Does industry-sponsored education foster overdiagnosis and overtreatment of depression, osteoporosis and over-active bladder syndrome? An Australian cohort study

ObjectivesTo investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment.Design and settingThis retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events. We hypothesised that companies marketing treatments for each condition would sponsor related events and that target audiences would mainly work in primary care, reflecting a broad patient population.Main outcome measuresEvent and attendee characteristics, sponsoring companies, related marketed treatments, cost-effectiveness ratings and dispensing rates.ResultsOver the study period, we identified 1567 events focusing on depression, 1375 on osteoporosis and 190 on overactive bladder (total n=3132, with 96 660 attendees). These events were attended by primary care doctors more often than sponsored events without a focus on these three conditions: relative risk (RR)=3.06 (95% CI 2.81 to 3.32) for depression, RR=1.48 (95% CI 1.41 to 1.55) for osteoporosis and RR=2.59 (95% CI 2.09 to 3.21) for overactive bladder. Servier, which markets agomelatine and AstraZeneca (quetiapine) sponsored 51.2% and 23.0% of depression events, respectively. Amgen and GlaxoSmithKline, which co-market denosumab, sponsored 49.5% of osteoporosis events and Astellas and Commonwealth Serum Laboratories (CSL) (mirabegron and solifenacin) sponsored 80.5% of overactive bladder events.ConclusionsThis 4-year overview of industry-sponsored events on three overdiagnosed and overtreated conditions found that primary care clinicians were often targeted, dinner was often provided and that a few companies sponsored most events. In most cases, sponsors’ products are not cost-effective choices for the specified condition. This pattern highlights the need for professional education to be free of commercial sponsorship.</jats:sec

A cross-sectional analysis of pharmaceutical industry-funded events for health professionals in Australia

Objectives: To analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages. Design: Cross-sectional analysis. Participants and setting: 301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015. Results: Forty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: 82.0% included medical doctors, including specialists and primary care doctors, and 38.3% trainees. Oncology, surgery and endocrinology were the most frequent clinical areas of focus. Most events (64.2%) were held in a clinical setting. The median cost per event was $A263 (IQR$A153–1195) and over 90% included food and beverages. Conclusions: Over this 4-year period, industry-sponsored events were widespread and pharmaceutical companies maintained a high frequency of contact with health professionals. Most events were held in clinical settings, suggesting a pervasive commercial presence in everyday clinical practice. Food and beverages, known to be associated with changes to prescribing practice, were almost always provided. New Australian transparency provisions explicitly exclude meals from the reporting requirements; thus, a large proportion of potentially influential payments from pharmaceutical companies to health professionals will disappear from public view

Deriving modified rankin scores from medical records

&lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.&lt;/p&gt

RESOLVE (Regolith & Environmental Science Oxygen & Lunar Volatile Extraction) Project

The RESOLVE Project is a lunar prospecting mission whose primary goal is to characterize water and other volatiles in lunar regolith. The Lunar Advanced Volatiles Analysis (LAVA) subsystem is comprised of a fluid subsystem that transports flow to the gas chromatograph - mass spectrometer (GC-MS) instruments that characterize volatiles and the Water Droplet Demonstration (WDD) that will capture and display water condensation in the gas stream. The LAVA Engineering Test Unit (ETU) is undergoing risk reduction testing this summer and fall within a vacuum chamber to understand and characterize component and integrated system performance. Testing of line heaters, printed circuit heaters, pressure transducers, temperature sensors, regulators, and valves in atmospheric and vacuum environments was done. Test procedures were developed to guide experimental tests and test reports to analyze and draw conclusions from the data. In addition, knowledge and experience was gained with preparing a vacuum chamber with fluid and electrical connections. Further testing will include integrated testing of the fluid subsystem with the gas supply system, near-infrared spectrometer for the Surge Tank (NIRST), WDD, Sample Delivery System, and GC-MS in the vacuum chamber. Since LAVA is a scientific subsystem, the near infrared spectrometer and GC-MS instruments will be tested during the ETU testing phase

Incentive-based approaches to sustainable fisheries (now replaced by EEN0508)

Using examples from more than a dozen fisheries, we highlight the failures of ‘command control’ management and show that approaches that empower fishers with the incentives and the mandate to be co-custodians of the marine environment can promote sustainability. Evidence is provided that where harvesters share well-defined management responsibilities over fish, and experience both the pain of overexploitation and the gains from conservation, they are much more likely to protect fish stocks and habitat. The key insight is that to maintain marine ecosystems for present and future generations, fishing incentives must be compatible with long-term goals of sustainability.incentives, sustainability, rights, fisheries management

Incentive-based approaches to sustainable fisheries

The failures of traditional target-species management have led many to propose an ecosystem approach to fisheries to promote sustainability. The ecosystem approach is necessary, especially to account for fishery-ecosystem interactions, but by itself is not sufficient to address two important factors contributing to unsustainable fisheries — inappropriate incentives bearing on fishers, and the ineffective governance that frequently exists in commercial, developed fisheries managed primarily by total harvest limits and input-controls. We contend that much greater emphasis must be placed on fisher motivation when managing fisheries. Using evidence from more than a dozen ‘natural experiments’ in commercial fisheries, we argue that incentive-based approaches that better specify community, individual harvest, or territorial rights and also price ecosystem services — coupled with public research, monitoring and effective oversight — promote sustainable fisheries.incentives, sustainability, rights, fisheries management

Radiation Test Results for a MEMS Microshutter Operating at 60 K

The James Webb Space Telescope (JWST), the successor to the Hubble Space Telescope, is due to be launched in 2013 with the goal of searching the very distant Universe for stars that formed shortly after the Big Bang. Because this occurred so far back in time, the available light is strongly red-shifted, requiring the use of detectors sensitive to the infrared portion of the electromagnetic spectrum. HgCdTe infrared focal plane arrays, cooled to below 30 K to minimize noise, will be used to detect the faint signals. One of the instruments on JWST is the Near Infrared Spectrometer (NIRSPEC) designed to measure the infrared spectra of up to 100 separate galaxies simultaneously. A key component in NIRSPEC is a Micro-Electromechanical System (MEMS), a two-dimensional micro-shutter array (MSA) developed by NASA/GSFC. The MSA is inserted in front of the detector to allow only the light from the galaxies of interest to reach the detector and to block the light from all other sources. The MSA will have to operate at 30 K to minimize the amount of thermal radiation emitted by the optical components from reaching the detector array. It will also have to operate in the space radiation environment that is dominated by the MSA will be exposed to a large total ionizing dose of approximately 200 krad(Si). Following exposure to ionizing radiation, a variety of MEMS have exhibited performance degradation. MEMS contain moving parts that are either controlled or sensed by changes in electric fields. Radiation degradation can be expected for those devices where there is an electric field applied across an insulating layer that is part of the sensing or controlling structure. Ionizing radiation will liberate charge (electrons and holes) in the insulating layers, some of which may be trapped within the insulating layer. Trapped charge will partially cancel the externally applied electric field and lead to changes in the operation of the MEMS. This appears to be a general principle for MEMS. Knowledge of the above principle has raised the concern at NASA that the MSA might also exhibit degraded performance because, i) each shutter flap is a multilayer structure consisting of metallic and insulating layers and ii) the movement of the shutter flaps is partially controlled by the application of an electric field between the shutter flap and the substrate (vertical support grid). The whole mission would be compromised if radiation exposure were to prevent the shutters from opening and closing properly. energetic ionizing particles. Because it is located A unique feature of the MSA is that, as outside the spacecraft and has very little shielding, previously mentioned, it will have to operate at temperatures near 30 K. To date, there are no published reports on how very low temperatures (- 30K) affect the response of MEMS devices to total ionizing dose. Experiments on SiO2 structures at low temperatures (80 K) indicate that the electrons generated by the ionizing radiation are mobile and will move rapidly under the application of an external electric field. Holes, on the other hand, that would normally move in the opposite direction through the SiO2 via a "thermal hopping" process, are effectively immobile at low electric fields as they are trapped close to their generation sites. However, for sufficiently large electric fields (greater than 3 MV/cm) holes are able to move through the SiO2. The larger the field, the more rapidly the holes move. The separation of the electrons and holes leads to a reduced electric field within the insulating layer. To overcome this reduction in electric field, a greater external voltage will have to be applied that alters the normal operation of the device. This report presents the results of radiation testing of the MSA at 60 K. The temperature was higher than the targeted temperature because of a faulty electrical interconnect on the test board. Specifically, our goal was to determine whether the MSA would function propey after a TID of 200 krad(Si)

Clinical Outcomes Following Revision Total Knee Arthroplasty: Minimum 2-Year Follow-up

BACKGROUD: The longer-term outcomes of revision total knee arthroplasty are not well described in the current literature. Managing patient expectations of revision total knee arthroplasty can be challenging for orthopedic surgeons due to a paucity of data to guide decision-making. We present outcomes of revision total knee arthroplasty performed by a single surgeon over a 12-year period from 2004 through 2015. METHODS: A retrospective review of hospital and private medical records demonstrated 202 revision total knee arthroplasties performed by the senior author in 178 patients from 2004 through 2015. Of these, 153 patients were available for assessment. Patients were contacted and invited to participate in a structured telephone interview to assess Oxford Knee Score (OKS) and patient satisfaction. All patients received the PFC (Depuy) prosthesis at a single institution and were followed up for minimum 2 years postoperatively at the time of review. Retrospective chart review was used to obtain other data for analysis including patient demographics, preoperative and postoperative range of motion (ROM), and intraoperative details. RESULTS: This cohort demonstrated a 93.5% survival rate and an 85% satisfaction rate at a mean of 6.5 years postoperatively. Mean ROM improved from 100° (range, 5°–145°) to 112° (range, 35°–135°) (p < 0.001). The mean OKS was 39.25 (range, 14–48). The factors associated with improved postoperative outcomes included male gender, fewer previous revision total knee arthroplasty procedures, increased preoperative ROM, and receiving a less constrained implant. CONCLUSIONS: This study provides a comprehensive description of outcomes following revision total knee arthroplasty in a large patient cohort with a long follow-up. Although revision total knee arthroplasty is a challenging and complex aspect of arthroplasty surgery, high patient satisfaction and good functional outcomes can be achieved for the majority of patients

A Reliable Surgical Approach to Revision Total Knee Arthroplasty

BACKGROUD: The surgical exposure obtained in revision total knee arthroplasty should facilitate the utilisation of instrumentation and implants, including adjuncts such as stemmed prostheses, bone allograft, and artificial augments. We have previously identified within this cohort of revision total knee arthroplasty patients a high satisfaction rate of 93.5% at a mean 6.5 years of follow-up and a high level of postoperative function. We, therefore, seek to describe in detail the operative technique and perioperative care and report the early postoperative complications. METHODS: We report on the surgical approach, closure technique, and postoperative care used by the senior author for revision total knee arthroplasty procedures. The patient demographics, intraoperative details, and postoperative outcomes are also reported. We aim to provide a clear description of the intraoperative technique and postoperative outcome, facilitating adoption or comparison with other surgeons or techniques. Patient inclusion criteria were revision total knee arthroplasty performed by the senior author using the PFC (Depuy) prosthesis at John Flynn Private Hospital with a minimum of 2-year postoperative follow-up. A retrospective chart review was combined with a structured telephone assessment questionnaire to assess outcomes. RESULTS: A total of 202 revision total knee arthroplasties were available for follow-up in 185 patients. The mean 1-year postoperative range of motion was 110°. Key features of surgical approach include incision planning, soft-tissue plane development, parapatellar scar debridement, safe removal of implants, management of bone defects, and closure technique. The overall 90-day complication rate was 9%, including 4.4% requiring manipulation under anaesthesia and 3% superficial surgical site infections (1 patient requiring intravenous antibiotics). CONCLUSIONS: We suggest that the described technique is reproducible and reliable. It rarely requires modification and facilitates successful postoperative outcomes with a low complication rate. The adoption of this surgical technique allows surgeons to approach complex knee arthroplasty with confidence in the appropriate exposure of anatomy, facilitating subsequent steps in their arthroplasty procedures

Gemini/GMOS Imaging of Globular Cluster Systems in Five Early-type Galaxies

This paper presents deep high quality photometry of globular cluster (GC) systems belonging to five early-type galaxies covering a range of mass and environment. Photometric data were obtained with the Gemini North and Gemini South telescopes in the filter passbands g', r', and i'. The combination of these filters with good seeing conditions allows an excellent separation between GC candidates and unresolved field objects. Bimodal GC colour distributions are found in all five galaxies. Most of the GC systems appear bimodal even in the (g' -r') vs (r' -i') plane. A population of resolved/marginally resolved GC and Ultra Compact Dwarf candidates was found in all the galaxies. A search for the so-called "blue tilt" in the colour-magnitude diagrams reveals that NGC 4649 clearly shows that phenomenon although no conclusive evidence was found for the other galaxies in the sample. This "blue tilt" translates into a mass-metallicity relation given by Z \propto M^0.28\pm0.03 . This dependence was found using a new empirical (g' -i') vs [Z/H] relation which relies on an homogeneous sample of GC colours and metallicities. This paper also explores the radial trends in both colour and surface density for the blue (metal-poor) and red (metal-rich) GC subpopulations. As usual, the red GCs show a steeper radial distribution than the blue ones. Evidence of galactocentric colour gradients is found in some of the GC systems, being more significant for the two S0 galaxies in the sample. Red GC subpopulations show similar colours and gradients to the galaxy halo stars in their inner region. A GC mean colour-galaxy luminosity relation, consistent with [Z/H] \propto L_B ^0.26\pm0.08, is present for the red GCs. An estimate of the total GC populations and specific frequency SN values is presented for NGC 3115, NGC 3379, NGC 3923 and NGC 4649.Comment: 23 pages, 13 figures and 9 tables. Tables A1 and A2 will be published in full online only. Accepted for publication in MNRA