Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

<p>Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.</p> <p>Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.</p> <p>Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.</p&gt

Assessing Sustainability Indicators for Tropical Forests: Spatio-temporal Heterogeneity, Logging Intensity, and Dung Beetle Communities

Sustainable management of tropical forests has been identified as one of the main objectives for conservation of global biodiversity and management of carbon stocks. To achieve this goal, managers need tools to assess the sustainability of current management practices. Several international initiatives have undertaken the development of sets of criteria and indicators to help managers move towards sustainability. Among the indicators considered, the structure and composition of dung beetle communities have been identified as excellent indicators of ecological sustainability. However, as occurs with most indicators of the ecological sustainability of forest management, dung beetle surveys require intensive field work making their application over large areas expensive, time consuming, and logistically challenging. A need for prioritization is evident. This work presents a novel approach to the assessment of the Center for International Forestry Research (CIFOR) ecological sustainability indicator I.2.1.2: ‘‘The change in diversity of habitats as a result of human interventions is maintained within critical limits as defined by natural variation and/or regional conservation objectives’’. Using variography of vegetation index data derived from remotely sensed imagery, we show (1) how the differences in forest structural heterogeneity observed between forest management units and natural areas can be used to identify priority areas for field survey of ecological sustainability indicators (hereafter ‘‘priority-for-survey’’) and (2) how these priorities correspond to dung beetle community structure and composition. Links between temporal change in forest structural heterogeneity, logging intensity, and dung beetle community structure and composition were established by means of correlation analysis and matrix regression modeling. We found that areas ranked as low priority-for-survey based on image analysis showed no significant difference in dung beetle species richness or diversity from natural reference areas. Further, we found significantly higher dung beetle species richness and diversity estimates in areas ranked as moderate or moderate-low priority-for-survey over the low and reference areas. Finally, the dung beetle community composition in the high priority-for-survey category was significantly less rich and less diverse than any other category. We identified a logging intensity threshold of four trees per hectare as a transition to significant differences in forest structural heterogeneity and the richness and diversity of associated dung beetle communities

Characterizing Tropical Forest Spatio-temporal Heterogeneity Using the Wide Dynamic Range Vegetation Index (WDRVI)

Sustainable management of tropical forests has been identified as one of the main objectives for conservation and management of carbon stocks. Thus, managers need tools to assess whether current management practices are sustainable. Although sets of criteria and indicators have been developed to help managers, there is a need to assess these indicators from an operational perspective. We present an approach using geospatial analysis to assess a key ecoindicator: ‘The change in diversity of habitats as a result of human interventions is maintained within critical limits as defined by natural variation and/or regional conservation objectives’. Applying variography to the Wide Dynamic Range Vegetation Index (WDRVI) data from Landsat 5 Thematic Mapper (TM) imagery and comparing the changes in spatial structure before and after selective logging, we identified which managed forest areas exhibited significant differences with respect to natural reference areas

Analysis of Waveform Lidar Data Using Shape-based Metrics

Models that use large-footprint waveform light detection and ranging (lidar) to estimate forest height, structure, and biomass have typically used either point data extracted from the waveforms or cumulative distributions of the waveform energy, disregarding potential information latent within the waveform shape. Shape-based metrics such as the centroid and the radius of gyration can capture features missed by height-based metrics that are likely related to forest structure and biomass. Noise analyses demonstrated the relative insensitivity of and , supporting the hypothesis that these metrics could be used to identify similar shapes within noisy waveforms [such as the Laser Vegetation Imaging Sensor (LVIS) and Geoscience Laser Altimeter Sensor (GLAS)] or to discriminate among waveforms with different underlying shapes. These findings suggest that and can be successfully used in future lidar studies of forest structure and that further research should be conducted to develop additional shape-based metrics, as well as to investigate the relationship between forest structure and lidar waveform shape

Mammography Utilization: Patient Characteristics and Breast Cancer Stage at Diagnosis

OBJECTIVE. Missed mammograms represent missed opportunities for earlier breast cancer diagnosis. The purposes of this study were to identify patient characteristics associated with missed mammograms and to examine the association between missed mammograms and breast cancer stage at diagnosis. MATERIALS AND METHODS. Mammography frequency and cancer stage were retrospectively examined in 1368 cases of primary breast cancer diagnosed at our clinic from 2002 to 2008. RESULTS. Regardless of age (median, 62.7 years), 1428 women who underwent mammography were more likely to have early-stage (stage 0-II) breast cancer at diagnosis than were those who did not undergo mammography (p < 0.001). Similarly, the number of mammographic examinations in the 5 years before diagnosis was inversely related to stage: 57.3% (94/164) of late-stage cancers were diagnosed in women missing their last five annual mammograms. In a multivariate analysis, family history of breast cancer was most predictive of undergoing mammography (odds ratio, 3.492; 95% CI, 2.616-4.662; p < 0.0001) followed by number of medical encounters (odds ratio, 1.022; 95% CI, 1.017-1.027; p < 0.0001). Time to travel to the nearest mammography center was also predictive of missing mammograms: Each additional minute of travel time decreased the odds of undergoing at least one mammographic examination in the 5 years before cancer diagnosis (odds ratio, 0.990; 95% CI, 0.986-0.993; p < 0.0001). CONCLUSION. Missing a mammogram, even in the year before a breast cancer diagnosis, increases the chance of a cancer diagnosis at a later stage. Interventions to encourage use of mammography may be of particular benefit to women most likely to miss mammograms, including those with no family history of breast cancer, fewer encounters with the health care system, and greater travel distance to the mammography center