Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

BackgroundShared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.ObjectiveIn July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.DesignTwo-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.ParticipantsSixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).Main measuresPanelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.Key resultsHighly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.ConclusionsConference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers

Design and development of a deployable self-inflating adaptive membrane

Space structures nowadays are often designed to serve just one objective during their mission life, examples include truss structures that are used as support structures, solar sails for propulsion or antennas for communication. Each and every single one of these structures is optimized to serve just their distinct purpose and are more or less useless for the rest of the mission and therefore dead weight. By developing a smart structure that can change its shape and therefore adapt to different mission requirements in a single structure, the flexibility of the spacecraft can be increased by greatly decreasing the mass of the entire system. This paper will introduce such an adaptive structure called the Self-inflating Adaptive Membrane (SAM) concept which is being developed at the Advanced Space Concepts Laboratory of the University of Strathclyde. An idea presented in this paper is to adapt these basic changeable elements from nature’s heliotropism. Heliotropism describes a movement of a plant towards the sun during a day; the movement is initiated by turgor pressure change between adjacent cells. The shape change of the global structure can be significant by adding up these local changes induced by local elements, for example the cell’s length. To imitate the turgor pressure change between the motor cells in plants to space structures, piezoelectric micro pumps are added between two neighboring cells. A passive inflation technique is used for deploying the membrane at its destination in space. The trapped air in the spheres will inflate the spheres when subjected to vacuum, therefore no pump or secondary active deployment methods are needed. The paper will present the idea behind the adaption of nature’s heliotropism principle to space structures. The feasibility of the residual air inflation method is verified by LS-DYNA simulations and prototype bench tests under vacuum conditions. Additionally, manufacturing techniques and folding patterns are presented to optimize the actual bench test structure and to minimize the required storage volume. It is shown that through a bio-inspired concept, a high ratio of adaptability of the membrane can be obtained. The paper concludes with the design of a technology demonstrator for a sounding rocket experiment to be launched in March 2013 from the Swedish launch side Esrange

Evaluation of the Water Footprint of Beef Cattle Production in Nebraska

Data were compiled on feed usage to model the amount of water needed to produce beef in typical Nebraska production systems. Production systems where cows were wintered on corn residue utilized 18% less water than systems utilizing native range as a wintering source, because of water allocations. Therefore, the water footprint (gallons of water required to produce one pound of boneless meat) was decreased by 18%. In addition, increasing the dietary inclusion of distillers grains from 0% to 40% decreased the water footprint in the finishing phase by 29%, again based on water allocation. Utilizing corn residue and distillers grains in Nebraska beef cattle systems decreases the overall water footprint of production. Additionally, the water footprint of the systems analyzed was 80% green water as rain, minimizing the environmental impact of beef production on freshwater use and ecological water balance

Gait Transitions for Quasi-Static Hexapedal Locomotion on Level Ground

As robot bodies become more capable, the motivation grows to better coordinate them—whether multiple limbs attached to a body or multiple bodies assigned to a task. This paper introduces a new formalism for coordination of periodic tasks, with specific application to gait transitions for legged platforms. Specifically, we make modest use of classical group theory to replace combinatorial search and optimization with a computationally simpler and conceptually more straightforward appeal to elementary algebra. We decompose the space of all periodic legged gaits into a cellular complex indexed using “Young Tableaux”, making transparent the proximity to steady state orbits and the neighborhood structure. We encounter the simple task of transitioning between these gaits while locomoting over level ground. Toward that end, we arrange a family of dynamical reference generators over the “Gait Complex” and construct automated coordination controllers to force the legged system to converge to a specified cell’s gait, while assessing the relative static stability of gaits by approximating their stability margin via transit through a “Stance Complex”. To integrate these two different constructs—the Gait Complex describing possible gaits, the Stance Complex defining safe locomotion—we utilize our compositional lexicon to plan switching policies for a hybrid control approach. Results include automated gait transitions for a variety of useful gaits, shown via tests on a hexapedal robot

Interannual variability of the air-sea flux of oxygen in the North Atlantic

In studies using timeseries observations of atmospheric O[subscript 2]/N[subscript 2] to infer the fate of fossil fuel CO[subscript 2], it has been assumed that multi-year trends in observed O[subscript 2]/N[subscript 2] are insensitive to interannual variability in air-sea fluxes of oxygen. We begin to address the validity of this assumption by investigating the magnitude and mechanisms of interannual variability in the flux of oxygen across the sea surface using a North Atlantic biogeochemical model. The model, based on the MIT ocean general circulation model, captures the gross patterns and seasonal cycle of nutrients and oxygen within the basin. The air-sea oxygen flux exhibits significant interannual variability in the North Atlantic, with a standard deviation (0.36 mol m[superscript −2] y[superscript −1]) that is a large fraction of the mean (0.85 mol m[superscript −2] y[subscript −1]). This is primarily a consequence of variability in winter convection in the subpolar gyre.Goddard Space Flight Center (Grants NGTS-30189 and NCC5-244

The association of statin use after cancer diagnosis with survival in pancreatic cancer patients: a SEER-medicare analysis.

BackgroundPancreatic cancer has poor prognosis and existing interventions provide a modest benefit. Statin has anti-cancer properties that might enhance survival in pancreatic cancer patients. We sought to determine whether statin treatment after cancer diagnosis is associated with longer survival in those with pancreatic ductal adenocarcinoma (PDAC).MethodsWe analyzed data on 7813 elderly patients with PDAC using the linked Surveillance, Epidemiology, and End Results (SEER) - Medicare claims files. Information on the type, intensity and duration of statin use after cancer diagnosis was extracted from Medicare Part D. We treated statin as a time-dependent variable in a Cox regression model to determine the association with overall survival adjusting for follow-up, age, sex, race, neighborhood income, stage, grade, tumor size, pancreatectomy, chemotherapy, radiation, obesity, dyslipidemia, diabetes, chronic pancreatitis and chronic obstructive pulmonary disease (COPD).ResultsOverall, statin use after cancer diagnosis was not significantly associated with survival when all PDAC patients were considered (HR = 0.94, 95%CI 0.89, 1.01). However, statin use after cancer diagnosis was associated with a 21% reduced hazard of death (Hazard ratio = 0.79, 95% confidence interval (CI) 0.67, 0.93) in those with grade I or II PDAC and to a similar extent in those who had undergone a pancreatectomy, in those with chronic pancreatitis and in those who had not been treated with statin prior to cancer diagnosis.ConclusionsWe found that statin treatment after cancer diagnosis is associated with enhanced survival in patients with low-grade, resectable PDAC

Strength Training Improves Body Image and Physical Activity Behaviors Among Midlife and Older Rural Women

The effect of strength training on body image is understudied. The Strong Women Program, a 10-week, twice weekly strength-training program, was provided by Extension agents to 341 older rural women (62±12 years); changes in body image and other psychosocial variables were evaluated. Paired-sample t-test analyses were conducted to assess mean differences pre- to post-program. Strength training was associated with significant improvements in several dimensions of body image, health-related quality of life, and physical activity behaviors, satisfaction, and comfort among rural aging women—an often underserved population that stands to benefit considerably from similar programs

Focused ultrasound-enabled brain tumor liquid biopsy

Abstract Although blood-based liquid biopsies have emerged as a promising non-invasive method to detect biomarkers in various cancers, limited progress has been made for brain tumors. One major obstacle is the blood-brain barrier (BBB), which hinders efficient passage of tumor biomarkers into the peripheral circulation. The objective of this study was to determine whether FUS in combination with microbubbles can enhance the release of biomarkers from the brain tumor to the blood circulation. Two glioblastoma tumor models (U87 and GL261), developed by intracranial injection of respective enhanced green fluorescent protein (eGFP)-transduced glioblastoma cells, were treated by FUS in the presence of systemically injected microbubbles. Effect of FUS on plasma eGFP mRNA levels was determined using quantitative polymerase chain reaction. eGFP mRNA were only detectable in the FUS-treated U87 mice and undetectable in the untreated U87 mice (maximum cycle number set to 40). This finding was replicated in GL261 mice across three different acoustic pressures. The circulating levels of eGFP mRNA were 1,500–4,800 fold higher in the FUS-treated GL261 mice than that of the untreated mice for the three acoustic pressures. This study demonstrated the feasibility of FUS-enabled brain tumor liquid biopsies in two different murine glioma models across different acoustic pressures

Economic Analysis of Increased Corn Silage Inclusion in Beef Finishing Cattle

An economic analysis was conducted to assess the feasibility of feeding greater inclusions of corn silage in finishing diets. Cattle were fed two inclusions of corn silage (15 and 45% of diet dry matter) with or without tylosin. Cattle fed 15% corn silage with tylosin had the best feed conversion, 15 % corn silage without tylosin was intermediate, and both 45% corn silage with and without tylosin had the poorest feed conversion. Feeding corn silage at greater inclusions decreased ADG but increased final body weight when fed to an equal fatness (28 days longer). However, feeding corn silage at 45% was more economical compared to feeding 15% corn silage, especially at higher corn prices, provided shrink is well managed (less than 15%). Feeding elevated concentrations of corn silage may have an economic advantage while also offering the addition of liver abscess control in finishing diets without tylosin