Coding of Barrett's oesophagus with high-grade dysplasia in national administrative databases: a population-based cohort study.

OBJECTIVES: The International Classification of Diseases 10th Revision (ICD-10) system used in the English hospital administrative database (Hospital Episode Statistics (HES)) does not contain a specific code for oesophageal high-grade dysplasia (HGD). The aim of this paper was to examine how patients with HGD were coded in HES and whether it was done consistently. SETTING: National population-based cohort study of patients with newly diagnosed with HGD in England. The study used data collected prospectively as part of the National Oesophago-Gastric Cancer Audit (NOGCA). These records were linked to HES to investigate the pattern of ICD-10 codes recorded for these patients at the time of diagnosis. PARTICIPANTS: All patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014 in England, who had data submitted to the NOGCA. OUTCOMES MEASURED: The main outcome assessed was the pattern of primary and secondary ICD-10 diagnostic codes recorded in the HES records at endoscopy at the time of diagnosis of HGD. RESULTS: Among 452 patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014, Barrett's oesophagus was the only condition coded in 200 (44.2%) HES records. Records for 59 patients (13.1%) contained no oesophageal conditions. The remaining 193 patients had various diagnostic codes recorded, 93 included a diagnosis of Barrett's oesophagus and 57 included a diagnosis of oesophageal/gastric cardia cancer. CONCLUSIONS: HES is not suitable to support national studies looking at the management of HGD. This is one reason for the UK to adopt an extended ICD system (akin to ICD-10-CM)

Asteroid (16) Psyche’s primordial shape: A possible Jacobi ellipsoid

Context. Asteroid (16) Psyche is the largest M-type asteroid in the main belt and the target of the NASA Psyche mission. It is also the only asteroid of this size (D >  200 km) known to be metal rich. Although various hypotheses have been proposed to explain the rather unique physical properties of this asteroid, a perfect understanding of its formation and bulk composition is still missing. Aims. We aim to refine the shape and bulk density of (16) Psyche and to perform a thorough analysis of its shape to better constrain possible formation scenarios and the structure of its interior. Methods. We obtained disk-resolved VLT/SPHERE/ZIMPOL images acquired within our ESO large program (ID 199.C-0074), which complement similar data obtained in 2018. Both data sets offer a complete coverage of Psyche’s surface. These images were used to reconstruct the three-dimensional (3D) shape of Psyche with two independent shape modeling algorithms (MPCD and ADAM). A shape analysis was subsequently performed, including a comparison with equilibrium figures and the identification of mass deficit regions. Results. Our 3D shape along with existing mass estimates imply a density of 4.20  ±  0.60 g cm−3, which is so far the highest for a solar system object following the four telluric planets. Furthermore, the shape of Psyche presents small deviations from an ellipsoid, that is, prominently three large depressions along its equator. The flatness and density of Psyche are compatible with a formation at hydrostatic equilibrium as a Jacobi ellipsoid with a shorter rotation period of ∼3h. Later impacts may have slowed down Psyche’s rotation, which is currently ∼4.2 h, while also creating the imaged depressions. Conclusions. Our results open the possibility that Psyche acquired its primordial shape either after a giant impact while its interior was already frozen or while its interior was still molten owing to the decay of the short-lived radionuclide 26Al.Based on observations collected at the European Organisation for Astronomical Research in the Southern Hemisphere under ESO programme 199.C-0074 (principal investigator: P. Vernazza). P. Vernazza, A. Drouard, M. Ferrais and B. Carry were supported by CNRS/INSU/PNP. J.H. and J.D. were supported by grant 18-09470S of the Czech Science Foundation and by the Charles University Research Programme no. UNCE/SCI/023. E.J. is F.R.S.-FNRS Senior Research Associate. The work of TSR was carried out through grant APOSTD/2019/046 by Generalitat Valenciana (Spain). This work was supported by the MINECO (Spanish Ministry of Economy) through grant RTI2018-095076-B-C21 (MINECO/FEDER, UE)

Binary asteroid (31) Euphrosyne: ice-rich and nearly spherical

Aims. Asteroid (31) Euphrosyne is one of the biggest objects in the asteroid main belt and it is also the largest member of its namesake family. The Euphrosyne family occupies a highly inclined region in the outer main belt and contains a remarkably large number of members, which is interpreted as an outcome of a disruptive cratering event. Methods. The goals of this adaptive-optics imaging study are threefold: to characterize the shape of Euphrosyne, to constrain its density, and to search for the large craters that may be associated with the family formation event. Results. We obtained disk-resolved images of Euphrosyne using SPHERE/ZIMPOL at the ESO 8.2 m VLT as part of our large program (ID: 199.C-0074, PI: Vernazza). We reconstructed its 3D shape via the ADAM shape modeling algorithm based on the SPHERE images and the available light curves of this asteroid. We analyzed the dynamics of the satellite with the Genoid meta-heuristic algorithm. Finally, we studied the shape of Euphrosyne using hydrostatic equilibrium models. Conclusions. Our SPHERE observations show that Euphrosyne has a nearly spherical shape with the sphericity index of 0.9888 and its surface lacks large impact craters. Euphrosyne’s diameter is 268 ± 6 km, making it one of the top ten largest main belt asteroids. We detected a satellite of Euphrosyne – S/2019 (31) 1 – that is about 4 km across, on a circular orbit. The mass determined from the orbit of the satellite together with the volume computed from the shape model imply a density of 1665 ± 242 kg m−3, suggesting that Euphrosyne probably contains a large fraction of water ice in its interior. We find that the spherical shape of Euphrosyne is a result of the reaccumulation process following the impact, as in the case of (10) Hygiea. However, our shape analysis reveals that, contrary to Hygiea, the axis ratios of Euphrosyne significantly differ from those suggested by fluid hydrostatic equilibrium following reaccumulation.This work has been supported by the Czech Science Foundation through grant 18-09470S (J. Hanuš, O. Chrenko, P. Ševeček) and by the Charles University Research program No. UNCE/SCI/023. M.B. was supported by the Czech Science Foundation grant 18-04514J. Computational resources were supplied by the Ministry of Education, Youth and Sports of the Czech Republic under the projects CESNET (LM2015042) and IT4Innovations National Supercomputing Centre (LM2015070). P. Vernazza, A. Drouard, M. Ferrais and B. Carry were supported by CNRS/INSU/PNP. M.M. was supported by the National Aeronautics and Space Administration under grant No. 80NSSC18K0849 issued through the Planetary Astronomy Program. The work of TSR was carried out through grant APOSTD/2019/046 by Generalitat Valenciana (Spain). This work was supported by the MINECO (Spanish Ministry of Economy) through grant RTI2018-095076-B-C21 (MINECO/FEDER, UE). The research leading to these results has received funding from the ARC grant for Concerted Research Actions, financed by the Wallonia-Brussels Federation. TRAPPIST is a project funded by the Belgian Fonds (National) de la Recherche Scientifique (F.R.S.-FNRS) under grant FRFC 2.5.594.09.F. TRAPPIST-North is a project funded by the Université de Liège, and performed in collaboration with Cadi Ayyad University of Marrakesh. E. Jehin is a FNRS Senior Research Associate

A basin-free spherical shape as an outcome of a giant impact on asteroid Hygiea

(10) Hygiea is the fourth largest main belt asteroid and the only known asteroid whose surface composition appears similar to that of the dwarf planet (1) Ceres1,2, suggesting a similar origin for these two objects. Hygiea suffered a giant impact more than 2 Gyr ago3 that is at the origin of one of the largest asteroid families. However, Hygeia has never been observed with sufficiently high resolution to resolve the details of its surface or to constrain its size and shape. Here, we report high-angular-resolution imaging observations of Hygiea with the VLT/SPHERE instrument (~20 mas at 600 nm) that reveal a basin-free nearly spherical shape with a volume-equivalent radius of 217 ± 7 km, implying a density of 1,944 ± 250 kg m−3 to 1σ. In addition, we have determined a new rotation period for Hygiea of ~13.8 h, which is half the currently accepted value. Numerical simulations of the family-forming event show that Hygiea’s spherical shape and family can be explained by a collision with a large projectile (diameter ~75–150 km). By comparing Hygiea’s sphericity with that of other Solar System objects, it appears that Hygiea is nearly as spherical as Ceres, opening up the possibility for this object to be reclassified as a dwarf planet.P.V., A.D. and B.C. were supported by CNRS/INSU/PNP. M.Brož was supported by grant 18-04514J of the Czech Science Foundation. J.H. and J.D. were supported by grant 18-09470S of the Czech Science Foundation and by the Charles University Research Programme no. UNCE/SCI/023. This project has received funding from the European Union’s Horizon 2020 research and innovation programmes under grant agreement nos 730890 and 687378. This material reflects only the authors’ views, and the European Commission is not liable for any use that may be made of the information contained herein. TRAPPIST-North is a project funded by the University of Liège, in collaboration with Cadi Ayyad University of Marrakech (Morocco). TRAPPIST-South is a project funded by the Belgian Fonds (National) de la Recherche Scientifique (F.R.S.-FNRS) under grant FRFC 2.5.594.09.F. E.J. and M.G. are F.R.S.-FNRS Senior Research Associates

Impact of case‐mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: a cohort study

Aim: This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics. Methods: The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment. Results: Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer-free at 12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non-specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer-free at follow-up. Conclusions/Interpretations: Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment

Rationale and design of the Diet Restriction and Exercise-induced Adaptations in Metastatic breast cancer (DREAM) study: a 2-arm, parallel-group, phase II, randomized control trial of a short-term, calorie-restricted, and ketogenic diet plus exercise during intravenous chemotherapy versus usual care

Abstract Background An underlying cause of solid tumor resistance to chemotherapy treatment is diminished tumor blood supply, which leads to a hypoxic microenvironment, dependence on anaerobic energy metabolism, and impaired delivery of intravenous treatments. Preclinical data suggest that dietary strategies of caloric restriction and low-carbohydrate intake can inhibit glycolysis, while acute exercise can transiently enhance blood flow to the tumor and reduce hypoxia. The Diet Restriction and Exercise-induced Adaptations in Metastatic Breast Cancer (DREAM) study will compare the effects of a short-term, 50% calorie-restricted and ketogenic diet combined with aerobic exercise performed during intravenous chemotherapy treatment to usual care on changes in tumor burden, treatment side effects, and quality of life. Methods Fifty patients with measurable metastases and primary breast cancer starting a new line of intravenous chemotherapy will be randomly assigned to usual care or the combined diet and exercise intervention. Participants assigned to the intervention group will be provided with food consisting of 50% of measured calorie needs with 80% of calories from fat and ≤ 10% from carbohydrates for 48–72 h prior to each chemotherapy treatment and will perform 30–60 min of moderate-intensity cycle ergometer exercise during each chemotherapy infusion, for up to six treatment cycles. The diet and exercise durations will be adapted for each chemotherapy protocol. Tumor burden will be assessed by change in target lesion size using axial computed tomography (primary outcome) and magnetic resonance imaging (MRI)-derived apparent diffusion coefficient (secondary outcome) after up to six treatments. Tertiary outcomes will include quantitative MRI markers of treatment toxicity to the heart, thigh skeletal muscle, and liver, and patient-reported symptoms and quality of life. Exploratory outcome measures include progression-free and overall survival. Discussion The DREAM study will test a novel, short-term diet and exercise intervention that is targeted to mechanisms of tumor resistance to chemotherapy. A reduction in lesion size is likely to translate to improved cancer outcomes including disease progression and overall survival. Furthermore, a lifestyle intervention may empower patients with metastatic breast cancer by actively engaging them to play a key role in their treatment. Trial registration ClinicalTrials.gov, NCT03795493 , registered 7 January, 2019

Support for real-time decision making in mobile financial applications

Mobile users making real-time decisions based on current information need confidence about their context been taken into consideration in producing recommendations. This chapter reviews current use of mobile technologies for decision support. Specifically, it describes a framework for assessing the impact of mobility in decision-making. The framework uses dynamic context representation of data quality to represent uncertainties in the mobile computing environment. This framework can be used for developing visual interactive displays for communicating to the user relevant changes in data quality when working in mobile environment. As an illustration, this chapter proposes a real-time decision support procedure that aims at providing on-the-spot assistance to the mobile consumer when choosing the best payment option to efficiently manage the user’s budget. The proposed procedure is based on multi-attribute decision analysis, scenario reasoning and a quality of data framework. Feasibility of the approach is demonstrated with a mobile decision support system prototype implementation

(16) Psyche: A mesosiderite-like asteroid?

International audienceContext. Asteroid (16) Psyche is the target of the NASA Psyche mission. It is considered one of the few main-belt bodies that could be an exposed proto-planetary metallic core and that would thus be related to iron meteorites. Such an association is however challenged by both its near- and mid-infrared spectral properties and the reported estimates of its density. Aims: Here, we aim to refine the density of (16) Psyche to set further constraints on its bulk composition and determine its potential meteoritic analog. Methods: We observed (16) Psyche with ESO VLT/SPHERE/ZIMPOL as part of our large program (ID 199.C-0074). We used the high angular resolution of these observations to refine Psyche's three-dimensional (3D) shape model and subsequently its density when combined with the most recent mass estimates. In addition, we searched for potential companions around the asteroid. Results: We derived a bulk density of 3.99 ± 0.26 g cm-3 for Psyche. While such density is incompatible at the 3-sigma level with any iron meteorites (˜7.8 g cm-3), it appears fully consistent with that of stony-iron meteorites such as mesosiderites (density ˜4.25 g cm-3). In addition, we found no satellite in our images and set an upper limit on the diameter of any non-detected satellite of 1460 ± 200 m at 150 km from Psyche (0.2% × RHill, the Hill radius) and 800 ± 200 m at 2000 km (3% × RHill). Conclusions: Considering that the visible and near-infrared spectral properties of mesosiderites are similar to those of Psyche, there is merit to a long-published initial hypothesis that Psyche could be a plausible candidate parent body for mesosiderites. Based on observations made with 1) ESO Telescopes at the La Silla Paranal Observatory under programs 086.C-0785 (PI Carry) and 199.C-0074 (PI Vernazza); and 2) the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation.Tables A1 and A2 and reduced images are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/619/L