Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study.

PURPOSE: To determine if topical beta-blocker use is associated with increased cardiovascular mortality, particularly among people with self-reported glaucoma. METHODS: All participants who participated in the first health check (N = 25,639) of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort (1993-2013) were included in this prospective cohort study, with a median follow-up of 17.0 years. We determined use of topical beta-blockers at baseline through a self-reported questionnaire and prescription check at the first clinical visit. Cardiovascular mortality was ascertained through data linkage with the Office for National Statistics mortality database. Hazard ratios (HRs) were estimated using multivariable Cox regression models. Meta-analysis of the present study's results together with other identified literature was performed using a random effects model. RESULTS: We did not find an association between the use of topical beta-blockers and cardiovascular mortality (HR 0.93, 95% confidence interval, CI, 0.67-1.30). In the 514 participants with self-reported glaucoma, no association was found between the use of topical beta-blockers and cardiovascular mortality (HR 0.89, 95% CI 0.56-1.40). In the primary meta-analysis of four publications, there was no evidence of an association between the use of topical beta-blockers and cardiovascular mortality (pooled HR estimate 1.10, 95% CI 0.84-1.36). CONCLUSION: Topical beta-blockers do not appear to be associated with excess cardiovascular mortality. This evidence does not indicate that a change in current practice is warranted, although clinicians should continue to assess individual patients and their cardiovascular risk prior to commencing topical beta-blockers.EPIC-Norfolk infrastructure and core functions are supported by grants from the Medical Research Council (G1000143) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Age UK Research into Ageing (262). Mr Khawaja is a Wellcome Trust Clinical Research Fellow. Mr Foster has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology.This is the final version of the article. It first appeared from Taylor & Francis via http://dx.doi.org/10.1080/09286586.2016.1213301

Improving value for underserved populations with a community-based intervention: a retrospective cohort study

Abstract Background Healthcare inequity drives high costs, worse outcomes and is heavily influenced by social determinants of health (SDOH). Addressing health behaviors and SDOH through a culturally competent community-based exposure may be effective in improving value for Medicaid enrollees. This study aims to evaluate whether such an exposure lowers costs at equal or improved quality. Methods A retrospective cohort study leveraging claims data was conducted in Detroit, Michigan from April 2021 to April 2022 to examine the impact of a community-based peer support program on clinical, utilization and financial outcomes. A one-to-one propensity matching of 738 pairs of African American Medicaid enrollees was generated, and compared the difference of differences between inpatient, emergency department, prescription and outpatient paid amounts, utilization, and available claims-based quality metrics. Results Compared to controls, peer support recipients generated significantly lower per member per month costs ($115, (95$20.2 to $210)). Recipients showed a significant increase in the Adult Access to Preventative/Ambulatory Health Services 20–44 year old quality metric (8.31% (95% CI 0.35–16.3%)). Member retention in the health insurance plan was significantly higher for peer support recipients vs. the control group by 3.62% (p < 0.05). Peer support recipients displayed non-significant improvement on all other utilization and actuarial measures. No significant difference was found for any of the other examined quality metrics. Conclusions Among a population of African American Medicaid enrollees, a culturally competent community-based intervention was associated with lower cost and better member retention with preserved or improved quality

Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study.

PURPOSE: To determine if topical beta-blocker use is associated with increased cardiovascular mortality, particularly among people with self-reported glaucoma. METHODS: All participants who participated in the first health check (N = 25,639) of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort (1993-2013) were included in this prospective cohort study, with a median follow-up of 17.0 years. We determined use of topical beta-blockers at baseline through a self-reported questionnaire and prescription check at the first clinical visit. Cardiovascular mortality was ascertained through data linkage with the Office for National Statistics mortality database. Hazard ratios (HRs) were estimated using multivariable Cox regression models. Meta-analysis of the present study's results together with other identified literature was performed using a random effects model. RESULTS: We did not find an association between the use of topical beta-blockers and cardiovascular mortality (HR 0.93, 95% confidence interval, CI, 0.67-1.30). In the 514 participants with self-reported glaucoma, no association was found between the use of topical beta-blockers and cardiovascular mortality (HR 0.89, 95% CI 0.56-1.40). In the primary meta-analysis of four publications, there was no evidence of an association between the use of topical beta-blockers and cardiovascular mortality (pooled HR estimate 1.10, 95% CI 0.84-1.36). CONCLUSION: Topical beta-blockers do not appear to be associated with excess cardiovascular mortality. This evidence does not indicate that a change in current practice is warranted, although clinicians should continue to assess individual patients and their cardiovascular risk prior to commencing topical beta-blockers.EPIC-Norfolk infrastructure and core functions are supported by grants from the Medical Research Council (G1000143) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Age UK Research into Ageing (262). Mr Khawaja is a Wellcome Trust Clinical Research Fellow. Mr Foster has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology.This is the final version of the article. It first appeared from Taylor & Francis via http://dx.doi.org/10.1080/09286586.2016.1213301

3-year experience of a dedicated prostate mpMRI pre-biopsy programme and effect on timed cancer diagnostic pathways

Objectives: To evaluate the effect of pre-biopsy MRI on cancer diagnostic times, and to report MRI-directed pathology outcomes. Methods: 1483 patients were referred with suspicion of prostate cancer during a 30-month period. Upfront MRI was performed in 745 patients: 332 MRIs in 15 months prior to dedicated scanning slots (group 1), and 413 in 15 months post-introduction (group 2). A further 88 patients had initial MRI following clinical assessment. Transrectal (TR) or transperineal (TP) was performed, with MRI/US-fusion for MRI targets. Clinically significant cancer (csPCa) was defined as Gleason ≥3+4. Negative MRIs were defined as no suspicious lesion identified, herein, per-case clinical decisions were taken to biopsy/not. Results: 484/833 (58.1%) of MRIs were negative, with 44.4% of patients avoiding biopsy due to negative or low suspicion mpMRI. 37.4% of negative MRI patients had initial or subsequent biopsy with NPV of 92.8% and 98.3% for Gleason ≥3+4 and ≥4+3. Overall prostate cancer prevalence was 34.3%, with 24.6% having csPCa. In 323 MRI-positive cases, any cancer was present in 78.9% and csPCa in 60.4%. 1232/1483 (83.1%) patients completed all diagnostic tests within 28-days. Upfront MRI patients met this standard in 621/833 (74.5%), improving from 66.9% to 81.1% with reserved slots (group 2) with a reduced diagnostic time from median 25.5 to 20.9 days. Biopsy scheduling delayed the pathway in 69.7%, with MRI responsible in 22.3%, reducing to 10.3% in group 2. TP biopsies met the 28-day standard in significantly less cases (29.7%), compared to TR (67.4%), p<0.0001. Conclusion: Reserved MRI slots reduces time-to-diagnosis, and upfront MRI safely avoids biopsy in a significant proportion of men, whilst maintaining expected csPCa detection rates

DARN/SuperDARN

International audienceThe Dual Auroral Radar Network (DARN) is a global-scale network of I-IF and VHF radars capable of sensing backscatter from ionospheric irregularities in the E and F-regions of the high-latitude ionosphere. Currently, the network consists of the STARE VHF radar system in northern Scandinavia, a northern-hemisphere, longitudinal chain of HF radars that is funded to extend from Saskatoon, Canada to central Finland, and a southern-hemisphere chain that is funded to include Halley Station, SANAE and Syowa Station in Antarctica. When all of the HF radars have been completed they will operate in pairs with common viewing areas so that the Doppler information contained in the backscattered signals may be combined to yield maps of high-latitude plasma convection and the convection electric field. In this paper, the evolution of DARN and particularly the development of its SuperDARN HF radar element is discussed. The DARN/SuperDARN network is particularly suited to studies of large-scale dynamical processes in the magnetosphere-ionosphere system, such as the evolution of the global configuration of the convection electric field under changing IMF conditions and the development and global extent of large-scale Mi-ID waves in the magnetosphere-ionosphere cavity. A description of the HF radars within SuperDARN is given along with an overview of their existing and intended locations, intended start of operations, Principal Investigators, and sponsoring agencies. Finally, the operation of the DARN experiment within ISTP/GGS, the availability of data, and the form and availability of the Key Parameter files is discussed

The GEISA spectroscopic database: Current and future archive for Earth and planetary atmosphere studies

The development of Gestion et Etude des Informations Spectroscopiques Atmosphériques (GEISA: Management and Study of Spectroscopic Information) was started over three decades at Laboratoire de Météorologie Dynamique (LMD) in France. GEISA is a computer accessible spectroscopic database, designed to facilitate accurate forward radiative transfer calculations using a line-by-line and layer-by-layer approach. More than 350 users have been registered for on-line use of the GEISA facilities. The current 2003 edition of GEISA (GEISA-03) is a system comprising three independent sub-databases devoted respectively to: line transition parameters, infrared and ultraviolet/visible absorption cross-sections, microphysical and optical properties of atmospheric aerosols. Currently, GEISA is involved in activities related to the assessment of the capabilities of IASI (Infrared Atmospheric Sounding Interferometer on board of the METOP European satellite) through the GEISA/IASI database derived from GEISA. The GEISA-03 content is presented, placing emphasis on molecular species of interest for Earth and planetary atmosphere studies, with details on the updated 2008 archive underway. A critical assessment on the needs, in terms of molecular parameters archive, related with recent satellite astrophysical missions is made. Detailed information on free on-line GEISA and GEISA/IASI access is given at http://ara.lmd.polytechnique.fr and http://ether.ipsl.jussieu.fr. © 2008 Elsevier Ltd. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe