Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population

Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population.BackgroundNontraumatic lower limb amputation is a serious complication of both diabetic neuropathy and peripheral vascular disease. Many people with end-stage renal disease (ESRD) suffer from advanced progression of these diseases. This study presents descriptive information on the rate of lower limb amputation among people with ESRD who are covered by the Medicare program.MethodsUsing hospital bill data for the years 1991 through 1994 from the Health Care Financing Administration's ESRD program management and medical information system (PMMIS), amputations were based on ICD9 coding. These hospitalizations were then linked back to the PMMIS enrollment database for calculation of rates.ResultsThe rate of lower limb amputation increased during the four-year period from 4.8 per 100 person years in 1991 to 6.2 in 1994. Among persons whose renal failure was attributed to diabetic nephropathy, the rates in 1991 and 1994 were 11.8 and 13.8, respectively. The rate among diabetic persons with ESRD was 10 times as great as among the diabetic population at large. Two thirds died within two years following the first amputation.ConclusionsThe ESRD population is at an extremely high risk of lower limb amputation. Coordinated programs to screen for high-risk feet and to provide regular foot care for those at high risk combined with guidelines for treatment and referral of ulceration are needed

Human Microbiome Mixture Analysis Using Weighted Quantile Sum Regression

: Studies of the health effects of the microbiome often measure overall associations by using diversity metrics, and individual taxa associations in separate analyses, but do not consider the correlated relationships between taxa in the microbiome. In this study, we applied random subset weighted quantile sum regression with repeated holdouts (WQSRSRH), a mixture method successfully applied to 'omic data to account for relationships between many predictors, to processed amplicon sequencing data from the Human Microbiome Project. We simulated a binary variable associated with 20 operational taxonomic units (OTUs). WQSRSRH was used to test for the association between the microbiome and the simulated variable, adjusted for sex, and sensitivity and specificity were calculated. The WQSRSRH method was also compared to other standard methods for microbiome analysis. The method was further illustrated using real data from the Growth and Obesity Cohort in Chile to assess the association between the gut microbiome and body mass index. In the analysis with simulated data, WQSRSRH predicted the correct directionality of association between the microbiome and the simulated variable, with an average sensitivity and specificity of 75% and 70%, respectively, in identifying the 20 associated OTUs. WQSRSRH performed better than all other comparison methods. In the illustration analysis of the gut microbiome and obesity, the WQSRSRH analysis identified an inverse association between body mass index and the gut microbe mixture, identifying Bacteroides, Clostridium, Prevotella, and Ruminococcus as important genera in the negative association. The application of WQSRSRH to the microbiome allows for analysis of the mixture effect of all the taxa in the microbiome, while simultaneously identifying the most important to the mixture, and allowing for covariate adjustment. It outperformed other methods when using simulated data, and in analysis with real data found results consistent with other study findings

Paclitaxel-loaded phosphonated calixarene nanovesicles as a modular drug delivery platform

This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/A modular p-phosphonated calix[4]arene vesicle (PCV) loaded with paclitaxel (PTX) and conjugated with folic acid as a cancer targeting ligand has been prepared using a thin film-sonication method. It has a pH-responsive capacity to trigger the release of the encapsulated PTX payload under mildly acidic conditions. PTX-loaded PCV conjugated with alkyne-modified PEG-folic acid ligands prepared via click ligation (fP-PCVPTX) has enhanced potency against folate receptor (FR)-positive SKOV-3 ovarian tumour cells over FR-negative A549 lung tumour cells. Moreover, fP-PCVPTX is also four times more potent than the non-targeting PCVPTX platform towards SKOV-3 cells. Overall, as a delivery platform the PCVs have the potential to enhance efficacy of anticancer drugs by targeting a chemotherapeutic payload specifically to tumours and triggering the release of the encapsulated drug in the vicinity of cancer cells

Engineering geological models: an introduction: IAEG commission 25

The generation and use of engineering geological models should be a fundamental activity for any geotechnical project. Such models are an essential tool for engineering quality control and provide a transparent way of identifying project-specific critical engineering geological issues and parameters. Models should also form the basis for designing the scope, the method and assessing the effectiveness of site investigations. However, whilst the idea of models in engineering geology has existed for several decades, there has been little published that systematically distinguishes the different model types and how and when they might be used. This paper presents the views of the International Association for Engineering Geology and the Environment Commission C25 on the ‘Use of Engineering Geological Models

The change in weight perception of weight status among the overweight: comparison of NHANES III (1988–1994) and 1999–2004 NHANES

<p>Abstract</p> <p>Objectives</p> <p>This study seeks to determine whether perception of weight status among the overweight has changed with the increasing overweight/obesity prevalence.</p> <p>Methods</p> <p>The perception of weight status was compared between overweight participants (BMI between 25.0–29.9 kg/m²) from NHANES III (1988–1994) and overweight participants from NHANES 1999–2004. Perception of weight status was assessed by asking participants to classify their weight as about the right weight, underweight or overweight. Comparisons were made across age groups, genders, race/ethnicities and various income levels.</p> <p>Results</p> <p>Fewer overweight people during the NHANES 1999–2004 survey perceived themselves as overweight when compared to overweight people during the NHANES III survey. The change in distortion between the survey periods was greatest among persons with lower income, males and African-Americans.</p> <p>Conclusion</p> <p>The increase in overweight/obesity between the survey years (NHANES III and NHANES 1999–2004 has been accompanied with fewer overweight people perceiving themselves as overweight.</p

Wavelength Scaling and Square/Stripe and Grain Mobility Transitions in Vertically Oscillated Granular Layers

Laboratory experiments are conducted to examine granular wave patterns near onset as a function of the container oscillation frequency f and amplitude A, layer depth H, and grain diameter D. The primary transition from a flat grain layer to standing waves occurs when the layer remains dilated after making contact with the container. With a flat layer and increasing dimensionless peak container acceleration G = 4 pi^2 f^2 A/g (g is the acceleration due to gravity), the wave transition occurs for G=2.6, but with decreasing G the waves persist to G=2.2. For 2.2<G<3.8, patterns are squares for f<f_ss and stripes for f>f_ss; H determines the square/stripe transition frequency f_ss=0.33(g/H)^0.5. The dispersion relations for layers with varying H collapse onto the curve L/H=1.0+1.1[f(H/g)^0.5]^(-1.32 +/- 0.03) (L is the wavelength) when the peak container velocity v exceeds a critical value v_gm of approximately 3 (Dg)^0.5. Local collision pressure measurements suggest that v_gm is associated with a transition in the horizontal grain mobility: for v>v_gm, there is a hydrodynamic-like horizontal sloshing motion, while for v<v_gm, the grains are essentially immobile and the stripe pattern apparently arises from a bending of the granular layer. For f at v_gm less than f_ss and v<v_gm, patterns are tenuous and disordered.Comment: 21 pages, 15 figures, submitted to Physica

Status and promise of particle interferometry in heavy-ion collisions

After five years of running at RHIC, and on the eve of the LHC heavy-ion program, we highlight the status of femtoscopic measurements. We emphasize the role interferometry plays in addressing fundamental questions about the state of matter created in such collisions, and present an enumerated list of measurements, analyses and calculations that are needed to advance the field in the coming years

The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial

Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome