199 research outputs found
Unusually Weak Diffuse Interstellar Bands toward HD 62542
As part of an extensive survey of diffuse interstellar bands (DIBs), we have
obtained optical spectra of the moderately reddened B5V star HD 62542, which is
known to have an unusual UV extinction curve of the type usually identified
with dark clouds. The typically strongest of the commonly catalogued DIBs
covered by the spectra -- those at 5780, 5797, 6270, 6284, and 6614 A -- are
essentially absent in this line of sight, in marked contrast with other lines
of sight of similar reddening. We compare the HD 62542 line of sight with
others exhibiting a range of extinction properties and molecular abundances and
interpret the weakness of the DIBs as an extreme case of deficient DIB
formation in a dense cloud whose more diffuse outer layers have been stripped
away. We comment on the challenges these observations pose for identifying the
carriers of the diffuse bands.Comment: 20 pages, 4 figures; aastex; accepted by Ap
Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms
BACKGROUND: Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions. METHODS: A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. RESULTS: The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers. CONCLUSION: For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms
Preventing foot ulceration in diabetes:systematic review and meta-analyses of RCT data
Aims/hypothesis:
Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.
Methods:
We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.
Results:
Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.
Conclusions/interpretation:
Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit
The state of the Martian climate
60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes
Developing a utility index for the Aberrant Behavior Checklist (ABC-C) for fragile X syndrome
Purpose This study aimed to develop a utility index (the
ABC-UI) from the Aberrant Behavior Checklist-Community
(ABC-C), for use in quantifying the benefit of
emerging treatments for fragile X syndrome (FXS).
Methods The ABC-C is a proxy-completed assessment of
behaviour and is a widely used measure in FXS. A subset
of ABC-C items across seven dimensions was identified to
include in health state descriptions. This item reduction
process was based on item performance, factor analysis and
Rasch analysis performed on an observational study dataset,
and consultation with five clinical experts and a
methodological expert. Dimensions were combined into
health states using an orthogonal design and valued using
time trade-off (TTO), with lead-time TTO methods used
where TTO indicated a state valued as worse than dead.
Preference weights were estimated using mean, individual
level, ordinary least squares and random-effects maximum
likelihood estimation [RE (MLE)] regression models.
Results A representative sample of the UK general public
(n = 349; mean age 35.8 years, 58.2 % female) each valued
12 health states. Mean observed values ranged from
0.92 to 0.16 for best to worst health states. The RE (MLE)
model performed best based on number of significant
coefficients and mean absolute error of 0.018. Mean utilities
predicted by the model covered a similar range to that
observed.
Conclusions The ABC-UI estimates a wide range of
utilities from patient-level FXS ABC-C data, allowing
estimation of FXS health-related quality of life impact for
economic evaluation from an established FXS clinical trial
instrument
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