Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study.

BackgroundThe US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins.MethodsThe study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics.ResultsAmong males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years.ConclusionsBased on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk

Broad-band radio circular polarization spectrum of the relativistic jet in PKS B2126-158

We present full Stokes radio polarization observations of the quasar PKS B2126−158 (z = 3.268) from 1 to 10 GHz using the Australia Telescope Compact Array. The source has large fractional circular polarization (CP), mc ≡ |V|/I, detected at high significance across the entire band (from 15 to 90σ per 128 MHz subband). This allows us to construct the most robust CP spectrum of an active galactic nucleus (AGN) jet to date. We find mc ∝ ν+0.60 ± 0.03 from 1.5 to 6.5 GHz, with a peak of mc ∼ 1 per cent before the spectrum turns over somewhere between 6.5 and 8 GHz, above which mc ∝ ν−3.0 ± 0.4. The fractional linear polarization (LP;p) varies from 0.2 to ∼1 per cent across our frequency range and is strongly anticorrelated with the fractional CP, with a best-fitting power law giving mc ∝ p−0.24 ± 0.03. This is the first clear relation between the observed LP and CP of an AGN jet, revealing the action of Faraday conversion of LP to CP within the jet. More detailed modelling in conjunction with high spatial resolution observations are required to determine the true driving force behind the conversion (i.e. magnetic twist or internal Faraday rotation). In particular determining whether the observed Faraday rotation is internal or entirely external to the jet is key to this goal. The simplest interpretation of our observations favours some internal Faraday rotation, implying that Faraday rotation-driven conversion of LP to CP is the dominant CP generation mechanism. In this case, a small amount of vector-ordered magnetic field along the jet axis is required, along with internal Faraday rotation from the low-energy end of the relativistic electron energy spectrum in an electron–proton-dominated jet

The Open Cluster NGC 7789: I. Radial Velocities for Giant Stars

A total of 597 radial-velocity observations for 112 stars in the ~1.6 Gyr old open cluster NGC 7789 have been obtained since 1979 with the radial velocity spectrometer at the Dominion Astrophysical Observatory. The mean cluster radial velocity is -54.9 +/- 0.12 km/s and the dispersion is 0.86 km/s, from 50 constant-velocity stars selected as members from this radial-velocity study and the proper motion study of McNamara and Solomon (1981). Twenty-five stars (32%) among 78 members are possible radial-velocity variable stars, but no orbits are determined because of the sparse sampling. Seventeen stars are radial-velocity non-members, while membership estimates of six stars are uncertain. There is a hint that the observed velocity dispersion falls off at large radius. This may due to the inclusion of long-period binaries preferentially in the central area of the cluster. The known radial-velocity variables also seem to be more concentrated toward the center than members with constant velocity. Although this is significant at only the 85% level, when combined with similar result of Raboud and Mermilliod (1994) for three other clusters, the data strongly support the conclusion that mass segregation is being detected.Comment: 16 pages (including 3 figures) and 3 table

A Star Catalog for the Open Cluster NGC188

We present new BVRI broad-band photometry for the old open cluster NGC188 based upon analysis of 299 CCD images either obtained by us, donated by colleagues, or retrieved from public archives. We compare our results on a star-by-star basis with data from eleven previous photometric investigations of the cluster. We homogenize and merge the data from all the photometric studies, and also merge membership probabilities from four previous proper-motion studies of the cluster field. Fiducial cluster sequences in the BV (Johnson) RI (Cousins) photometric system of Landolt (1992, AJ, 104, 340) represent the principal result of this paper. These have been compared to reference samples defined by (a) Landolt's standard stars, (b) the old open clusters M67 and NGC6791, and (c) stars within 25 pc having modern photometry and precise Hipparcos parallaxes. In a companion paper we show that our derived cluster results agree well with the predictions of modern stellar-interior and -evolution theory, given reasonable estimates of the cluster chemical abundances and foreground reddening. The individual and combined datasets for NGC188 have been made available through our web site.Comment: Accepted for PAS

A randomised study of rituximab and belimumab sequential therapy in PR3 ANCA-associated vasculitis (COMBIVAS): design of the study protocol

Background: Sequential B cell-targeted immunotherapy with BAFF antagonism (belimumab) and B cell depletion (rituximab) may enhance B cell targeting in ANCA-associated vasculitis (AAV) through several mechanisms. Methods: Study design: COMBIVAS is a randomised, double-blind, placebo-controlled trial designed to assess the mechanistic effects of sequential therapy of belimumab and rituximab in patients with active PR3 AAV. The recruitment target is 30 patients who meet the criteria for inclusion in the per-protocol analysis. Thirty-six participants have been randomised to one of the two treatment groups in a 1:1 ratio: either rituximab plus belimumab or rituximab plus placebo (both groups with the same tapering corticosteroid regimen), and recruitment is now closed (final patient enrolled April 2021). For each patient, the trial will last for 2 years comprising a 12-month treatment period followed by a 12-month follow-up period. Participants: Participants have been recruited from five of seven UK trial sites. Eligibility criteria were age ≥ 18 years and a diagnosis of AAV with active disease (newly diagnosed or relapsing disease), along with a concurrent positive test for PR3 ANCA by ELISA. Interventions: Rituximab 1000 mg was administered by intravenous infusions on day 8 and day 22. Weekly subcutaneous injections of 200 mg belimumab or placebo were initiated a week before rituximab on day 1 and then weekly through to week 51. All participants received a relatively low prednisolone (20 mg/day) starting dose from day 1 followed by a protocol-specified corticosteroid taper aiming for complete cessation by 3 months. Outcomes: The primary endpoint of this study is time to PR3 ANCA negativity. Key secondary outcomes include change from baseline in naïve, transitional, memory, plasmablast B cell subsets (by flow cytometry) in the blood at months 3, 12, 18 and 24; time to clinical remission; time to relapse; and incidence of serious adverse events. Exploratory biomarker assessments include assessment of B cell receptor clonality, B cell and T cell functional assays, whole blood transcriptomic analysis and urinary lymphocyte and proteomic analysis. Inguinal lymph node and nasal mucosal biopsies have been performed on a subgroup of patients at baseline and month 3. Discussion: This experimental medicine study provides a unique opportunity to gain detailed insights into the immunological mechanisms of belimumab-rituximab sequential therapy across multiple body compartments in the setting of AAV. Trial registration: ClinicalTrials.gov NCT03967925. Registered on May 30, 2019

Hemoglobin concentrations and adverse birth outcomes in south Asian pregnant women: Findings from a prospective maternal and neonatal health registry

Background: While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women.Methods: For this study, we used data collected from two South Asian countries (Pakistan - Sindh Province and two sites in India - Belagavi and Nagpur) in a prospective maternal and newborn health registry study. To assess the association between Hb concentrations and various maternal and fetal outcomes, we classified the Hb concentrations into seven categories. Regression analyses adjusting for multiple potential confounders were performed to assess adverse pregnancy outcomes across the range of Hb concentrations.Findings: Between January 2012 and December 2018, 130,888 pregnant women were enrolled in the South Asian sites had a Hb measurement available, delivered and were included in the analyses. Overall, the mean Hb concentration of pregnant women from the sites was 9.9 g/dL, 10.0 g/dL in the Indian sites and 9.5 g/dL in the Pakistan site. Hb concentrations \u3c 7 g/dL were observed in 6.9% of the pregnant Pakistani women and 0.2% of the Indian women. In both the Pakistani and Indian sites, women with higher parity and women with no formal education had lower Hb concentrations. In the Pakistani site, women \u3e 35 years of age, women with ≥4 children and those who enrolled in the third trimester were more likely to have Hb concentrations of \u3c 7 g/dL but these associations were not found for the Indian sites. When adjusting for potential confounders, for both India and Pakistan, lower Hb concentrations were associated with stillbirth, preterm birth, lower mean birthweight, and increased risk of low birthweight. In the Pakistani site, there was evidence of a U-shaped relationship between Hb concentrations and low birth weight, and neonatal mortality, and in India with hypertensive disease.Interpretation: This study documented the relationship between maternal Hb concentrations and adverse pregnancy outcomes in women from the Pakistani and Indian sites across the range of Hb values. Both low and high Hb concentrations were associated with risk of at least some adverse outcomes. Hence, both low and high values of Hb should be considered risk factors for the mother and fetus