Organizational Characteristics of High- and Low-Clozapine-Utilization Clinics in the Veterans Health Administration

Objective: Treatment-resistance schizophrenia occurs in 20-30% of patients. Clozapine is the only medication proven effective for treatment-resistant schizophrenia. However, less than 25% of treatment-resistant schizophrenia patients receive clozapine in most settings. Therefore, this study was conducted to identify facilitators and barriers to clozapine use, to inform development of interventions to maximize appropriate clozapine-utilization. Methods: Seventy semi-structured phone interviews were conducted with five high- and five low-utilization VA Medical Centers, from different US regions including urban and rural areas. Interviewees were key informants of clozapine processes, including mental health leadership, psychiatrists, clinical pharmacists and advanced practice nurses. Interviews were analyzed using an emergent thematic strategy to identify barriers and facilitators to clozapine prescribing. Results: Key elements associated with high-utilization included integration of non-physician psychiatric providers and clear organizational processes and infrastructure for treatment of severe mental illness (e.g. clozapine clinics, larger mental health intensive case management services). Low-utilization was associated with lack of champions to support clozapine processes and limited-capacity care systems. Obstacles identified at both high- and low-utilization sites included complex time-consuming paperwork, reliance on few individuals to facilitate processes, and issues related to transportation for patients living far from care facilities. Conclusions: Implementation efforts to organize, streamline and simplify clozapine processes, development of a multidisciplinary clozapine clinic, increasing the size and capacity of existing clinics, and provision of transportation are reasonable targets to increase clozapine utilization

Physiology

Contains reports on seven research projects.Bell Laboratories, Inc.Ortho InstrumentsNational Institutes of Health (Grant 5 TO1 EY00090

Should Endovascular Repair Be Reimbursed for Low Risk Abdominal Aortic Aneurysm Patients? Evidence from Ontario, Canada

Background. This paper presents unpublished clinical and economic data associated with open surgical repair (OSR) in low risk (LR) patients and how it compares with EVAR and OSR in high risk (HR) patients with an AAA > 5.5 cm. Design. Data from a 1-year prospective observational study was used to compare EVAR in HR patients versus OSR in HR and LR patients. Results. Between 2003 and 2005, 140 patients were treated with EVAR and 195 with OSR (HR: 52; LR: 143). The 1-year mortality rate with EVAR was statistically lower than HR OSR patients and comparable to LR OSR patients. One-year health-related quality of life was lower in the EVAR patients compared to OSR patients. EVAR was cost-effective compared to OSR HR but not when compared to OSR LR patients. Conclusions. Despite a similar clinical effectiveness, these results suggest that, at the current price, EVAR is more expensive than open repair for low risk patients

Prospective Analysis of Traffic Exposure as a Risk Factor for Incident Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study

BackgroundFor people living close to busy roads, traffic is a major source of air pollution. Few prospective data have been published on the effects of long-term exposure to traffic on the incidence of coronary heart disease (CHD).ObjectivesIn this article, we examined the association between long-term traffic exposure and incidence of fatal and nonfatal CHD in a population-based prospective cohort study.MethodsWe studied 13,309 middle-age men and women in the Atherosclerosis Risk in Communities study, without previous CHD at enrollment, from 1987 to 1989 in four U.S. communities. Geographic information system–mapped traffic density and distance to major roads served as measures of traffic exposure. We examined the association between traffic exposure and incident CHD using proportional hazards regression models, with adjustment for background air pollution and a wide range of individual cardiovascular risk factors.ResultsOver an average of 13 years of follow-up, 976 subjects developed CHD. Relative to those in the lowest quartile of traffic density, the adjusted hazard ratio (HR) in the highest quartile was 1.32 [95% confidence interval (CI), 1.06–1.65; p-value for trend across quartiles = 0.042]. When we treated traffic density as a continuous variable, the adjusted HR per one unit increase of log-transformed density was 1.03 (95% CI, 1.01–1.05; p = 0.006). For residents living within 300 m of major roads compared with those living farther away, the adjusted HR was 1.12 (95% CI, 0.95–1.32; p = 0.189). We found little evidence of effect modification for sex, smoking status, obesity, low-density lipoprotein cholesterol level, hypertension, age, or education.ConclusionHigher long-term exposure to traffic is associated with incidence of CHD, independent of other risk factors. These prospective data support an effect of traffic-related air pollution on the development of CHD in middle-age persons

Back to the Future: Surveying the Northern Hemisphere and Reprocessing the Southern TESS Data Set

TESS launched 18 April 2018 to conduct a two-year, near all-sky survey for at least 50 small, nearby exoplanets for which masses can be ascertained and whose atmospheres can be characterized by ground- and space-based follow-on observations. TESS has completed its survey of the southern hemisphere and begun its survey of the northern hemisphere, identifying >1000 candidate exoplanets and unveiling a plethora of exciting non-exoplanet astrophysics results, such as asteroseismology, asteroids, and supernova. The TESS Science Processing Operations Center (SPOC) processes the data downlinked every two weeks to generate a range of data products hosted at the Mikulski Archive for Space Telescopes (MAST). For each sector (~1 month) of observations, the SPOC calibrates the image data for both 30-min Full Frame Images (FFIs) and up to 20,000 pre-selected 2-min target star postage stamps. Data products for the 2-min targets include simple aperture photometry and systematic error-corrected flux time series. The SPOC also conducts searches for transiting exoplanets in the 2-min data for each sector and generates Data Validation time series and associated reports for each transit-like feature identified in the search. Multi-sector searches for exoplanets are conducted periodically to discover longer period planets, including those in the James Webb Continuous Viewing Zone (CVZ), which are observed for up to one year. Starting with Sector 8, scattered light from the Earth and Moon contaminated significant portions of the data in each orbit. We have developed algorithms for automated identification of the scattered light features at the individual target level. Previously, data for all stars on a CCD affected by scattered light were manually excluded. The automated flagging will allow us to retain significantly more data for stars that are not affected by the scattered light even though it is occurring elsewhere on the CCD. We also discuss enhancements to the SPOC pipeline and the newly available FFI light curves. The TESS Mission is funded by NASA's Science Mission Directorate as an Astrophysics Explorer Mission

Meeting report : 1st international functional metagenomics workshop May 7–8, 2012, St. Jacobs, Ontario, Canada

This report summarizes the events of the 1st International Functional Metagenomics Workshop. The workshop was held on May 7 and 8 in St. Jacobs, Ontario, Canada and was focused on building a core international functional metagenomics community, exploring strategic research areas, and identifying opportunities for future collaboration and funding. The workshop was initiated by researchers at the University of Waterloo with support from the Ontario Genomics Institute (OGI), Natural Sciences and Engineering Research Council of Canada (NSERC) and the University of Waterloo

Variation in Rates of Fatal Coronary Heart Disease by Neighborhood Socioeconomic Status: The Atherosclerosis Risk in Communities Surveillance (1992–2002)

Racial and gender disparities in out-of-hospital deaths from coronary heart disease (CHD) have been well-documented, yet disparities by neighborhood socioeconomic status have been less systematically studied in US population-based surveillance efforts