis of a marketScan® claims database cohort

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications. Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database. Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. Logistic regression was used to account for and quantify the contribution of risk factors, and to make direct comparisons between different osteoporosis medications. Results: A total of 51649 patients were included in the cohort, with an average age of 56 years. The overall incidence rate of fracture was 1.55 per 100 person - years of treatment. Orally administered medications had the lowest fracture rates, led by raloxifene and alendronate (1.24 and 1.54 respectively), while parenterally administered medications including teriparatide and zolerdonic acid had the highest rates (3.90 and 1.98 respectively). No statistically significant differences found between oral or parenterally administered bisphosphonate medications. Conclusions: While patients taking orally administered drugs including bisphosphonates had less frequent incident fracture no statistically significant differences were found between most drugs in head - to - head comparisons, even considering the route of administration of bisphosphonates. These findings support previous evidence that minimal differences in efficacy exist between different osteoporosis medications. This is the first study using a large database to compare all currently available osteoporosis treatments and will hopefully be augmented by further study to provide more evidence to make clinical decisions on osteoporosis medication use. © 2017 American Association of Neuropathologists, Inc

Bucking the trend: the diversity of Anthropocene ‘winners’ among British moths

An appreciation of how some species are becoming more common despite unprecedented anthropogenic pressures could offer key insights for mitigating the global biodiversity crisis.  Research to date has largely focused on declining species, while species that are becoming more common have received relatively little attention. Macro-moths in Great Britain are well-studied and species-rich, making them an ideal group for addressing this knowledge gap. Here, we examine changes in 51 successful species between 1968 and 2016 using 4.5 million occurrence records and a systematic monitoring dataset. We employ 3D graphical analysis to visualise long-term multidimensional trends in prevalence (abundance and range) and use vector autoregression models to test whether past values of local abundance are useful for predicting changes in the extent of occurrence. The responses of Anthropocene winners are heterogeneous, suggesting multiple drivers are responsible. Changes in range and local abundance frequently occur intermittently through time, demonstrating the value of long-term, continuous monitoring. There is significant diversity among the winners themselves, which include widespread generalists, habitat specialists, and recent colonists. We offer brief discussion of possible causal factors and the wider ecosystem implications of these trends

New Onset Thyrotoxicosis Presenting as Vomiting, Abdominal Pain and Transaminitis in the Emergency Department

This case report describes an unusual presentation of an emergency department (ED) patient with nausea, vomiting, and epigastric pain, who was initially suspected of having viral hepatitis. The patient returned to the ED seven days later with persistent tachycardia and was diagnosed with new onset thyrotoxicosis

Plasticization and antiplasticization of polymer melts diluted by low molar mass species

An analysis of glass formation for polymer melts that are diluted by structured molecular additives is derived by using the generalized entropy theory, which involves a combination of the Adam-Gibbs model and the direct computation of the configurational entropy based on a lattice model of polymer melts that includes monomer structural effects. Antiplasticization is accompanied by a "toughening" of the glass mixture relative to the pure polymer, and this effect is found to occur when the diluents are small species with strongly attractive interactions with the polymer matrix. Plasticization leads to a decreased glass transition temperature T_g and a "softening" of the fragile host polymer in the glass state. Plasticization is prompted by small additives with weakly attractive interactions with the polymer matrix. The shifts in T_g of polystyrene diluted by fully flexible short oligomers are evaluated from the computations, along with the relative changes in the isothermal compressibility at T_g to characterize the extent to which the additives act as antiplasticizers or plasticizers. The theory predicts that a decreased fragility can accompany both antiplasticization and plasticization of the glass by molecular additives. The general reduction in the T_g and fragility of polymers by these molecular additives is rationalized by analyzing the influence of the diluent's properties (cohesive energy, chain length, and stiffness) on glass formation in diluted polymer melts. The description of glass formation at fixed temperature that is induced upon change the fluid composition directly implies the Angell equation for the structural relaxation time as function of the polymer concentration, and the computed "zero mobility concentration" scales linearly with the inverse polymerization index N.Comment: 12 pages, 15 figure

You are what you eat? Vegetarianism, health and identity

This paper examines the views of ‘health vegetarians’ through a qualitative study of an online vegetarian message board. The researcher participated in discussions on the board, gathered responses to questions from 33 participants, and conducted follow-up e-mail interviews with 18 of these participants. Respondents were predominantly from the United States, Canada and the UK. Seventy per cent were female, and ages ranged from 14 to 53 years, with a median of 26 years. These data are interrogated within a theoretical framework that asks, ‘what can a vegetarian body do?’ and explores the physical, psychic, social and conceptual relations of participants. This provides insights into the identities of participants, and how diet and identity interact. It is concluded that vegetarianism is both a diet and a bodily practice with consequences for identity formation and stabilisation

Smartphone-based pathogen diagnosis in urinary sepsis patients.

BackgroundThere is an urgent need for rapid, sensitive, and affordable diagnostics for microbial infections at the point-of-care. Although a number of innovative systems have been reported that transform mobile phones into potential diagnostic tools, the translational challenge to clinical diagnostics remains a significant hurdle to overcome.MethodsA smartphone-based real-time loop-mediated isothermal amplification (smaRT-LAMP) system was developed for pathogen ID in urinary sepsis patients. The free, custom-built mobile phone app allows the phone to serve as a stand-alone device for quantitative diagnostics, allowing the determination of genome copy-number of bacterial pathogens in real time.FindingsA head-to-head comparative bacterial analysis of urine from sepsis patients revealed that the performance of smaRT-LAMP matched that of clinical diagnostics at the admitting hospital in a fraction of the time (~1 h vs. 18-28 h). Among patients with bacteremic complications of their urinary sepsis, pathogen ID from the urine matched that from the blood - potentially allowing pathogen diagnosis shortly after hospital admission. Additionally, smaRT-LAMP did not exhibit false positives in sepsis patients with clinically negative urine cultures.InterpretationThe smaRT-LAMP system is effective against diverse Gram-negative and -positive pathogens and biological specimens, costs less than $100 US to fabricate (in addition to the smartphone), and is configurable for the simultaneous detection of multiple pathogens. SmaRT-LAMP thus offers the potential to deliver rapid diagnosis and treatment of urinary tract infections and urinary sepsis with a simple test that can be performed at low cost at the point-of-care. FUND: National Institutes of Health, Chan-Zuckerberg Biohub, Bill and Melinda Gates Foundation

An Upper Mass Limit on a Red Supergiant Progenitor for the Type II-Plateau Supernova SN 2006my

We analyze two pre-supernova (SN) and three post-SN high-resolution images of the site of the Type II-Plateau supernova SN 2006my in an effort to either detect the progenitor star or to constrain its properties. Following image registration, we find that an isolated stellar object is not detected at the location of SN 2006my in either of the two pre-SN images. In the first, an I-band image obtained with the Wide-Field and Planetary Camera 2 on board the Hubble Space Telescope, the offset between the SN 2006my location and a detected source ("Source 1") is too large: > 0.08", which corresponds to a confidence level of non-association of 96% from our most liberal estimates of the transformation and measurement uncertainties. In the second, a similarly obtained V-band image, a source is detected ("Source 2") that has overlap with the SN 2006my location but is definitively an extended object. Through artificial star tests carried out on the precise location of SN 2006my in the images, we derive a 3-sigma upper bound on the luminosity of a red supergiant that could have remained undetected in our pre-SN images of log L/L_Sun = 5.10, which translates to an upper bound on such a star's initial mass of 15 M_Sun from the STARS stellar evolutionary models. Although considered unlikely, we can not rule out the possibility that part of the light comprising Source 1, which exhibits a slight extension relative to other point sources in the image, or part of the light contributing to the extended Source 2, may be due to the progenitor of SN 2006my. Only additional, high-resolution observations of the site taken after SN 2006my has faded beyond detection can confirm or reject these possibilities.Comment: Minor text changes from Version 1. Appendix added detailing the determination of confidence level of non-association of point sources in two registered astronomical image

Temporal Relationship Between Serum Neurofilament Light Chain and Radiologic Disease Activity in Patients With Multiple Sclerosis

Serum neurofilament light chain; Radiologic disease; Multiple sclerosisCadena ligera de neurofilamentos séricos; Enfermedad radiológica; Esclerosis múltipleCadena lleugera de neurofilaments sèrics; Malaltia radiològica; Esclerosi múltipleBackground and Objectives Serum neurofilament light chain (sNfL) levels correlate with multiple sclerosis (MS) disease activity, but the dynamics of this correlation are unknown. We evaluated the relationship between sNfL levels and radiologic MS disease activity through monthly assessments during the 24-week natalizumab treatment interruption period in RESTORE (NCT01071083). Methods In the RESTORE trial, participants with relapsing forms of MS who had received natalizumab for ≥12 months were randomized to either continue or stop natalizumab and followed with MRI and blood draws every 4 weeks to week 28 and again at week 52 The sNfL was measured, and its dynamics were correlated with the development of gadolinium-enhancing (Gd+) lesions. Log-linear trend in sNfL levels were modeled longitudinally using generalized estimating equations with robust variance estimator from baseline to week 28. Results Of 175 patients enrolled in RESTORE, 166 had serum samples for analysis. Participants with Gd+ lesions were younger (37.7 vs 43.1, p = 0.001) and had lower Expanded Disability Status Scale scores at baseline (2.7 vs 3.4, p = 0.017) than participants without Gd+ lesions. sNfL levels increased in participants with Gd+ lesions (n = 65) compared with those without (n = 101, mean change from baseline to maximum sNfL value, 12.1 vs 3.2 pg/mL, respectively; p = 0.003). As the number of Gd+ lesions increased, peak median sNfL change also increased by 1.4, 3.0, 4.3, and 19.6 pg/mL in the Gd+ lesion groups of 1 (n = 12), 2–3 (n = 18), 4–9 (n = 21), and ≥10 (n = 14) lesions, respectively. However, 46 of 65 (71%) participants with Gd+ lesions did not increase above the 95th percentile threshold of the group without Gd+ lesions. The initial increase of sNfL typically trailed the first observation of Gd+ lesions, and the peak increase in sNfL was a median [interquartile range] of 8 [0, 12] weeks after the first appearance of the Gd+ lesion. Discussion Although sNfL correlated with the presence of Gd+ lesions, most participants with Gd+ lesions did not have elevations in sNfL levels. These observations have implications for the use and interpretation of sNfL as a biomarker for monitoring MS disease activity in controlled trials and clinical practice.The study was sponsored and funded by Biogen (Cambridge, MA)

Computational hyperspectral interferometry for studies of brain function: Proof of concept

Hyperspectral interferometric microscopy uses a unique combination of optics and algorithm design to extract information. Local brain activity rapidly changes local blood flow and red blood cell concentration (absorption) and oxygenation (color). We demonstrate that brain activity evoked during whisker stimulation can be detected with hyperspectral interferometric microscopy to identify the active whisker-barrel cortex in the rat brain. Information about constituent components is extracted across the entire spectral band. Algorithms can be flexibly optimized to discover, detect, quantify, and visualize a wide range of significant biological events, including changes relevant to the diagnosis and treatment of disease. © 2006 Optical Society of America