Defining 'actionable' high- costhealth care use : results using the Canadian Institute for Health Information population grouping methodology

BACKGROUND: A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations. METHODS: The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clinically relevant health profile sub-groups. High-cost users (> = 90th percentile of health care spending) were defined within each sub-group. Univariate analyses explored demographic, socio-economic status, health status and health care utilization variables associated with high-cost use. Multivariable logistic regression models were constructed for the costliest health profile groups. RESULTS: From 2015 to 2017, 1,175,147 individuals were identified for study. High-cost users consumed 41% of total health care resources. Average annual health care spending for individuals not high-cost were $642; high-cost users were$16,316. The costliest health profile groups were 'long-term care', 'palliative', 'major acute', 'major chronic', 'major cancer', 'major newborn', 'major mental health' and 'moderate chronic'. Both 'major acute' and 'major cancer' health profile groups were largely explained by measures of health care utilization and multi-morbidity. In the remaining costliest health profile groups modelled, 'major chronic', 'moderate chronic', 'major newborn' and 'other mental health', a measure of socio-economic status, low neighbourhood income, was statistically significantly associated with high-cost use. INTERPRETATION: Model results point to specific, actionable information within clinically meaningful subgroups to reduce high-cost health care use. Health equity, specifically low socio-economic status, was statistically significantly associated with high-cost use in the majority of health profile sub-groups. Population segmentation methods, and more specifically, the CIHI Population Grouping Methodology, provide specificity to high-cost health care use; informing interventions aimed at reducing health care costs and improving population health

Human occupation of northern India spans the Toba super-eruption ~74,000 years ago

Abstract: India is located at a critical geographic crossroads for understanding the dispersal of Homo sapiens out of Africa and into Asia and Oceania. Here we report evidence for long-term human occupation, spanning the last ~80 thousand years, at the site of Dhaba in the Middle Son River Valley of Central India. An unchanging stone tool industry is found at Dhaba spanning the Toba eruption of ~74 ka (i.e., the Youngest Toba Tuff, YTT) bracketed between ages of 79.6 ± 3.2 and 65.2 ± 3.1 ka, with the introduction of microlithic technology ~48 ka. The lithic industry from Dhaba strongly resembles stone tool assemblages from the African Middle Stone Age (MSA) and Arabia, and the earliest artefacts from Australia, suggesting that it is likely the product of Homo sapiens as they dispersed eastward out of Africa

Human occupation of northern India spans the Toba super-eruption ~74,000 years ago

Abstract: India is located at a critical geographic crossroads for understanding the dispersal of Homo sapiens out of Africa and into Asia and Oceania. Here we report evidence for long-term human occupation, spanning the last ~80 thousand years, at the site of Dhaba in the Middle Son River Valley of Central India. An unchanging stone tool industry is found at Dhaba spanning the Toba eruption of ~74 ka (i.e., the Youngest Toba Tuff, YTT) bracketed between ages of 79.6 ± 3.2 and 65.2 ± 3.1 ka, with the introduction of microlithic technology ~48 ka. The lithic industry from Dhaba strongly resembles stone tool assemblages from the African Middle Stone Age (MSA) and Arabia, and the earliest artefacts from Australia, suggesting that it is likely the product of Homo sapiens as they dispersed eastward out of Africa

Acute high-intensity interval exercise reduces human monocyte Toll-like receptor 2 expression in type 2 diabetes

Acute highintensity interval exercise reduces human monocyte Toll-like receptor 2 expression in type 2 diabetes. Am J Physiol Regul Integr Comp Physiol 312: R529 -R538, 2017. First published January 25, 2017; doi:10.1152/ajpregu.00348.2016.-Type 2 diabetes (T2D) is characterized by chronic low-grade inflammation that contributes to disease pathophysiology. Exercise has anti-inflammatory effects, but the impact of high-intensity interval training (HIIT) is not known. The purpose of this study was to determine the impact of a single session of HIIT on cellular, molecular, and circulating markers of inflammation in individuals with T2D. Participants with T2D (n 10) and healthy age-matched controls (HC; n 9) completed an acute bout of HIIT (7 1 min at ~85% maximal aerobic power output, separated by 1 min of recovery) on a cycle ergometer with blood samples obtained before (Pre), immediately after (Post), and at 1 h of recovery (1-h Post). Inflammatory markers on leukocytes were measured by flow cytometry, and TNF- was assessed in both LPS-stimulated whole blood cultures and plasma. A single session of HIIT had an overall anti-inflammatory effect, as evidenced by 1) significantly lower levels of Toll-like receptor (TLR) 2 surface protein expression on both classical and CD16 monocytes assessed at Post and 1-h Post compared with Pre (P 0.05 for all); 2) significantly lower LPSstimulated TNF- release in whole blood cultures at 1-h Post (P 0.05 vs. Pre); and 3) significantly lower levels of plasma TNF- at 1-h Post (P 0.05 vs. Pre). There were no differences between T2D and HC, except for a larger decrease in plasma TNF- in HC vs. T2D (group time interaction, P 0.05). One session of low-volume HIIT has immunomodulatory effects and provides potential antiinflammatory benefits to people with, and without, T2D

The Impact of Acute Ingestion of a Ketone Monoester Drink on LPS-Stimulated NLRP3 Activation in Humans with Obesity

Activation of the NOD-like receptor pyrin-domain containing 3 (NLRP3) inflammasome is associated with chronic low-grade inflammation in metabolic diseases such as obesity. Mechanistic studies have shown that β-hydroxybutyrate (OHB) attenuates activation of NLRP3, but human data are limited. In a randomized, double-blind, placebo-controlled crossover trial (n = 11) we tested the hypothesis that acutely raising β-OHB by ingestion of exogenous ketones would attenuate NLRP3 activation in humans with obesity. Blood was sampled before and 30 min post-ingestion of a ketone monoester drink ((R)-3-hydroxybutyl (R)-3-hydroxybutyrate, 482 mg/kg body mass) or placebo. A 75 g oral glucose load was then ingested, and a third blood sample was obtained 60 min following glucose ingestion. NLRP3 activation was quantified by assessing monocyte caspase-1 activation and interleukin (IL)-1β secretion in ex vivo lipopolysaccharide (LPS)-stimulated whole-blood cultures. LPS-stimulated caspase-1 activation increased following glucose ingestion (main effect of time; p = 0.032), with no differences between conditions. IL-1β secretion did not differ between conditions but was lower 60 min post-glucose ingestion compared to the fasting baseline (main effect of time, p = 0.014). Plasma IL-1β was detectable in ~80% of samples and showed a decrease from fasting baseline to 60 min in the ketone condition only (condition × time interaction, p = 0.01). In individuals with obesity, an excursion into hyperglycemia following ingestion of a glucose load augments LPS-induced activation of caspase-1 in monocytes with no apparent impact of raising circulating β-OHB concentration via ingestion of exogenous ketones. Exogenous ketone supplementation may impact plasma IL-1β, but these findings require confirmation in studies with larger sample sizes.Health and Social Development, Faculty of (Okanagan)Health and Exercise Sciences, School of (Okanagan)ReviewedFacult

Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes

Postprandial hyperglycemia has deleterious effects on endothelial function. Restricting carbohydrate intake and postmeal walking have each been shown to reduce postprandial hyperglycemia, but their combination and subsequent effects on endothelial function have not been investigated. Here, we sought to examine the effect of blunting postprandial hyperglycemia by following a low-carbohydrate diet, with or without postmeal walking exercise, on markers of vascular health in type 2 diabetes (T2D). In a randomized crossover design, individuals with T2D (n \u3c 11) completed three 4-day controlled diet interventions consisting of 1) low-carbohydrate diet alone (LC), 2) low-carbohydrate diet with 15-min postmeal walks (LC \u3e Ex), and 3) low-fat control diet (CON). Fasting blood samples and brachial artery flow-mediated dilation (%FMD) were measured before and after each intervention. Total circulating microparticles (MPs), endothelial MPs, platelet MPs, monocyte-platelet aggregates, and adhesion molecules were assessed as biomarkers of vascular health. There was a significant condition = time interaction for %FMD (P \u3c 0.01), with post hoc tests revealing improved %FMD after LC \u3e Ex (\u3e0.8 ± 1.0%, P \u3c 0.02), with no change after LC or CON. Endothelial MPs were significantly reduced with the LC diet by ~45% (from 99 ± 60 to 44 ± 31 MPs/μl, P \u3c 0.02), with no change after LC \u3e Ex or CON (interaction: P \u3c 0.04). Total MPs were lower (main effect time: P \u3c 0.02), whereas monocyte-platelet aggregates were higher (main effect time: P = 0.01) after all interventions. Plasma adhesion molecules and C-reactive protein were unaltered. Attenuating postprandial hyperglycemic excursions using a low-carbohydrate diet combined with postmeal walking appears to be an effective strategy to improve endothelial function in individuals with T2D. NEW & NOTEWORTHY Carbohydrate restriction and postmeal walking lower postprandial hyperglycemia in individuals with type 2 diabetes. Here, we show that the combination significantly improved endothelial function and that carbohydrate restriction alone reduced circulating endothelial microparticles in individuals with type 2 diabetes. Listen to this article\u27s corresponding podcast at http://ajpheart.pod-bean.com/e/low-carb-diet-and-exercise-improve-endothelial-health/

Performance and photosynthetic ecophysiology of three photo-types of Dioscorea zingiberensis under differing light intensities

Li HM, He P, Veste M, Neudorf K. Performance and photosynthetic ecophysiology of three photo-types of Dioscorea zingiberensis under differing light intensities. Plant Biology. 2002;4(3):384-391.The performance and photosynthetic ecophysiology of three photo-types of Dioscorea zingiberensis were studied. The three types are designated DzTL, DzTM and DzTH, according to their adaptation to low (LL), medium (ML) and high (HL) light intensities, respectively. Under LL (23-55 mumol m(-2) s(-1)) and simulated natural light (SNL), DzTM grows well with increased longevity, and green leaves which are unspotted; while its leaves became small, light yellow and short-lived under HL (550 - 850 mumol m(-2) s(-1)). In contrast, under LL the leaves of DzTH were very large, spotted, light yellow and short-lived; while they were small, green and long-lived under HL. Under HL, DzTH had a much higher chlorophyll content than DzTM. Under LL, DzTM and DzTL had a higher Chl content than DzTH. Among the three types, DzTM had the highest peroxidase activity. DzTL had a higher electron transport rate (ETR), maximal quantum yield (MQY) and effective quantum yield (EQY) than DzTH and DzTL under LL, while DzTH had higher ETR, MQY and EQY than the other two types under ML and HL. Therefore, three different photo-types can be characterized according to their adaptation to LL, ML and HL: DzTL, DzTM and DzTH, respectively

Human occupation of northern India spans the Toba super-eruption ~74,000 years ago.

India is located at a critical geographic crossroads for understanding the dispersal of Homo sapiens out of Africa and into Asia and Oceania. Here we report evidence for long-term human occupation, spanning the last ~80 thousand years, at the site of Dhaba in the Middle Son River Valley of Central India. An unchanging stone tool industry is found at Dhaba spanning the Toba eruption of ~74 ka (i.e., the Youngest Toba Tuff, YTT) bracketed between ages of 79.6 ± 3.2 and 65.2 ± 3.1 ka, with the introduction of microlithic technology ~48 ka. The lithic industry from Dhaba strongly resembles stone tool assemblages from the African Middle Stone Age (MSA) and Arabia, and the earliest artefacts from Australia, suggesting that it is likely the product of Homo sapiens as they dispersed eastward out of Africa