Non-adherence to eye care in people with diabetes

Objective Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes. Design and methods A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit. Results Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index. Conclusions Patients with moderate to severe DR and/ or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved

Help or hindrance? The travel, energy and carbon impact of highly automated vehicles

Experts predict that new automobiles will be capable of driving themselves under limited conditions within 5-10 years, and under most conditions within 10-20 years. Automation may affect road vehicle energy consumption and greenhouse gas (GHG) emissions in a host of ways, positive and negative, by causing changes in travel demand, vehicle design, vehicle operating profiles, and choices of fuels. In this paper, we identify specific mechanisms through which automation may affect travel and energy demand and resulting GHG emissions and bring them together using a coherent energy decomposition framework. We review the literature for estimates of the energy impacts of each mechanism and, where the literature is lacking, develop our own estimates using engineering and economic analysis. We consider how widely applicable each mechanism is, and quantify the potential impact of each mechanism on a common basis: the percentage change it is expected to cause in total GHG emissions from light-duty or heavy-duty vehicles in the U.S. Our primary focus is travel related energy consumption and emissions, since potential lifecycle impacts are generally smaller in magnitude. We explore the net effects of automation on emissions through several illustrative scenarios, finding that automation might plausibly reduce road transport GHG emissions and energy use by nearly half – or nearly double them – depending on which effects come to dominate. We also find that many potential energy-reduction benefits may be realized through partial automation, while the major energy/emission downside risks appear more likely at full automation. We close by presenting some implications for policymakers and identifying priority areas for further research

A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients.

BACKGROUND: As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients. STUDY DESIGN: One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 months after hospital discharge. RESULTS: Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, preoperative fatigue and pain levels, adjuvant therapy, and baseline walking distance. Patients in the IG had significantly improved scores on the FACIT-Fatigue Scale at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared with the UCG. Using hierarchical cluster analysis, 3 mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG. CONCLUSIONS: This is the first prospective, randomized controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients with regard to fatigue levels, physical functioning, and health-related quality of life

Quantum Electronics

Contains thirteen research projects split into three sections.U.S. Air Force - Rome Air Development Center (Contract F19628-80-C-0077)National Science Foundation (Grant PHY79-09739)Joint Services Electronics Program (Contract DAAG29-78-C-0020)Joint Services Electronics Program (Contract DAAG29-80-C-0104)U.S. Air Force Geophysics Laboratory (AFSC) (Contract F19628-79-C-0082)National Science Foundation (Grant ECS79-19475)National Science Foundation (Grant DAR80-08752)National Science Foundation (Grant ENG79-09980

Is energy security really too important to leave to markets?

Involvement by government in the energy sector has historically been extensive. Generally, however, regulation and direct ownership have involved secondary sectors such as electricity generation and transport on the grounds that these are natural monopolies exhibiting increasing returns to scale. With some exceptions, primary energy production has been left in private hands. But security of energy supply, particularly of petroleum, has been held to justify investment by governments in maintaining strategic reserves and other initiatives. This article argues, however, that petroleum markets are resilient and that the probability of disruptions is slight. Markets can be trusted to satisfy demand without shortages, at affordable prices. In light of structural changes and innovations in petroleum markets, unless the large strategic reserves held by almost all developed countries are actively used to reduce market volatility as a form of public good, maintaining them is difficult to justify

Analysis of blood type for SARS-CoV-2 and correlation for disease acquisition in various sociodemographic groups including women of childbearing age.

BACKGROUND: Multiple studies have occurred to determine if a patient\u27s blood type, Rhesus factor (Rh), and sociodemographic attributes contribute to contracting SARS-CoV-2. True association remains unknown. METHODS: Inclusion criteria included in-patients who were tested for SARS-CoV-2 with blood type assessed. Study endpoints combined ABO, Rh and all-cause inpatient mortality (ACIM) with testing positivity. Pregnancy status was one of several secondary endpoints evaluated. A logistic regression analysis was used to estimate association. RESULTS: Of the 27,662 patients who met inclusion criteria, Type A blood was associated with increased positivity [1.01 (1.0-1.21), P = .03]. Type B [1.10 (0.99-1.23), P = .08] and AB [0.98 (0.81-1.19), P = .84] showed no association. When evaluating ACIM, type A [1.18 (0.91-1.52), P = .22], B [1.13 (0.82- 1.56), P = .480], and AB [1.06 (0.62-1.81), P = .839] were not associated with increased mortality. The female subgroup was less likely to test positive [0.88 (0.82-0.986), P = .002]. Black patients demonstrated a higher likelihood of positivity when compared to White [1.96 (1.79-2.14), P \u3c .001]. Non-pregnant women exhibited a 2.5 times greater likelihood of testing positive [2.49 (2.04-3.04), P \u3c .001]. CONCLUSIONS: This study confirms results of previous research which showed SARS-Co-V-2 positivity related to blood type. It also confirms more recent research demonstrating inequities related to acquisition of SARS-CoV-2 for certain sociodemographic groups. Larger studies are warranted to confirm and further explore novel pregnancy findings