Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ-5D-3L in a randomized controlled trial show no benefit from lung metastasectomy.

AIM: The aim was to assess the health utility of lung metastasectomy in the treatment of patients with colorectal cancer (CRC) using the EQ-5D-3L questionnaire. METHODS: Multidisciplinary CRC teams at 14 sites recruited patients to a two-arm randomized controlled trial-Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC). Remote randomization was used, stratified by site and with minimization for seven known confounders. Participants completed the EQ-5D-3L questionnaire together with other patient reported outcome measures at randomization and then again at 3, 6, 12 and 24 months. These were returned by post to the coordinating centre. RESULTS: Between December 2010 and December 2016, 93 participants were randomized, 91 of whom returned questionnaires. Survival and patient reported quality of life have been published previously, revealing no significant differences between the trial arms. Described here are patient reported data from the five dimensions of the EQ-5D-3L and the visual analogue scale (VAS) health state. No significant difference was seen at any time point. The estimated difference between control and metastasectomy patients was -0.23 (95% CI -0.113, 0.066) for the composite 0 to 1 index scale based on the descriptive system and 0.123 (95% CI -7.24, 7.49) for the 0 to 100 VAS scale. CONCLUSIONS: Following lung metastasectomy for CRC, no benefit was demonstrated for health utility, which alongside a lack of a survival or quality of life benefit calls into question the widespread use of the procedure

Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study

<p>Background: Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.</p> <p>Methods and Findings: The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA1c of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.</p> <p>Conclusions: Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.</p&gt

Collapse of a molecular cloud core to stellar densities: the radiative impact of stellar core formation on the circumstellar disc

We present results from the first three-dimensional radiation hydrodynamical calculations to follow the collapse of a molecular cloud core beyond the formation of the stellar core. We find the energy released by the formation of the stellar core, within the optically-thick first hydrostatic core, is comparable to the binding energy of the disc-like first core. This heats the inner regions of the disc, drives a shock wave through the disc, dramatically decreases the accretion rate on to the stellar core, and launches a temporary bipolar outflow perpendicular to the rotation axis that travels in excess of 50 AU into the infalling envelope. This outburst may assist the young protostar in launching a conventional magnetic jet. Furthermore, if these events are cyclic, they may provide a mechanism for intense bursts of accretion separated by long periods of relatively quiescent accretion which can potentially solve both the protostellar luminosity problem and the apparent age spread of stars in young clusters. Such outbursts may also provide a formation mechanism for the chondrules found in meteorites, with the outflow transporting them to large distances in the circumstellar disc.Comment: Accepted by MNRAS Letters. 6 pages, 4 figures. Animations can be found at http://www.astro.ex.ac.uk/people/mbate/Animations/Stellar

The structure and function of complex networks

Inspired by empirical studies of networked systems such as the Internet, social networks, and biological networks, researchers have in recent years developed a variety of techniques and models to help us understand or predict the behavior of these systems. Here we review developments in this field, including such concepts as the small-world effect, degree distributions, clustering, network correlations, random graph models, models of network growth and preferential attachment, and dynamical processes taking place on networks.Comment: Review article, 58 pages, 16 figures, 3 tables, 429 references, published in SIAM Review (2003

A WFC3 Grism Emission Line Redshift Catalog in the GOODS-South Field

We combine HST/WFC3 imaging and G141 grism observations from the CANDELS and 3D-HST surveys to produce a catalog of grism spectroscopic redshifts for galaxies in the CANDELS/GOODS-South field. The WFC3/G141 grism spectra cover a wavelength range of 1.1<lambda<1.7 microns with a resolving power of R~130 for point sources, thus providing rest-frame optical spectra for galaxies out to z~3.5. The catalog is selected in the H-band (F160W) and includes both galaxies with and without previously published spectroscopic redshifts. Grism spectra are extracted for all H-band detected galaxies with H<24 and a CANDELS photometric redshift z_phot > 0.6. The resulting spectra are visually inspected to identify emission lines and redshifts are determined using cross-correlation with empirical spectral templates. To establish the accuracy of our redshifts, we compare our results against high-quality spectroscopic redshifts from the literature. Using a sample of 411 control galaxies, this analysis yields a precision of sigma_NMAD=0.0028 for the grism-derived redshifts, which is consistent with the accuracy reported by the 3D-HST team. Our final catalog covers an area of 153 square arcmin and contains 1019 redshifts for galaxies in GOODS-S. Roughly 60% (608/1019) of these redshifts are for galaxies with no previously published spectroscopic redshift. These new redshifts span a range of 0.677 < z < 3.456 and have a median redshift of z=1.282. The catalog contains a total of 234 new redshifts for galaxies at z>1.5. In addition, we present 20 galaxy pair candidates identified for the first time using the grism redshifts in our catalog, including four new galaxy pairs at z~2, nearly doubling the number of such pairs previously identified.Comment: 25 Pages, 9 Figures, submitted to A

Exploring patient experiences and perspectives of a heart failure telerehabilitation program: a mixed methods approach

To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing.Limited information currently exists on patient experiences of telerehabilitation for HF. Patient feedback and end-user perspectives provide important information regarding the acceptability of this new delivery model which may have a substantial impact on future uptake.We used mixed-methods design with purposive sampling of patients with HF. We used self-report surveys and semi-structured interviews to measure patient experiences and perspectives following a 12-week telerehabilitation program. The telerehabilitation program encompassed group-based exercise and education, and were delivered in real-time via videoconferencing. Interviews were transcribed and coded, with thematic analysis undertaken.Seventeen participants with HF (mean age [SD] of 69 [12] years and 88% males) were recruited. Participants reported high visual clarity and ease of use for the monitoring equipment. Major themes included motivating and inhibiting influences related to telerehabilitation and improvement suggestions. Participants liked the health benefits, access to care and social support. Participants highlighted a need for improved audio clarity and connectivity as well computer training for those with limited computer experience. The majority of participants preferred a combined face-to-face and online delivery model.Participants in this study reported high visual clarity and ease-of-use, but provided suggestions for further improvements in group-based video telerehabilitation for HF

Timed up and go test: a reliable and valid test in patients with chronic heart failure

Background The timed up and go test (TUGT) is a short-duration functional test frequently used in rehabilitation settings as a measure of balance and mobility. Reliability and validity for patients with chronic heart failure (CHF) has yet to be determined. This prospective cohort study aimed to determine test-retest reliability of the TUGT in patients with CHF, relationships between the TUGT and other variables, including functional tests, and predictors of the TUGT. Methods and Results This was a secondary analysis of data collected in a multicenter randomized controlled trial of exercise training in recently hospitalized patients with heart failure (EJECTION-HF). The TUGT was conducted twice at baseline to determine reliability. Assessments were compared with 6-minute walk distance (6MWD), 10-m walk test time, and other clinical variables. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability and correlations for relationships with other variables. A multiple regression was used to identify predictors of the TUGT. In 278 participants (mean age 62 years), the TUGT demonstrated excellent within-day test-retest reliability (ICC 0.93). A shorter (better) TUGT time was associated with longer 6MWD (r = −0.81; P < .001) and shorter 10-m walk test time (r = 0.80; P < .001). Best predictors of the TUGT were 6MWD and age, which accounted for 66% of the variance. Conclusions The TUGT appears to be a reliable and valid functional measurement in patients with CHF

TElmisartan in the management of abDominal aortic aneurYsm (TEDY): The study protocol for a randomized controlled trial

Background: Experimental studies suggest that angiotensin II plays a central role in the pathogenesis of abdominal aortic aneurysm. This trial aims to evaluate the efficacy of the angiotensin receptor blocker telmisartan in limiting the progression of abdominal aortic aneurysm. Methods/Design: Telmisartan in the management of abdominal aortic aneurysm (TEDY) is a multicentre, parallel-design, randomised, double-blind, placebo-controlled trial with an intention-to-treat analysis. We aim to randomly assign 300 participants with small abdominal aortic aneurysm to either 40 mg of telmisartan or identical placebo and follow patients over 2 years. The primary endpoint will be abdominal aortic aneurysm growth as measured by 1) maximum infra-renal aortic volume on computed tomographic angiography, 2) maximum orthogonal diameter on computed tomographic angiography, and 3) maximum diameter on ultrasound. Secondary endpoints include change in resting brachial blood pressure, abdominal aortic aneurysm biomarker profile and health-related quality of life. TEDY is an international collaboration conducted from major vascular centres in Australia, the United States and the Netherlands. Discussion: Currently, no medication has been convincingly demonstrated to limit abdominal aortic aneurysm progression. TEDY will examine the potential of a promising treatment strategy for patients with small abdominal aortic aneurysms. Trial registration: Australian and Leiden study centres: Australian New Zealand Clinical Trials Registry ACTRN12611000931976, registered on 30 August 2011; Stanford study centre: clinicaltrials.gov NCT01683084, registered on 5 September 2012