Absence of bias against smokers in access to coronary revascularization after cardiac catheterization

Objective. Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization. Design. Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada. Main measures. Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization. Results. Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers. Conclusion. Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoke

Women with coronary artery disease report worse health-related quality of life outcomes compared to men

BACKGROUND: Although there have been substantial medical advances that improve the outcomes following cardiac ischemic events, gender differences in the treatment and course of recovery for patients with coronary artery disease (CAD) continue to exist. There is a general paucity of data comparing the health related quality of life (HRQOL) in men and women undergoing treatment for CAD. The purpose of this study was to compare HRQOL outcomes of men and women in Alberta, at one-year following initial catheterization, after adjustment for known demographic, co-morbid, and disease severity predictors of outcome. METHOD: The HRQOL outcome data were collected by means of a self-reported questionnaire mailed to patients on or near the one-year anniversary of their initial cardiac catheterization. Using the Seattle Angina Questionnaire (SAQ), 5 dimensions of HRQOL were measured: exertional capacity, anginal stability, anginal frequency, quality of life and treatment satisfaction. Data from the APPROACH registry were used to risk-adjust the SAQ scale scores. Two analytical strategies were used including general least squares linear modeling, and proportional odds modeling sometimes referred to as the "ordinal logistic modeling". RESULTS: 3392 (78.1%) patients responded to the follow-up survey. The adjusted proportional odds ratios for men relative to women (PORs > 1 = better) indicated that men reported significantly better HRQOL on all 5 SAQ dimensions as compared to women. (PORs: Exertional Capacity 3.38 (2.75–4.15), Anginal Stability 1.23 (1.03–1.47), Anginal Frequency 1.70 (1.43–2.01), Treatment Satisfaction 1.27 (1.07–1.50), and QOL 1.74 (1.48–2.04). CONCLUSIONS: Women with CAD consistently reported worse HRQOL at one year follow-up compared to men. These findings underline the fact that conclusions based on research performed on men with CAD may not be valid for women and that more gender-related research is needed. Future studies are needed to further examine gender differences in psychosocial adjustment following treatment for CAD, as adjustment for traditional clinical variables fails to explain sex differences in health related quality of life outcomes

Stratus 10 tenth setting of the Stratus Ocean Reference Station : cruise RB-10-01, January 2 - January 30, 2010 Charleston, South Carolina - Valparaiso, Chile

The Ocean Reference Station at 20°S, 85°W under the stratus clouds west of northern Chile is being maintained to provide ongoing climate-quality records of surface meteorology, air-sea fluxes of heat, freshwater, and momentum, and of upper ocean temperature, salinity, and velocity variability. The Stratus Ocean Reference Station (ORS Stratus) is supported by the National Oceanic and Atmospheric Administration’s (NOAA) Climate Observation Program. It is recovered and redeployed annually, with past cruises that have come between October and December. Due to necessary repairs on the electric motors of the ship’s propulsion system, this year the cruise was delayed until January. During the 2009/2010 cruise on the NOAA ship Ronald H. Brown to the ORS Stratus site, the primary activities were the recovery of the Stratus 9 WHOI surface mooring that had been deployed in October 2008, deployment of a new (Stratus 10) WHOI surface mooring at that site, in-situ calibration of the buoy meteorological sensors by comparison with instrumentation installed on the ship by staff of the NOAA Earth System Research Laboratory (ESRL), and collection of underway and on station oceanographic data to continue to characterize the upper ocean in the stratus region. Both underway CTD (UCTD) profiles and Vertical Microstructure Profiles (VMP) were collected along the track and during surveys dedicated to investigating eddy variability in the region. Surface drifters were also launched along the track. The intent was also to visit a buoy for the Pacific tsunami warning system maintained by the Hydrographic and Oceanographic Service of the Chilean Navy (SHOA). This DART (Deep- Ocean Assessment and Reporting of Tsunami) buoy had been equipped with IMET sensors and subsurface oceanographic instruments, and a recovery and replacement of the IMET sensors was planned. However, the DART buoy broke free from its mooring on January 3rd and was recovered by the Chilean navy; the work done at that site during this cruise was the recovery of the bottom pressure unit.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA17RJ1223 for the Cooperative Institute for Climate and Ocean Research (CICOR)

Accuracy of city postal code coordinates as a proxy for location of residence

BACKGROUND: Health studies sometimes rely on postal code location as a proxy for the location of residence. This study compares the postal code location to that of the street address using a database from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH(©)). Cardiac catheterization cases in an urban Canadian City were used for calendar year 1999. We determined location in meters for both the address (using the City of Calgary Street Network File in ArcView 3.2) and postal code location (using Statistic Canada's Postal Code Conversion File). RESULTS: The distance between the two estimates of location for each case were measured and it was found that 87.9% of the postal code locations were within 200 meters of the true address location (straight line distances) and 96.5% were within 500 meters of the address location (straight line distances). CONCLUSIONS: We conclude that postal code locations are a reasonably accurate proxy for address location. However, there may be research questions for which a more accurate description of location is required

WHOI Hawaii Ocean Timeseries Station (WHOTS) : WHOTS-6 2009 mooring turnaround cruise report

The Woods Hole Oceanographic Institution (WHOI) Hawaii Ocean Timeseries Site (WHOTS), 100 km north of Oahu, Hawaii, is intended to provide long-term, high-quality air-sea fluxes as a part of the NOAA Climate Observation Program. The WHOTS mooring also serves as a coordinated part of the Hawaiian Ocean Timeseries (HOT) program, contributing to the goals of observing heat, fresh water and chemical fluxes at a site representative of the oligotrophic North Pacific Ocean. The approach is to maintain a surface mooring outfitted for meteorological and oceanographic measurements at a site near 22.75°N, 158°W by successive mooring turnarounds. These observations will be used to investigate air–sea interaction processes related to climate variability. The first WHOTS mooring (WHOTS-1) was deployed in August 2004. Turnaround cruises for successive moorings (WHOTS-2 through WHOTS-5) have typically been in either June or July. This report documents recovery of the WHOTS-5 mooring and deployment of the sixth mooring (WHOTS-6). The moorings utilize Surlyn foam buoys as the surface element and are outfitted with two Air–Sea Interaction Meteorology (ASIMET) systems. Each ASIMET system measures, records, and transmits via Argos satellite the surface meteorological variables necessary to compute air–sea fluxes of heat, moisture and momentum. The upper 155 m of the mooring is outfitted with oceanographic sensors for the measurement of temperature, conductivity and velocity in a cooperative effort with R. Lukas of the University of Hawaii (UH). A pCO2 system is installed on the buoy in a cooperative effort with Chris Sabine at the Pacific Marine Environmental Laboratory. Dr. Frank Bradley, CSIRO, Australia, assisted with meteorological sensor comparisons. A NOAA “Teacher at Sea” and a NOAA “Teacher in the Lab” participated in the cruise. The WHOTS mooring turnaround was done on the University of Hawaii research vessel Kilo Moana, Cruise KM-09-16, by the Upper Ocean Processes Group of the Woods Hole Oceanographic Institution in cooperation with UH and NOAA’s Earth System Research Laboratory, Physical Sciences Division (ESRL/PSD). The cruise took place between 9 and 17 July 2009. Operations began with deployment of the WHOTS-6 mooring on 10 July at approximately 22°40.0'N, 157°57.0'W in 4758 m of water. This was followed by meteorological intercomparisons and CTDs at the WHOTS-6 and WHOTS-5 sites. The WHOTS-5 mooring was recovered on 15 July 2009. The Kilo Moana then moved to the HOT central site (22°45.0'N, 158°00.0'W) for CTD casts. This report describes the cruise operations in more detail, as well as some of the in-port operations and pre-cruise buoy preparations.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA17RJ1223 for the Cooperative Institute for Climate and Ocean Research (CICOR)

An administrative data merging solution for dealing with missing data in a clinical registry: adaptation from ICD-9 to ICD-10

<p>Abstract</p> <p>Background</p> <p>We have previously described a method for dealing with missing data in a prospective cardiac registry initiative. The method involves merging registry data to corresponding ICD-9-CM administrative data to fill in missing data 'holes'. Here, we describe the process of translating our data merging solution to ICD-10, and then validating its performance.</p> <p>Methods</p> <p>A multi-step translation process was undertaken to produce an ICD-10 algorithm, and merging was then implemented to produce complete datasets for 1995–2001 based on the ICD-9-CM coding algorithm, and for 2002–2005 based on the ICD-10 algorithm. We used cardiac registry data for patients undergoing cardiac catheterization in fiscal years 1995–2005. The corresponding administrative data records were coded in ICD-9-CM for 1995–2001 and in ICD-10 for 2002–2005. The resulting datasets were then evaluated for their ability to predict death at one year.</p> <p>Results</p> <p>The prevalence of the individual clinical risk factors increased gradually across years. There was, however, no evidence of either an abrupt drop or rise in prevalence of any of the risk factors. The performance of the new data merging model was comparable to that of our previously reported methodology: c-statistic = 0.788 (95% CI 0.775, 0.802) for the ICD-10 model versus c-statistic = 0.784 (95% CI 0.780, 0.790) for the ICD-9-CM model. The two models also exhibited similar goodness-of-fit.</p> <p>Conclusion</p> <p>The ICD-10 implementation of our data merging method performs as well as the previously-validated ICD-9-CM method. Such methodological research is an essential prerequisite for research with administrative data now that most health systems are transitioning to ICD-10.</p

ABUNDANCES, STELLAR PARAMETERS, AND SPECTRA FROM THE SDSS-III/APOGEE SURVEY

The SDSS-III/Apache Point Observatory Galactic Evolution Experiment (APOGEE) survey operated from 2011–2014 using the APOGEE spectrograph, which collects high-resolution (R ~ 22,500), near-IR (1.51–1.70 µm) spectra with a multiplexing (300 fiber-fed objects) capability. We describe the survey data products that are publicly available, which include catalogs with radial velocity, stellar parameters, and 15 elemental abundances for over 150,000 stars, as well as the more than 500,000 spectra from which these quantities are derived. Calibration relations for the stellar parameters (Teff , log g, [M/H], [a/M]) and abundances (C, N, O, Na, Mg, Al, Si, S, K, Ca, Ti, V, Mn, Fe, Ni) are presented and discussed. The internal scatter of the abundances within clusters indicates that abundance precision is generally between 0.05 and 0.09 dex across a broad temperature range; it is smaller for some elemental abundances within more limited ranges and at high signal-to-noise ratio. We assess the accuracy of the abundances using comparison of mean cluster metallicities with literature values, APOGEE observations of the solar spectrum and of Arcturus, comparison of individual star abundances with other measurements, and consideration of the locus of derived parameters and abundances of the entire sample, and find that it is challenging to determine the absolute abundance scale; external accuracy may be good to 0.1–0.2 dex. Uncertainties may be larger at cooler temperatures (Teff < 4000 K). Access to the public data release and data products is described, and some guidance for using the data products is provided

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), one of the programs in the Sloan Digital Sky Survey III (SDSS-III), has now completed its systematic, homogeneous spectroscopic survey sampling all major populations of the Milky Way. After a three-year observing campaign on the Sloan 2.5 m Telescope, APOGEE has collected a half million high-resolution (R ~ 22,500), high signal-to-noise ratio (>100), infrared (1.51–1.70 μm) spectra for 146,000 stars, with time series information via repeat visits to most of these stars. This paper describes the motivations for the survey and its overall design—hardware, field placement, target selection, operations—and gives an overview of these aspects as well as the data reduction, analysis, and products. An index is also given to the complement of technical papers that describe various critical survey components in detail. Finally, we discuss the achieved survey performance and illustrate the variety of potential uses of the data products by way of a number of science demonstrations, which span from time series analysis of stellar spectral variations and radial velocity variations from stellar companions, to spatial maps of kinematics, metallicity, and abundance patterns across the Galaxy and as a function of age, to new views of the interstellar medium, the chemistry of star clusters, and the discovery of rare stellar species. As part of SDSS-III Data Release 12 and later releases, all of the APOGEE data products are publicly available

The Eleventh and Twelfth Data Releases of the Sloan Digital Sky Survey: Final Data from SDSS-III

The third generation of the Sloan Digital Sky Survey (SDSS-III) took data from 2008 to 2014 using the original SDSS wide-field imager, the original and an upgraded multi-object fiber-fed optical spectrograph, a new near-infrared high-resolution spectrograph, and a novel optical interferometer. All of the data from SDSS-III are now made public. In particular, this paper describes Data Release 11 (DR11) including all data acquired through 2013 July, and Data Release 12 (DR12) adding data acquired through 2014 July (including all data included in previous data releases), marking the end of SDSS-III observing. Relative to our previous public release (DR10), DR12 adds one million new spectra of galaxies and quasars from the Baryon Oscillation Spectroscopic Survey (BOSS) over an additional 3000 deg2 of sky, more than triples the number of H-band spectra of stars as part of the Apache Point Observatory (APO) Galactic Evolution Experiment (APOGEE), and includes repeated accurate radial velocity measurements of 5500 stars from the Multi-object APO Radial Velocity Exoplanet Large-area Survey (MARVELS). The APOGEE outputs now include the measured abundances of 15 different elements for each star. In total, SDSS-III added 5200 deg2 of ugriz imaging; 155,520 spectra of 138,099 stars as part of the Sloan Exploration of Galactic Understanding and Evolution 2 (SEGUE-2) survey; 2,497,484 BOSS spectra of 1,372,737 galaxies, 294,512 quasars, and 247,216 stars over 9376 deg2; 618,080 APOGEE spectra of 156,593 stars; and 197,040 MARVELS spectra of 5513 stars. Since its first light in 1998, SDSS has imaged over 1/3 of the Celestial sphere in five bands and obtained over five million astronomical spectra. \ua9 2015. The American Astronomical Society

Economic evaluation of sirolimus-eluting stents

BACKGROUND: Sirolimus-eluting stents have recently been shown to reduce the risk of restenosis among patients who undergo percutaneous coronary intervention (PCI). Given that sirolimus-eluting stents cost about 4 times as much as conventional stents, and considering the volume of PCI procedures, the decision to use sirolimus-eluting stents has large economic implications. METHODS: We performed an economic evaluation comparing treatment with sirolimus-eluting and conventional stents in patients undergoing PCI and in subgroups based on age and diabetes mellitus status. The probabilities of transition between clinical states and estimates of resource use and health-related quality of life were derived from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Information on effectiveness was based on a meta-analysis of randomized controlled clinical trials (RCTs) comparing sirolimus-eluting and conventional stents. RESULTS: Cost per quality-adjusted life year (QALY) gained in the baseline analysis was Can$58 721. Sirolimus-eluting stents were more cost-effective in patients with diabetes and in those over 75 years of age, the costs per QALY gained being$44 135 and $40 129, respectively. The results were sensitive to plausible variations in the cost of stents, the estimate of the effectiveness of sirolimus-eluting stents and the assumption that sirolimus-eluting stents would prevent the need for cardiac catheterizations in the subsequent year when no revascularization procedure was performed to treat restenosis. INTERPRETATION: The use of sirolimus-eluting stents is associated with a cost per QALY that is similar to or higher than that of other accepted medical forms of therapy and is associated with a significant incremental cost. Sirolimus-eluting stents are more economically attractive for patients who are at higher risk of restenosis or at a high risk of death if a second revascularization procedure were to be required