Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

Purpose: To evaluate a frequently used regression model and a new, modified regression model to estimate cerebrospinal fluid pressure (CSFP). Methods: Datasets from the Beijing iCOP study from Tongren Hospital, Beijing, China, and the Mayo Clinic, Rochester, Minnesota, were tested in this retrospective, case-control study. An often-used regression model derived from the Beijing iCOP dataset, but without radiographic data, was used to predict CSFP by using demographic and physiologic data. A regression model was created using the Mayo Clinic dataset and tested against a validation group. The Mayo Clinic-derived formula was also tested against the Beijing Eye Study population. Intraclass correlation was used to assess predicted versus actual CSFP. Results: The Beijing-derived regression equation was reported to have an intraclass correlation coefficient (ICC) of 0.71, indicating strong correlation between predicted and actual CSFP in the study population. The Beijing iCOP regression model poorly predicted CSFP in the Mayo Clinic population with an ICC of 0.14. The Mayo Clinic-derived regression model similarly did not predict CSFP in its Mayo Clinic validation group (ICC 0.28 ± 0.04) nor in the Beijing Eye Study population (ICC 0.06). Conclusions: Formulae used to predict CSFP derived from clinical data fared poorly against a large retrospective dataset. This may be related to differences in lumbar puncture technique, in the populations tested, or the timing of collection of physiologic variables in the Mayo Clinic dataset. Caution should be used when interpreting results based on formulaic derivation of CSFP

Body Mass Index Has a Linear Relationship with Cerebrospinal Fluid Pressure

To examine the relationship between body mass index (BMI) and cerebrospinal fluid pressure (CSFP), as low BMI and low CSFP have recently been described as risk factors for primary open-angle glaucoma (POAG)

Cerebrospinal Fluid Pressure Decreases with Older Age

Clinical studies implicate low cerebrospinal fluid pressure (CSFP) or a high translaminar pressure difference in the pathogenesis of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). This study was performed to examine the effect of age, sex, race and body mass index (BMI) on CSFP

Cost-Comparison of Two Trabecular Micro-Bypass Stents Versus Selective Laser Trabeculoplasty or Medications Only for Intraocular Pressure Control for Patients with Open-Angle Glaucoma

Aim: Patients with open-angle glaucoma (OAG) whose intraocular pressure is not adequately controlled by one medication have several treatment options in the US. This analysis evaluated direct costs of unilateral eye treatment with two trabecular micro-bypass stents (two iStents) compared to selective laser trabeculoplasty (SLT) or medications only. Materials and methods: A population-based, annual state-transition, probabilistic, cost-of-care model was used to assess OAG-related costs over 5 years. Patients were modeled to initiate treatment in year zero with two iStents, SLT, or medications only. In years 1–5, patients could remain on initial treatment or move to another treatment option(s), or filtration surgery. Treatment strategy change probabilities were identified by a clinician panel. Direct costs were included for drugs, procedures, and complications. Results: The projected average cumulative cost at 5 years was lower in the two-stent treatment arm ($4,420) compared to the SLT arm ($4,730) or medications-only arm ($6,217). Initial year-zero costs were higher with two iStents ($2,810) than with SLT ($842) or medications only ($996). Average marginal annual costs in years 1–5 were $322 for two iStents,$777 for SLT, and $1,044 for medications only. The cumulative cost differences between two iStents vs SLT or medications only decreased over time, with breakeven by 5 or 3 years post-initiation, respectively. By year 5, cumulative savings with two iStents over SLT or medications only was$309 or $1,797, respectively. Limitations: This analysis relies on clinical expert panel opinion and would benefit from real-world evidence on use of multiple procedures and treatment switching after two-stent treatment, SLT, or polypharmaceutical initial approaches. Conclusions: Despite higher costs in year zero, annual costs thereafter were lowest in the two-stent treatment arm. Two-stent treatment may reduce OAG-related health resource use, leading to direct savings, especially over medications only or at longer time horizons

Characterization of Testing Locations for Developing Cool-Season Grass Species

The identification of best testing locations facilitates the allocation of resources in a breeding program, allowing emphasis to be placed at the sites best suited for identifying superior plant materials for the target environment. The objective of this study was the identification of best locations for the evaluation and testing of cool-season grass species within the Northern Great Plains and Intermountain regions of the USA. This study also sought to subdivide the locations into meaningful environmental groupings based on similar entry performance. The study characterized initial stand frequency and forage production (over a 3-yr period) of crested wheatgrass [Agropyron cristatum (L.) Gaertn.; A. desertorum (Fisch. ex Link) Schultes; A. fragile (Roth) Candargy], intermediate wheatgrass [Thinopyrum intermedium (Host) Barkworth & D.R. Dewey], and smooth bromegrass (Bromus inermis Leyss.) at six locations within these regions. Results suggested the existence of best testing locations and environmental groupings for each of the species. For example, the Ithaca, NE, location was consistently a good location for testing forage production. Although there were some consistencies, generally, the best testing locations and environmental groupings were species and trait specific. Thus, the targeted use of locations appeared to be most useful on an individual species basis, rather than considered across the cool-season grass species

Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status

Stratospheric aerosol - Observations, processes, and impact on climate

Interest in stratospheric aerosol and its role in climate have increased over the last decade due to the observed increase in stratospheric aerosol since 2000 and the potential for changes in the sulfur cycle induced by climate change. This review provides an overview about the advances in stratospheric aerosol research since the last comprehensive assessment of stratospheric aerosol was published in 2006. A crucial development since 2006 is the substantial improvement in the agreement between in situ and space-based inferences of stratospheric aerosol properties during volcanically quiescent periods. Furthermore, new measurement systems and techniques, both in situ and space based, have been developed for measuring physical aerosol properties with greater accuracy and for characterizing aerosol composition. However, these changes induce challenges to constructing a long-term stratospheric aerosol climatology. Currently, changes in stratospheric aerosol levels less than 20% cannot be confidently quantified. The volcanic signals tend to mask any nonvolcanically driven change, making them difficult to understand. While the role of carbonyl sulfide as a substantial and relatively constant source of stratospheric sulfur has been confirmed by new observations and model simulations, large uncertainties remain with respect to the contribution from anthropogenic sulfur dioxide emissions. New evidence has been provided that stratospheric aerosol can also contain small amounts of nonsulfate matter such as black carbon and organics. Chemistry-climate models have substantially increased in quantity and sophistication. In many models the implementation of stratospheric aerosol processes is coupled to radiation and/or stratospheric chemistry modules to account for relevant feedback processes

Cataract Surgery to Lower Intraocular Pressure

Cataract and glaucoma are common co morbidities. Cataract surgery is frequently performed in patients with glaucoma. In this study, a review of literature with search terms of cataract, glaucoma and intraocular pressure is followed by evaluation and synthesis of data to determine the effect of cataract surgery on intraocular pressure. Cataract surgery seems to lower intraocular pressure on a sustained basis, especially in patients with higher preoperative intraocular pressure. The mechanism of action of these finds remains speculative

Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma

Purpose: To compare cerebrospinal fluid (CSF) pressure in patients with primary open-angle glaucoma (POAG) with that in nonglaucomatous patients. Design: Case–control study. Participants: Thirty-one thousand, seven hundred and eighty-six subjects underwent lumbar puncture (LP

Herbicides for Establishing Switchgrass in the Central and Northern Great Plains

Weed interference limits switchgrass (Panicum virgatum L.) establishment from seed. Our objectives were to determine the effect of selected post-plant, preemergence herbicides on stand establishment and subsequent biomass yields of adapted upland switchgrass cultivars grown in three environments in the Central and Northern Great Plains. A separate experiment was conducted in eastern Nebraska to determine if there were any differences among switchgrass ecotypes for herbicide tolerance to the optimal herbicide combination. Herbicides applied immediately after planting were different concentrations of atrazine [Aatrex 4L®; 6- chloro-N-ethyl-N′-(1-methylethyl)-1,3,5-triazine-2,4-diamine], quinclorac (Paramount®; 3,7-Dichloro-8-quinolinecarboxylic acid), atrazine+quinclorac, imazapic {Plateau®; 2-[4,5- dihydro-4-methyl-4-(1-methylethyl)-5-oxo-1H-imidazol-2-yl]- 5-methyl-3-pyridinecarboxylic acid}, and quinclorac+ imazapic. Herbicide efficacy was determined by measuring stand frequency of occurrence and biomass yield the year after establishment. The application of quinclorac plus atrazine resulted in acceptable stands and high biomass yields. Imazapic often reduced switchgrass stands in comparison to the nontreated control and is not recommended for switchgrass establishment. In the multi-state trials, the herbicide by cultivar interaction was not significant for stands or biomass yields, indicating that the effects of herbicides on switchgrass stands and biomass yields were consistent over the upland cultivars used in the trials. No differences were detected among switchgrass lowland and upland ecotypes for tolerance to atrazine and quinclorac. Quinclorac, which provides effective control of grassy weeds, and herbicides such as atrazine which provide good broadleaf weed control are an excellent herbicide combination for establishing switchgrass for biomass production in the Great Plains and the Midwest