59 research outputs found
Recommended from our members
Improving Treatment Intensification to Reduce Cardiovascular Disease Risk: A Cluster Randomized Trial
Background: Blood pressure, lipid, and glycemic control are essential for reducing cardiovascular disease (CVD) risk. Many health care systems have successfully shifted aspects of chronic disease management, including population-based outreach programs designed to address CVD risk factor control, to non-physicians. The purpose of this study is to evaluate provision of new information to non-physician outreach teams on need for treatment intensification in patients with increased CVD risk. Methods Cluster randomized trial (July 1-December 31, 2008) in Kaiser Permanente Northern California registry of members with diabetes mellitus, prior CVD diagnoses and/or chronic kidney disease who were high-priority for treatment intensification: blood pressure ≥ 140 mmHg systolic, LDL-cholesterol ≥ 130 mg/dl, or hemoglobin A1c ≥ 9%; adherent to current medications; no recent treatment intensification). Randomization units were medical center-based outreach teams (4 intervention; 4 control). For intervention teams, priority flags for intensification were added monthly to the registry database with recommended next pharmacotherapeutic steps for each eligible patient. Control teams used the same database without this information. Outcomes included 3-month rates of treatment intensification and risk factor levels during follow-up. Results: Baseline risk factor control rates were high (82-90%). In eligible patients, the intervention was associated with significantly greater 3-month intensification rates for blood pressure (34.1 vs. 30.6%) and LDL-cholesterol (28.0 vs 22.7%), but not A1c. No effects on risk factors were observed at 3 months or 12 months follow-up. Intervention teams initiated outreach for only 45-47% of high-priority patients, but also for 27-30% of lower-priority patients. Teams reported difficulties adapting prior outreach strategies to incorporate the new information. Conclusions: Information enhancement did not improve risk factor control compared to existing outreach strategies at control centers. Familiarity with prior, relatively successful strategies likely reduced uptake of the innovation and its potential for success at intervention centers. Trial registration ClinicalTrials.gov Identifier NCT0051768
Improving treatment intensification to reduce cardiovascular disease risk: a cluster randomized trial
Abstract
Background
Blood pressure, lipid, and glycemic control are essential for reducing cardiovascular disease (CVD) risk. Many health care systems have successfully shifted aspects of chronic disease management, including population-based outreach programs designed to address CVD risk factor control, to non-physicians. The purpose of this study is to evaluate provision of new information to non-physician outreach teams on need for treatment intensification in patients with increased CVD risk.
Methods
Cluster randomized trial (July 1-December 31, 2008) in Kaiser Permanente Northern California registry of members with diabetes mellitus, prior CVD diagnoses and/or chronic kidney disease who were high-priority for treatment intensification: blood pressure ≥ 140 mmHg systolic, LDL-cholesterol ≥ 130 mg/dl, or hemoglobin A1c ≥ 9%; adherent to current medications; no recent treatment intensification). Randomization units were medical center-based outreach teams (4 intervention; 4 control). For intervention teams, priority flags for intensification were added monthly to the registry database with recommended next pharmacotherapeutic steps for each eligible patient. Control teams used the same database without this information. Outcomes included 3-month rates of treatment intensification and risk factor levels during follow-up.
Results
Baseline risk factor control rates were high (82-90%). In eligible patients, the intervention was associated with significantly greater 3-month intensification rates for blood pressure (34.1 vs. 30.6%) and LDL-cholesterol (28.0 vs 22.7%), but not A1c. No effects on risk factors were observed at 3 months or 12 months follow-up. Intervention teams initiated outreach for only 45-47% of high-priority patients, but also for 27-30% of lower-priority patients. Teams reported difficulties adapting prior outreach strategies to incorporate the new information.
Conclusions
Information enhancement did not improve risk factor control compared to existing outreach strategies at control centers. Familiarity with prior, relatively successful strategies likely reduced uptake of the innovation and its potential for success at intervention centers.
Trial registration
ClinicalTrials.gov Identifier NCT00517686http://deepblue.lib.umich.edu/bitstream/2027.42/112310/1/12913_2012_Article_2076.pd
The Host Galaxy and Redshift of the Repeating Fast Radio Burst FRB 121102
The precise localization of the repeating fast radio burst (FRB 121102) has
provided the first unambiguous association (chance coincidence probability
) of an FRB with an optical and persistent radio
counterpart. We report on optical imaging and spectroscopy of the counterpart
and find that it is an extended ()
object displaying prominent Balmer and [OIII] emission lines. Based on the
spectrum and emission line ratios, we classify the counterpart as a
low-metallicity, star-forming, AB mag dwarf galaxy at a
redshift of , corresponding to a luminosity distance of 972 Mpc.
From the angular size, the redshift, and luminosity, we estimate the host
galaxy to have a diameter kpc and a stellar mass of
, assuming a mass-to-light ratio between 2 to
3. Based on the H flux, we estimate the star
formation rate of the host to be and a
substantial host dispersion measure depth .
The net dispersion measure contribution of the host galaxy to FRB 121102 is
likely to be lower than this value depending on geometrical factors. We show
that the persistent radio source at FRB 121102's location reported by Marcote
et al (2017) is offset from the galaxy's center of light by 200 mas and
the host galaxy does not show optical signatures for AGN activity. If FRB
121102 is typical of the wider FRB population and if future interferometric
localizations preferentially find them in dwarf galaxies with low metallicities
and prominent emission lines, they would share such a preference with long
gamma ray bursts and superluminous supernovae.Comment: 12 pages, 3 figures, Published in ApJ Letters. V2: Corrected mistake
in author lis
Self-management support intervention to control cancer pain in the outpatient setting: a randomized controlled trial study protocol
Background: Pain is a prevalent and distressing symptom in patients with cancer, having an enormous impact on functioning and quality of life. Fragmentation of care, inadequate pain communication, and reluctance towards pain medication contribute to difficulties in optimizing outcomes. Integration of patient self-management and professional care by means of healthcare technology provides new opportunities in the outpatient setting.
Methods/Design: This study protocol outlines a two-armed multicenter randomized controlled trial that compares a technology based multicomponent self-management support intervention with care as usual and includes an effect, economic and process evaluation. Patients will be recruited consecutively via the outpatient oncology clinics and inpatient oncology wards of one academic hospital and one regional hospital in the south of the Netherlands. Irrespective of the stage of disease, patients are eligible when they are diagnosed with cancer and have uncontrolled moderate to severe cancer (treatment) related pain defined as NRS ≥ 4 for more than two weeks. Randomization (1:1) will assign patients to either the intervention or control group; patients in the intervention group receive self-management support and patients in the control group receive care as usual. The intervention will be delivered by registered nurses specialized in pain and palliative care. Important components include monitoring of pain, adverse effects and medication as well as graphical feedback, education, and nurse support. Effect measurements for both groups will be carried out with questionnaires at baseline (T0), after 4 weeks (T1) and after 12 weeks (T2). Pain intensity and quality of life are the primary outcomes. Secondary outcomes include self-efficacy, knowledge, anxiety, depression and pain medication use. The final questionnaire contains also questions for the economic evaluation that includes both cost-effectiveness and cost-utility analysis. Data for the process evaluation will be gathered continuously over the study period and focus on recruitment, reach, dose delivered and dose received.
Discussion: The proposed study will provide insight into the effectiveness of the self-management support intervention delivered by nurses to outpatients with uncontrolled cancer pain. Study findings will be used to empower patients and health professionals to improve cancer pain control.
Trial registration:
NCT02333968 December 29, 201
High-Throughput Analysis of Calcium Signalling Kinetics in Astrocytes Stimulated with Different Neurotransmitters
Astrocytes express a wide range of receptors for neurotransmitters and hormones that are coupled to increases in intracellular Ca2+ concentration, enabling them to detect activity in both neuronal and vascular networks. There is increasing evidence that astrocytes are able to discriminate between different Ca2+-linked stimuli, as the efficiency of some Ca2+ dependent processes – notably release of gliotransmitters – depends on the stimulus that initiates the Ca2+ signal. The spatiotemporal complexity of Ca2+ signals is substantial, and we here tested the hypothesis that variation in the kinetics of Ca2+ responses could offer a means of selectively engaging downstream targets, if agonists exhibited a “signature shape” in evoked Ca2+ response. To test this, astrocytes were exposed to three different receptor agonists (ATP, glutamate and histamine) and the resultant Ca2+ signals were analysed for systematic differences in kinetics that depended on the initiating stimulus. We found substantial heterogeneity between cells in the time course of Ca2+ responses, but the variation did not correlate with the type or concentration of the stimulus. Using a simple metric to quantify the extent of difference between populations, it was found that the variation between agonists was insufficient to allow signal discrimination. We conclude that the time course of global intracellular Ca2+ signals does not offer the cells a means for distinguishing between different neurotransmitters
Sub-second periodicity in a fast radio burst
Fast radio bursts (FRBs) are millisecond-duration flashes of radio waves that
are visible at distances of billions of light-years. The nature of their
progenitors and their emission mechanism remain open astrophysical questions.
Here we report the detection of the multi-component FRB 20191221A and the
identification of a periodic separation of 216.8(1) ms between its components
with a significance of 6.5 sigmas. The long (~3 s) duration and nine or more
components forming the pulse profile make this source an outlier in the FRB
population. Such short periodicity provides strong evidence for a neutron-star
origin of the event. Moreover, our detection favours emission arising from the
neutron-star magnetosphere, as opposed to emission regions located further away
from the star, as predicted by some models.Comment: Updated to conform to the accepted versio
The NANOGrav 15-year Data Set: Observations and Timing of 68 Millisecond Pulsars
We present observations and timing analyses of 68 millisecond pulsars (MSPs)
comprising the 15-year data set of the North American Nanohertz Observatory for
Gravitational Waves (NANOGrav). NANOGrav is a pulsar timing array (PTA)
experiment that is sensitive to low-frequency gravitational waves. This is
NANOGrav's fifth public data release, including both "narrowband" and
"wideband" time-of-arrival (TOA) measurements and corresponding pulsar timing
models. We have added 21 MSPs and extended our timing baselines by three years,
now spanning nearly 16 years for some of our sources. The data were collected
using the Arecibo Observatory, the Green Bank Telescope, and the Very Large
Array between frequencies of 327 MHz and 3 GHz, with most sources observed
approximately monthly. A number of notable methodological and procedural
changes were made compared to our previous data sets. These improve the overall
quality of the TOA data set and are part of the transition to new pulsar timing
and PTA analysis software packages. For the first time, our data products are
accompanied by a full suite of software to reproduce data reduction, analysis,
and results. Our timing models include a variety of newly detected astrometric
and binary pulsar parameters, including several significant improvements to
pulsar mass constraints. We find that the time series of 23 pulsars contain
detectable levels of red noise, 10 of which are new measurements. In this data
set, we find evidence for a stochastic gravitational-wave background.Comment: 90 pages, 74 figures, 6 tables; published in Astrophysical Journal
Letters as part of Focus on NANOGrav's 15-year Data Set and the Gravitational
Wave Background. For questions or comments, please email
[email protected]
The NANOGrav 15-year Data Set: Search for Anisotropy in the Gravitational-Wave Background
The North American Nanohertz Observatory for Gravitational Waves (NANOGrav)
has reported evidence for the presence of an isotropic nanohertz gravitational
wave background (GWB) in its 15 yr dataset. However, if the GWB is produced by
a population of inspiraling supermassive black hole binary (SMBHB) systems,
then the background is predicted to be anisotropic, depending on the
distribution of these systems in the local Universe and the statistical
properties of the SMBHB population. In this work, we search for anisotropy in
the GWB using multiple methods and bases to describe the distribution of the
GWB power on the sky. We do not find significant evidence of anisotropy, and
place a Bayesian upper limit on the level of broadband anisotropy such
that . We also derive conservative estimates on the
anisotropy expected from a random distribution of SMBHB systems using
astrophysical simulations conditioned on the isotropic GWB inferred in the
15-yr dataset, and show that this dataset has sufficient sensitivity to probe a
large fraction of the predicted level of anisotropy. We end by highlighting the
opportunities and challenges in searching for anisotropy in pulsar timing array
data.Comment: 19 pages, 11 figures; submitted to Astrophysical Journal Letters as
part of Focus on NANOGrav's 15-year Data Set and the Gravitational Wave
Background. For questions or comments, please email [email protected]
The NANOGrav 12.5 yr Data Set: A Computationally Efficient Eccentric Binary Search Pipeline and Constraints on an Eccentric Supermassive Binary Candidate in 3C 66B
The radio galaxy 3C 66B has been hypothesized to host a supermassive black hole binary (SMBHB) at its center based on electromagnetic observations. Its apparent 1.05 yr period and low redshift (∼0.02) make it an interesting testbed to search for low-frequency gravitational waves (GWs) using pulsar timing array (PTA) experiments. This source has been subjected to multiple searches for continuous GWs from a circular SMBHB, resulting in progressively more stringent constraints on its GW amplitude and chirp mass. In this paper, we develop a pipeline for performing Bayesian targeted searches for eccentric SMBHBs in PTA data sets, and test its efficacy by applying it to simulated data sets with varying injected signal strengths. We also search for a realistic eccentric SMBHB source in 3C 66B using the NANOGrav 12.5 yr data set employing PTA signal models containing Earth term-only as well as Earth+pulsar term contributions using this pipeline. Due to limitations in our PTA signal model, we get meaningful results only when the initial eccentricity e 0 < 0.5 and the symmetric mass ratio η > 0.1. We find no evidence for an eccentric SMBHB signal in our data, and therefore place 95% upper limits on the PTA signal amplitude of 88.1 ± 3.7 ns for the Earth term-only and 81.74 ± 0.86 ns for the Earth+pulsar term searches for e 0 < 0.5 and η > 0.1. Similar 95% upper limits on the chirp mass are (1.98 ± 0.05) × 109 and (1.81 ± 0.01) × 109 M ☉. These upper limits, while less stringent than those calculated from a circular binary search in the NANOGrav 12.5 yr data set, are consistent with the SMBHB model of 3C 66B developed from electromagnetic observations
The NANOGrav 15 yr Data Set: Search for Transverse Polarization Modes in the Gravitational-wave Background
Recently we found compelling evidence for a gravitational-wave background with Hellings and Downs (HD) correlations in our 15 yr data set. These correlations describe gravitational waves as predicted by general relativity, which has two transverse polarization modes. However, more general metric theories of gravity can have additional polarization modes, which produce different interpulsar correlations. In this work, we search the NANOGrav 15 yr data set for evidence of a gravitational-wave background with quadrupolar HD and scalar-transverse (ST) correlations. We find that HD correlations are the best fit to the data and no significant evidence in favor of ST correlations. While Bayes factors show strong evidence for a correlated signal, the data does not strongly prefer either correlation signature, with Bayes factors ∼2 when comparing HD to ST correlations, and ∼1 for HD plus ST correlations to HD correlations alone. However, when modeled alongside HD correlations, the amplitude and spectral index posteriors for ST correlations are uninformative, with the HD process accounting for the vast majority of the total signal. Using the optimal statistic, a frequentist technique that focuses on the pulsar-pair cross-correlations, we find median signal-to-noise ratios of 5.0 for HD and 4.6 for ST correlations when fit for separately, and median signal-to-noise ratios of 3.5 for HD and 3.0 for ST correlations when fit for simultaneously. While the signal-to-noise ratios for each of the correlations are comparable, the estimated amplitude and spectral index for HD are a significantly better fit to the total signal, in agreement with our Bayesian analysis
- …