Factors associated with treatment of women with osteoporosis or osteopenia from a national survey

<p>Abstract</p> <p>Background</p> <p>Health outcomes could be improved if women at high risk for osteoporotic fracture were matched to effective treatment. This study determined the extent to which treatment for osteoporosis/osteopenia corresponded to the presence of specific risk factors for osteoporotic fracture.</p> <p>Methods</p> <p>This retrospective analysis of the United States 2007 National Health and Wellness Survey included women age ≥ 40 years who reported having a diagnosis of osteoporosis (69% of 3276) or osteopenia (31% of 3276). Patients were stratified by whether they were or were not taking prescription treatment for osteoporosis/osteopenia. Using 34 patient characteristics as covariates, logistic regression was used to determine factors associated with treatment.</p> <p>Results</p> <p>Current prescription treatment was reported by 1800 of 3276 (54.9%) women with osteoporosis/osteopenia. The following factors were associated with receiving prescription treatment: patient-reported diagnosis of osteoporosis (versus osteopenia); previous bone mineral density test; ≥ 2 fractures since age 50; older age; lower body mass index; better physical functioning; postmenopausal status; family history of osteoporosis; fewer comorbidities; prescription insurance coverage; higher total prescription count; higher ratio of prescription costs to monthly income; higher income; single status; previous visit to a rheumatologist or gynecologist; and 1 or 2 outpatient visits to healthcare provider (vs. none) in the prior 6 months. Glucocorticoid, tobacco, and daily alcohol use were risk factors for fracture that were not associated with treatment.</p> <p>Conclusions</p> <p>There is a mismatch between those women who could benefit from treatment for osteoporosis and those who are actually treated. For example, self-reported use of glucocorticoids, tobacco, and alcohol were not associated with prescription treatment of osteoporosis. Other clinical and socioeconomic factors were associated with treatment (e.g. prescription drug coverage and higher income) or not (e.g. comorbid osteoarthritis and anxiety) and could be opportunities to improve care.</p

Factors Associated with Persistence with Teriparatide Therapy: Results from the DANCE Observational Study

Purpose. Determine patient-reported reasons for discontinuation with teriparatide. Methods. Patients taking teriparatide in a multicenter, prospective, and observational study were given three questionnaires: baseline, follow-up questionnaire 1 (QF1, 2 to 6 months), and follow-up questionnaire 2 (QF2, 12 months). Discontinuation reported at QF1 and QF2 was defined as “early” and “late,” respectively, and remaining patients were considered persistent. Cochran-Armitage trend test was used to identify factors associated with discontinuation. Results. Side effects, concern about improper use, injection difficulties, and several patient-perceived physician issues were associated with early discontinuation. Low patient-perceived importance of continuing treatment, side effects, difficulty paying, and low patient-perceived physician knowledge were associated with late discontinuation. The most common specific reasons selected for discontinuing treatment were “concerns about treatment outweighing the benefits” (n = 53) and “difficulty paying” (n = 47). Conclusions. Persistence with teriparatide is dependent on managing side effects, addressing financial challenges, proper training, and obtaining support from the healthcare provider

Rehospitalization following percutaneous coronary intervention for commercially insured patients with acute coronary syndrome: a retrospective analysis

BACKGROUND: While prior research has provided important information about readmission rates following percutaneous coronary intervention, reports regarding charges and length of stay for readmission beyond 30 days post-discharge for patients in a large cohort are limited. The objective of this study was to characterize the rehospitalization of patients with acute coronary syndrome receiving percutaneous coronary intervention in a U.S. health benefit plan. METHODS: This study retrospectively analyzed administrative claims data from a large US managed care plan at index hospitalization, 30-days, and 31-days to 15-months rehospitalization. A valid Diagnosis Related Group code (version 24) associated with a PCI claim (codes 00.66, 36.0X, 929.73, 929.75, 929.78–929.82, 929.84, 929.95/6, and G0290/1) was required to be included in the study. Patients were also required to have an ACS diagnosis on the day of admission or within 30 days prior to the index PCI. ACS diagnoses were classified by the International Statistical Classification of Disease 9 (ICD-9-CM) codes 410.xx or 411.11. Patients with a history of transient ischemic attack or stroke were excluded from the study because of the focus only on ACS-PCI patients. A clopidogrel prescription claim was required within 60 days after hospitalization. RESULTS: Of the 6,687 ACS-PCI patients included in the study, 5,174 (77.4%) were male, 5,587 (83.6%) were <65 years old, 4,821 (72.1%) had hypertension, 5,176 (77.4%) had hyperlipidemia, and 1,777 (26.6%) had diabetes. At index hospitalization drug-eluting stents were the most frequently used: 5,534 (82.8%). Of the 4,384 patients who completed the 15-month follow-up, a total of 1,367 (31.2%) patients were rehospitalized for cardiovascular (CV)-related events, of which 811 (59.3%) were revascularization procedures: 13 (1.0%) for coronary artery bypass graft and 798 (58.4%) for PCI. In general, rehospitalizations associated with revascularization procedures cost more than other CV-related rehospitalizations. Patients rehospitalized for revascularization procedures had the shortest median time from post-index PCI to rehospitalization when compared to the patients who were rehospitalized for other CV-related events. CONCLUSIONS: For ACS patients who underwent PCI, revascularization procedures represented a large portion of rehospitalizations. Revascularization procedures appear to be the most frequent, most costly, and earliest cause for rehospitalization after ACS-PCI

The pale orange dot : the spectrum and habitability of hazy Archean Earth

Recognizing whether a planet can support life is a primary goal of future exoplanet spectral characterization missions, but past research on habitability assessment has largely ignored the vastly different conditions that have existed in our planet's long habitable history. This study presents simulations of a habitable yet dramatically different phase of Earth's history, when the atmosphere contained a Titan-like, organic-rich haze. Prior work has claimed a haze-rich Archean Earth (3.8–2.5 billion years ago) would be frozen due to the haze's cooling effects. However, no previous studies have self-consistently taken into account climate, photochemistry, and fractal hazes. Here, we demonstrate using coupled climate-photochemical-microphysical simulations that hazes can cool the planet's surface by about 20 K, but habitable conditions with liquid surface water could be maintained with a relatively thick haze layer (τ ∼ 5 at 200 nm) even with the fainter young Sun. We find that optically thicker hazes are self-limiting due to their self-shielding properties, preventing catastrophic cooling of the planet. Hazes may even enhance planetary habitability through UV shielding, reducing surface UV flux by about 97% compared to a haze-free planet and potentially allowing survival of land-based organisms 2.7–2.6 billion years ago. The broad UV absorption signature produced by this haze may be visible across interstellar distances, allowing characterization of similar hazy exoplanets. The haze in Archean Earth's atmosphere was strongly dependent on biologically produced methane, and we propose that hydrocarbon haze may be a novel type of spectral biosignature on planets with substantial levels of CO2. Hazy Archean Earth is the most alien world for which we have geochemical constraints on environmental conditions, providing a useful analogue for similar habitable, anoxic exoplanets.Publisher PDFPeer reviewe

Theoretical Evaluations of the Fission Cross Section of the 77 eV Isomer of 235-U

We have developed models of the fission barrier (barrier heights and transition state spectra) that reproduce reasonably well the measured fission cross section of $^{235}$U from neutron energy of 1 keV to 2 MeV. From these models we have calculated the fission cross section of the 77 eV isomer of $^{235}$U over the same energy range. We find that the ratio of the isomer cross section to that of the ground state lies between about 0.45 and 0.55 at low neutron energies. The cross sections become approximately equal above 1 MeV. The ratio of the neutron capture cross section to the fission cross section for the isomer is predicted to be about a factor of 3 larger for the isomer than for the ground state of $^{235}$U at keV neutron energies. We have also calculated the cross section for the population of the isomer by inelastic neutron scattering form the $^{235}$U ground state. We find that the isomer is strongly populated, and for $E_n = 1 MeV$ the $(n,n'\gamma)$ cross section leading to the population of the isomer is of the order of 0.5 barn. Thus, neutron reaction network calculations involving the uranium isotopes in a high neutron fluence are likely to be affected by the 77 eV isomer of $^{235}$U. With these same models the fission cross sections of $^{233}$U and $^{237}$U can be reproduced approximately using only minor adjustments to the barrier heights. With the significant lowering of the outer barrier that is expected for the outer barrier the general behavior of the fission cross section of $^{239}$Pu can also be reproduced.Comment: 17 pages including 8 figure

The Effect of Orbital Configuration on the Possible Climates and Habitability of Kepler-62f

Abstract As lower-mass stars often host multiple rocky planets, gravitational interactions among planets can have significant effects on climate and habitability over long timescales. Here we explore a specific case, Kepler-62f (Borucki et al., 2013), a potentially habitable planet in a five-planet system with a K2V host star. N-body integrations reveal the stable range of initial eccentricities for Kepler-62f is 0.00 ≤ e ≤ 0.32, absent the effect of additional, undetected planets. We simulate the tidal evolution of Kepler-62f in this range and find that, for certain assumptions, the planet can be locked in a synchronous rotation state. Simulations using the 3-D Laboratoire de Météorologie Dynamique (LMD) Generic global climate model (GCM) indicate that the surface habitability of this planet is sensitive to orbital configuration. With 3 bar of CO2 in its atmosphere, we find that Kepler-62f would only be warm enough for surface liquid water at the upper limit of this eccentricity range, providing it has a high planetary obliquity (between 60° and 90°). A climate similar to that of modern-day Earth is possible for the entire range of stable eccentricities if atmospheric CO2 is increased to 5 bar levels. In a low-CO2 case (Earth-like levels), simulations with version 4 of the Community Climate System Model (CCSM4) GCM and LMD Generic GCM indicate that increases in planetary obliquity and orbital eccentricity coupled with an orbital configuration that places the summer solstice at or near pericenter permit regions of the planet with above-freezing surface temperatures. This may melt ice sheets formed during colder seasons. If Kepler-62f is synchronously rotating and has an ocean, CO2 levels above 3 bar would be required to distribute enough heat to the nightside of the planet to avoid atmospheric freeze-out and permit a large enough region of open water at the planet's substellar point to remain stable. Overall, we find multiple plausible combinations of orbital and atmospheric properties that permit surface liquid water on Kepler-62f. Key Words: Extrasolar planets—Habitability—Planetary environments. Astrobiology 16, 443–464

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properly cited. Purpose. Determine patient-reported reasons for discontinuation with teriparatide. Methods. Patients taking teriparatide in a multicenter, prospective, and observational study were given three questionnaires: baseline, follow-up questionnaire 1 (QF1, 2 to 6 months), and follow-up questionnaire 2 (QF2, 12 months). Discontinuation reported at QF1 and QF2 was defined as &quot;early&quot; and &quot;late,&quot; respectively, and remaining patients were considered persistent. Cochran-Armitage trend test was used to identify factors associated with discontinuation. Results. Side effects, concern about improper use, injection difficulties, and several patient-perceived physician issues were associated with early discontinuation. Low patient-perceived importance of continuing treatment, side effects, difficulty paying, and low patient-perceived physician knowledge were associated with late discontinuation. The most common specific reasons selected for discontinuing treatment were &quot;concerns about treatment outweighing the benefits&quot; (n = 53) and &quot;difficulty paying&quot; (n = 47). Conclusions. Persistence with teriparatide is dependent on managing side effects, addressing financial challenges, proper training, and obtaining support from the healthcare provider

Bayesian model and selection signature analyses reveal risk factors for canine atopic dermatitis

Canine atopic dermatitis is an inflammatory skin disease with clinical similarities to human atopic dermatitis. Several dog breeds are at increased risk for developing this disease but previous genetic associations are poorly defined. To identify additional genetic risk factors for canine atopic dermatitis, we here apply a Bayesian mixture model adapted for mapping complex traits and a cross-population extended haplotype test to search for disease-associated loci and selective sweeps in four dog breeds at risk for atopic dermatitis. We define 15 associated loci and eight candidate regions under selection by comparing cases with controls. One associated locus is syntenic to the major genetic risk locus (Filaggrin locus) in human atopic dermatitis. One selection signal in common type Labrador retriever cases positions across the TBC1D1 gene (body weight) and one signal of selection in working type German shepherd controls overlaps the LRP1B gene (brain), near the KYNU gene (psoriasis). In conclusion, we identify candidate genes, including genes belonging to the same biological pathways across multiple loci, with potential relevance to the pathogenesis of canine atopic dermatitis. The results show genetic similarities between dog and human atopic dermatitis, and future across-species genetic comparisons are hereby further motivated

No thick carbon dioxide atmosphere on the rocky exoplanet TRAPPIST-1 c

Seven rocky planets orbit the nearby dwarf star TRAPPIST-1, providing a unique opportunity to search for atmospheres on small planets outside the Solar System (Gillon et al., 2017). Thanks to the recent launch of JWST, possible atmospheric constituents such as carbon dioxide (CO2) are now detectable (Morley et al., 2017, Lincowski et al., 2018}. Recent JWST observations of the innermost planet TRAPPIST-1 b showed that it is most probably a bare rock without any CO2 in its atmosphere (Greene et al., 2023). Here we report the detection of thermal emission from the dayside of TRAPPIST-1 c with the Mid-Infrared Instrument (MIRI) on JWST at 15 micron. We measure a planet-to-star flux ratio of fp/fs = 421 +/- 94 parts per million (ppm) which corresponds to an inferred dayside brightness temperature of 380 +/- 31 K. This high dayside temperature disfavours a thick, CO2-rich atmosphere on the planet. The data rule out cloud-free O2/CO2 mixtures with surface pressures ranging from 10 bar (with 10 ppm CO2) to 0.1 bar (pure CO2). A Venus-analogue atmosphere with sulfuric acid clouds is also disfavoured at 2.6 sigma confidence. Thinner atmospheres or bare-rock surfaces are consistent with our measured planet-to-star flux ratio. The absence of a thick, CO2-rich atmosphere on TRAPPIST-1 c suggests a relatively volatile-poor formation history, with less than 9.5 +7.5 -2.3 Earth oceans of water. If all planets in the system formed in the same way, this would indicate a limited reservoir of volatiles for the potentially habitable planets in the system.Comment: Published in Nature on June 19th. 2023, 10 figures, 4 table