Lessons Learned From Inspire Super-Performers

Objective: The purpose of this study is to examine what demographic factors correlate with greater rates of upper airway stimulation adherence and efficacy. Study Design: Case control study Introduction: Upper airway stimulation (UAS) is emerging as an effective procedure for select patients with obstructive sleep apnea. As initially studied, this procedure is reserved for those exhibiting body mass index (BMI) Methods: We queried a single surgeon’s database of UAS cases, totaling 97 at the time of study. The electronic medical record (EMR) was queried for each patient and pertinent demographics were recorded. We began by defining cohorts: super-adherers were those with greater than 6 hours of nightly device use; non-adherers less than 4. Super-responders had a post-operative AHI and ESS less than 10, and greater than 80% decrease in AHI. Non-responders had an AHI greater than 20 and less than 50% decrease. Super-performers met both super-adherer responder criteria, while non-performers similarly met both negative criteria. Results: Overall, 97 patients underwent hypoglossal nerve stimulation with an average AHI reduction of 67.1%, and 6.2 hours of nightly adherence. 11 patients were defined as super-performers, and 3 as non-performers. 20 patients were super responders vs 11 non-responders. 49 were super adherers vs 34 non-adherers. P-values for various categories will be displayed in Table 1, no difference was found between the groups as age, BMI, sex, pre-op AHI, and pre-op VOTE score were examined. Conclusions: Upper airway stimulation is an effective treatment for patients intolerant of CPAP. In this review there were no statistically significant differences found between the best and lowers performing patients in terms of baseline characteristics

The L_X--M relation of Clusters of Galaxies

We present a new measurement of the scaling relation between X-ray luminosity and total mass for 17,000 galaxy clusters in the maxBCG cluster sample. Stacking sub-samples within fixed ranges of optical richness, N_200, we measure the mean 0.1-2.4 keV X-ray luminosity, , from the ROSAT All-Sky Survey. The mean mass, , is measured from weak gravitational lensing of SDSS background galaxies (Johnston et al. 2007). For 9 <= N_200 < 200, the data are well fit by a power-law, /10^42 h^-2 erg/s = (12.6+1.4-1.3 (stat) +/- 1.6 (sys)) (/10^14 h^-1 M_sun)^1.65+/-0.13. The slope agrees to within 10% with previous estimates based on X-ray selected catalogs, implying that the covariance in L_X and N_200 at fixed halo mass is not large. The luminosity intercent is 30%, or 2\sigma, lower than determined from the X-ray flux-limited sample of Reiprich & Bohringer (2002), assuming hydrostatic equilibrium. This difference could arise from a combination of Malmquist bias and/or systematic error in hydrostatic mass estimates, both of which are expected. The intercept agrees with that derived by Stanek et al. (2006) using a model for the statistical correspondence between clusters and halos in a WMAP3 cosmology with power spectrum normalization sigma_8 = 0.85. Similar exercises applied to future data sets will allow constraints on the covariance among optical and hot gas properties of clusters at fixed mass.Comment: 5 pages, 1 figure, MNRAS accepte

Responses and relationship dynamics of men and their spouses during active surveillance for prostate cancer: health literacy as an inquiry framework

BACKGROUND: Early stage prostate cancer patients may be allocated to active surveillance, where the condition is observed over time with no intervention. Living with a cancer diagnosis may impose stress on both the men and their spouses. In this study we explore whether the scores of and verbal responses to a Health Literacy Questionnaire can be used to identify individuals in need of information and support and to reveal differences in perception and understanding in health related situations within couples. METHODS: We used the nine-domain Health Literacy Questionnaire (HLQ) as a framework to explore health literacy in eight couples where the men were on active surveillance for prostate cancer progression. Scores were calculated for each domain for both individuals. For each couple differences in scores were also calculated and related to the informants\u27 self-reported experiences and reflections in relation to participating in an active surveillance program. Also an inductive analysis was performed to identify themes in the responses and these themes were compared to those of HLQ. RESULTS: The men tended to score higher than their spouses. There was no consistent relation between scores and the reported experiences and reflections. However, some interesting patterns emerged, e.g. in two of the three couples with the largest within couple differences in HLQ scores, responses revealed discrepancies in how the men and their spouses perceived their situation. Also, three themes emerged which related to six of the HLQ domains, i.e. involvement of spouses and other people around the men; support from and interaction with healthcare professionals; and use of the Internet for information retrieval. CONCLUSIONS: Using the HLQ as an interview framework provided insight into the differences within couples and provided new perspectives on their experiences, including their contact with health professionals and the patient-spouse interaction when dealing with prostate cancer. The HLQ used as a dialogue tool may be an adjunct to assist healthcare providers to understand the need for support and information of men with prostate cancer on active surveillance and the dynamics within couples

The social value of a QALY : raising the bar or barring the raise?

Background: Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE. Discussion: The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents’ answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups. Summary: Although we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system

Evidence for a Weak Galactic Center Magnetic Field from Diffuse Low Frequency Nonthermal Radio Emission

New low-frequency 74 and 330 MHz observations of the Galactic center (GC) region reveal the presence of a large-scale (6\arcdeg\times 2\arcdeg) diffuse source of nonthermal synchrotron emission. A minimum energy analysis of this emission yields a total energy of $\sim (\phi^{4/7}f^{3/7})\times 10^{52}$ ergs and a magnetic field strength of $\sim 6(\phi/f)^{2/7}$ \muG (where $\phi$ is the proton to electron energy ratio and $f$ is the filling factor of the synchrotron emitting gas). The equipartition particle energy density is $1.2(\phi/f)^{2/7}$ \evcm, a value consistent with cosmic-ray data. However, the derived magnetic field is several orders of magnitude below the 1 mG field commonly invoked for the GC. With this field the source can be maintained with the SN rate inferred from the GC star formation. Furthermore, a strong magnetic field implies an abnormally low GC cosmic-ray energy density. We conclude that the mean magnetic field in the GC region must be weak, of order 10 \muG (at least on size scales \ga 125\arcsec).Comment: 12 pages, 1 JPEG figure, uses aastex.sty; Accepted for publication, ApJL (2005, published

Salmonella Isolated from Animals and Feed Production in Sweden Between 1993 and 1997

This paper presents Salmonella data from animals, feedstuffs and feed mills in Sweden between 1993 and 1997. During that period, 555 isolates were recorded from animals, representing 87 serotypes. Of those, 30 serotypes were found in animals in Sweden for the first time. The majority of all isolates from animals were S. Typhimurium (n = 91), followed by S. Dublin (n = 82). There were 115 isolates from cattle, 21 from broilers, 56 from layers and 18 from swine. The majority of these isolates were from outbreaks, although some were isolated at the surveillance at slaughterhouses. The number of isolates from the feed industry was similar to that of the previous 5-year period. Most of those findings were from dust and scrapings from feed mills, in accordance with the HACCP programme in the feed control programme. It can be concluded that the occurrence of Salmonella in animals and in the feed production in Sweden remained favourable during 1993–97

In vivo targeted DamID identifies CHD8 genomic targets in fetal mouse brain.

Funder: Royal SocietyFunder: Agouron InstituteGenetic studies of autism have revealed causal roles for chromatin remodeling gene mutations. Chromodomain helicase DNA binding protein 8 (CHD8) encodes a chromatin remodeler with significant de novo mutation rates in sporadic autism. However, relationships between CHD8 genomic function and autism-relevant biology remain poorly elucidated. Published studies utilizing ChIP-seq to map CHD8 protein-DNA interactions have high variability, consistent with technical challenges and limitations associated with this method. Thus, complementary approaches are needed to establish CHD8 genomic targets and regulatory functions in developing brain. We used in utero CHD8 Targeted DamID followed by sequencing (TaDa-seq) to characterize CHD8 binding in embryonic mouse cortex. CHD8 TaDa-seq reproduced interaction patterns observed from ChIP-seq and further highlighted CHD8 distal interactions associated with neuronal loci. This study establishes TaDa-seq as a useful alternative for mapping protein-DNA interactions in vivo and provides insights into the regulatory targets of CHD8 and autism-relevant pathophysiology associated with CHD8 mutations

Measuring the mean and scatter of the X-ray luminosity -- optical richness relation for maxBCG galaxy clusters

Determining the scaling relations between galaxy cluster observables requires large samples of uniformly observed clusters. We measure the mean X-ray luminosity--optical richness (L_X--N_200) relation for an approximately volume-limited sample of more than 17,000 optically-selected clusters from the maxBCG catalog spanning the redshift range 0.1<z<0.3. By stacking the X-ray emission from many clusters using ROSAT All-Sky Survey data, we are able to measure mean X-ray luminosities to ~10% (including systematic errors) for clusters in nine independent optical richness bins. In addition, we are able to crudely measure individual X-ray emission from ~800 of the richest clusters. Assuming a log-normal form for the scatter in the L_X--N_200 relation, we measure \sigma_\ln{L}=0.86+/-0.03 at fixed N_200. This scatter is large enough to significantly bias the mean stacked relation. The corrected median relation can be parameterized by L_X = (e^\alpha)(N_200/40)^\beta 10^42 h^-2 ergs/s, where \alpha = 3.57+/-0.08 and \beta = 1.82+/-0.05. We find that X-ray selected clusters are significantly brighter than optically-selected clusters at a given optical richness. This selection bias explains the apparently X-ray underluminous nature of optically-selected cluster catalogs.Comment: 21 pages, 12 figures, revised after referee's comments. ApJ accepte

Ancient coins: cluster analysis applied to find a correlation between corrosion process and burial soil characteristics

Although it is well known that any material degrades faster when exposed to an aggressive environment as well as that "aggressive" cannot be univocally defined as depending also on the chemical-physical characteristics of material, few researches on the identification of the most significant parameters influencing the corrosion of metallic object are available

The X-Ray Luminosity--Mass Relation for Local Clusters of Galaxies

We investigate the relationship between soft \xray luminosity and mass for low redshift clusters of galaxies by comparing observed number counts to expectations of $\Lambda$CDM cosmologies. We use a three-parameter model for the conditional probability of luminosity given mass and epoch, described as a log-normal distribution of fixed width centered on a power-law scaling relation, L \spropto M^p\rhoc^s(z). We use an ensemble of simulated clusters to argue that the observed, intrinsic variance in the temperature--luminosity relation is directly indicative of mass--luminosity variance, and derive \sigm \se 0.43 \pm 0.06 from HIFLUGCS data. Adding this to the likelihood analysis results in best-fit estimates p \se 1.59 \pm 0.05, \lnlf \se 1.34 \pm 0.09, and \sigm \se 0.37 \pm 0.05 for self-similar redshift evolution in a concordance (\Omega_m \se 0.3, \Omega_\Lambda \se 0.7, \sigma_8 \se0.9) universe. We show that the present-epoch intercept is very sensitive to power spectrum normalization, \lnlf \spropto \sigate^{-4}, and the slope is weakly sensitive to the matter density, p \spropto \Omega_m^{1/2}. The intercept derived here is dimmer by a factor 2, and slope slightly steeper, than the L-M relation published using hydrostatic mass estimates of the HIFLUGCS sample. We show that this discrepancy is largely due to Malmquist bias of the \xray\ flux-limited sample. In light of new WMAP constraints, we discuss the interplay between parameters and sources of systematic error, and offer a compromise model with \Omega_m \se 0.24, \sigma_8 \se 0.85, and somewhat lower scatter \sigm \se 0.25, in which hydrostatic mass estimates remain accurate to \ssim 15%. We stress the need for independent calibration of the L-M relation via weak gravitational lensing.Comment: 18 pages, 13 figures, accepted to ApJ. We have incorporated the WMAP cosmology constraints in our analysi