Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study.

BackgroundThe US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins.MethodsThe study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics.ResultsAmong males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years.ConclusionsBased on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk

Testing Assumptions of Distance Sampling on a Pelagic Seabird

Distance sampling along a line transect is used commonly for monitoring changes of birds’ abundance at sea. A critical yet rarely tested assumption of line-transect-sampling theory is that all birds along the transect line (i.e., directly in front of the boat) are detected or that probability of detecting a bird on the line can be estimated. As part of a long-term research and monitoring program for the Kittlitz’s Murrelet (Brachyramphus brevirostris), we tested the assumption of complete detection of murrelets on the water along a transect line directly in front of a moving boat. Following standard survey procedures, we approached groups of murrelets (n = 57) at sea and recorded their distance, response (diving or flying), and duration of response. Flying murrelets (n = 27) were easily detected, but diving birds (n = 30) were more difficult to detect because of the duration of their dive. The probability that a bird dove and remained underwater long enough to avoid detection was low because birds that dove more than 150 m from the boat surfaced before the boat passed whereas birds that “waited” to dive near the boat were easily detected prior to diving. The greatest probability of nondetection was for birds diving at 55 m (diving long enough for the boat to pass) but was only 0.032 ± 0.007 (P + SE). These experiments quantifying detection probability along the transect line could be applied to any species surveyed from a boat

Understanding Abundance Patterns of a Declining Seabird: Implications for Monitoring

The Kittlitz\u27s Murrelet (Brachyramphus brevirostris) is a rare, non-colonial seabird often associated with tidewater glaciers and a recent candidate for listing under the Endangered Species Act. We estimated abundance of Kittlitz\u27s Murrelets across space and time from at-sea surveys along the coast of Alaska (USA) and then used these data to develop spatial models to describe abundance patterns and identify environmental factors affecting abundance. Over a five-week period in the summer of 2005, we recorded 794 Kittlitz\u27s Murrelets, 16 Marbled Murrelets (B. marmoratus), and 70 unidentified murrelets. The overall population estimate (N, mean ± SE) during the peak period (3–9 July) was 1317 ± 294 birds, decreasing to 68 ± 37 by the last survey period (31 July–6 August). Density of Kittlitz\u27s Murrelets was highest in pelagic waters of Taan Fjord (18.6 ± 7.8 birds/km2, mean ± SE) during 10–16 July. Spatial models identified consistent “hotspots” of Kittlitz\u27s Murrelets, including several small areas where high densities of murrelets were found throughout the survey period. Of the explanatory variables that we evaluated, tidal current strength influenced murrelet abundance most consistently, with higher abundance associated with strong tidal currents. Simulations based on the empirically derived estimates of variation demonstrated that spatial variation strongly influenced power to detect trend, although power changed little across the threefold difference in the coefficient of variation on detection probability. We include recommendations for monitoring Kittlitz\u27s Murrelets (or other marine species) when there is a high degree of uncertainty about factors affecting abundance, especially spatial variability

The removal of thermally aged films of triacylglycerides by surfactant solutions

Thermal ageing of triacylglycerides (TAG) at high temperatures produces films which resist removal using aqueous surfactant solutions. We used a mass loss method to investigate the removal of thermally aged TAG films from hard surfaces using aqueous solutions of surfactants of different charge types. It was found that cationic surfactants are most effective at high pH, whereas anionics are most effective at low pH and a non-ionic surfactant is most effective at intermediate pH. We showed that the TAG film removal process occurs in several stages. In the first ‘‘lag phase’’ no TAG removal occurs; the surfactant first partitions into the thermally aged film. In the second stage, the TAG film containing surfactant was removed by solubilisation into micelles in the aqueous solution. The effects of pH and surfactant charge on the TAG removal process correlate with the effects of these variables on the extent of surfactant partitioning to the TAG film and on the maximum extent of TAG solubilisation within the micelles. Additionally, we showed how the TAG removal is enhanced by the addition of amphiphilic additives such as alcohols which act as co-surfactants. The study demonstrates that aqueous surfactant solutions provide a viable and more benign alternative to current methods for the removal of thermally aged TAG films

Report on Archaeological Investigations Conducted at the St. Mary's Site (18AP45), 107 Duke of Gloucester Street, Annapolis, Maryland, 1987-1990

In celebration of the 250th anniversary of the birth of Charles Carroll of Carrollton, Archaeology in Annapolis was invited to excavate the Carroll House and garden on 107 Duke of Gloucester Street in Annapolis, Maryland. The site, named the St. Mary's Site (18AP45) for the Catholic church on the property, is currently owned by the Redemptorists, a Roman Catholic congregation of priests and brothers who have occupied the site since 1852. Prior to the Redemptorists' tenure, the site was owned by the Carroll family from 1701-1852 and is perhaps best known as the home of Charles Carroll of Carrollton (1737-1832), signer of the Declaration of Independence. Excavations at the site were conducted during four consecutive summer seasons from 1987-1990. The investigation focused on three research questions. The first line of inquiry were questions surrounding the dating, architectural configuration, and artifact deposits of the "frame house," a structure adjoining the west wall of the brick Carroll House via a "passage" and later a three story addition. The frame house was partially demolished in the mid-nineteenth century but the construction was thought to pre-date the brick portion of the house. The second research question was spurred by documentary research which indicated that the property might have been the location of Proctor's Tavern, a late 17th-century tavern which served as the meeting place of the Maryland Provincial Assembly. Archaeological testing hoped to determine its location and, if found, investigate Annapolis' early Euro-American occupation. The third research question focused on the landscape of the site as it was shaped by its occupants over the past three hundred years. The research questions included investigating the stratigraphy, geometry, and architectural and planting features of Charles Carroll of Carrollton's terraced garden built during the 1770s, and investigating the changes to the landscape made by the Redemptorists in the nineteenth and twentieth centuries. While no structural evidence associated with Proctor’s Tavern was uncovered during limited excavations along Spa Creek, the historic shore of Spa Creek was identified, buried beneath deep fill deposits laid down during construction of the Carroll Garden. Features and deposits associated with this period likely remain intact in a waterlogged environment along the southeastern sea wall at the St. Mary’s Site. Evidence of extensive earth moving by Carroll is present in the garden and was identified during excavation and coring. This strongly suggests that the garden landscape visible at the St. Mary’s Site is the intact Carroll Garden, which survives beneath contemporary and late nineteenth century strata. The extant surviving garden should be considered highly sensitive to ground-disturbing activities, and is also highly significant considering demonstrable associations with the Carroll family. Other garden-related features were also discovered, including planting holes, and a brick pavilion or parapet located along Spa Creek to the south of the site. The Duke of Gloucester Street wall was shown to be associated with the Carroll occupation of the site. Finally, intensive archaeological research was directed at the vicinity of a frame house constructed and occupied by the Carrolls to the east of the existing brick house, which was replaced by the Redemptorists in the nineteenth century with a greenhouse. These superimposed buildings were documented in detail and remain highly significant features at the St. Mary’s Site

Physics of the Cosmos (PCOS) Program Technology Development 2018

We present a final report on our program to raise the Technology Readiness Level (TRL) of enhanced chargecoupleddevice (CCD) detectors capable of meeting the requirements of Xray grating spectrometers (XGS) and widefield Xray imaging instruments for small, medium, and large missions. Because they are made of silicon, all Xray CCDs require blocking filters to prevent corruption of the Xray signal by outofband, mainly optical and nearinfrared (nearIR) radiation. Our primary objective is to demonstrate technology that can replace the fragile, extremely thin, freestanding blocking filter that has been standard practice with a much more robust filter deposited directly on the detector surface. Highperformance, backilluminated CCDs have flown with freestanding filters (e.g., one of our detectors on Suzaku), and other relatively lowperformance CCDs with directly deposited filters have flown (e.g., on the Xray Multimirror MissionNewton, XMMNewton Reflection Grating Spectrometer, RGS). At the inception of our program, a highperformance, backilluminated CCD with a directly deposited filter has not been demonstrated. Our effort will be the first to show such a filter can be deposited on an Xray CCD that meets the requirements of a variety of contemplated future instruments. Our principal results are as follows: i) we have demonstrated a process for direct deposition of aluminum optical blocking filters on backilluminated MIT Lincoln Laboratory CCDs. Filters ranging in thickness from 70 nm to 220 nm exhibit expected bulk visibleband and Xray transmission properties except in a small number (affecting 1% of detector area) of isolated detector pixels ("pinholes"), which show higherthanexpected visibleband transmission; ii) these filters produce no measurable degradation in softXray spectral resolution, demonstrating that direct filter deposition is compatible with the MIT Lincoln Laboratory backillumination process; iii) we have shown that under sufficiently intense visible and nearIR illumination, outofband light can enter the detector through its sidewalls and mounting surfaces, compromising detector performance. This 'sidewall leakage' has been observed, for example, by a previous experiment on the International Space Station during its orbitday operations. We have developed effective countermeasures for this sidewall leakage; iv) we developed an exceptionally productive collaboration with the Regolith Xray Imaging Spectrometer (REXIS) team. REXIS is a student instrument now flying on the Origins Spectral Interpretation Resource Identification Security - Regolith Explorer (OSIRISREx) mission. REXIS students participated in our filter development program, adopted our technology for their flight instrument, and raised the TRL of this technology beyond our initial goals. This Strategic Astrophysics Technology (SAT) project, a collaboration between the MKI and MIT Lincoln Laboratory, began July 1, 2012, and ended on June 30, 2018

Technology Development for the Constellation-X Spectroscopy X-Ray Telescope

The Constellation-X Spectroscopy X-ray Telescope (SXT) is a large diameter, high throughput, grazing incidence imaging mirror system, designed to perform high sensitivity spectroscopy of cosmic X-ray sources in the 0.2-10.0 keV band. The baseline effective area requirement is -3 m# at 1 keV. The system-level angular-resolution requirement is a 15-arcseconds half-power diameter, with a 5-arcsecond goal. The effective area is attained through a modular design, involving the nesting of many confocal, thin-walled Wolter I mirror segments. Considerable progress has been made in developing thin, thermally formed, glass mirror substrates that meet or better the angular-resolution requirement. Several approaches to mounting and aligning reflector segments into a mirror system are under investigation. We report here on the progress of the SXT technology development program toward reaching the performance goals

The Future Direction of Inter-Professional Education in Ireland: Insights From Focus Groups With Key Stakeholders

Rationale: An inter-professional education (IPE) masterclass symposium titled, ‘The journey to team-based healthcare’, was jointly hosted by the School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), the Irish Institute of Pharmacy and the Bill Gatton College of Pharmacy in East Tennessee State University in May 2017. The masterclass provided a comprehensive overview of IPE initiatives based on the extensive experience of senior academics from the host institutions, which included staff from pharmacy, nursing and medicine. The masterclass was attended by healthcare professionals, policy makers and educationalists working in Ireland. As part of the symposium, focus groups were conducted with a sample of symposium attendees to determine their opinions and perceptions, as key stakeholders, regarding the development, implementation and future direction of IPE in Ireland. Methods: Focus groups were conducted with symposium attendees using a topic guide that was developed based on previous literature. Questions explored participants’ views and experiences on a range of topics including development and implementation of IPE activities, and key priorities for developing future IPE initiatives. Thematic analysis was conducted to identify key themes. Findings: Three focus groups were conducted each involving five to six participants (total 16 participants: nine female). Preliminary themes have been identified and further analysis is ongoing. Discussion/conclusion: The research findings will help to inform the future development and direction of IPE initiatives at both undergraduate and postgraduate level within the host institutions and could help in the development of an IPE strategy for undergraduate and post-graduate teaching across Ireland

Counting and effective rigidity in algebra and geometry

The purpose of this article is to produce effective versions of some rigidity results in algebra and geometry. On the geometric side, we focus on the spectrum of primitive geodesic lengths (resp., complex lengths) for arithmetic hyperbolic 2-manifolds (resp., 3-manifolds). By work of Reid, this spectrum determines the commensurability class of the 2-manifold (resp., 3-manifold). We establish effective versions of these rigidity results by ensuring that, for two incommensurable arithmetic manifolds of bounded volume, the length sets (resp., the complex length sets) must disagree for a length that can be explicitly bounded as a function of volume. We also prove an effective version of a similar rigidity result established by the second author with Reid on a surface analog of the length spectrum for hyperbolic 3-manifolds. These effective results have corresponding algebraic analogs involving maximal subfields and quaternion subalgebras of quaternion algebras. To prove these effective rigidity results, we establish results on the asymptotic behavior of certain algebraic and geometric counting functions which are of independent interest.Comment: v.2, 39 pages. To appear in Invent. Mat

The long-term safety and efficacy of vestronidase alfa, rhGUS enzyme replacement therapy, in subjects with mucopolysaccharidosis VII

Vestronidase alfa (recombinant human beta-glucuronidase) is an enzyme replacement therapy (ERT) for Mucopolysaccharidosis (MPS) VII, a highly heterogeneous, ultra-rare disease. Twelve subjects, ages 8-25 years, completed a Phase 3, randomized, placebo-controlled, blind-start, single crossover study (UX003-CL301; NCT02377921), receiving 24-48 weeks of vestronidase alfa 4 mg/kg IV. All 12 subjects completed the blind-start study, which showed significantly reduced urinary glycosaminoglycans (GAG) and clinical improvement in a multi-domain responder index, and enrolled in a long-term, open-label, extension study (UX003-CL202; NCT02432144). Here, we report the final results of the extension study, up to an additional 144 weeks after completion of the blind-start study. Three subjects (25%) completed all 144 weeks of study, eight subjects (67%) ended study participation before Week 144 to switch to commercially available vestronidase alfa, and one subject discontinued due to non-compliance after receiving one infusion of vestronidase alfa in the extension study. The safety profile of vestronidase alfa in the extension study was consistent with observations in the preceding blind-start study, with most adverse events mild to moderate in severity. There were no treatment or study discontinuations due to AEs and no noteworthy changes in a standard safety chemistry panel. Out of the eleven subjects who tested positive for anti-drug antibodies at any time during the blind-start or extension study, including the baseline assessment in the blind-start study, seven subjects tested positive for neutralizing antibodies and all seven continued to demonstrate a reduction in urinary GAG levels. There was no association between antibody formation and infusion associated reactions. Subjects receiving continuous vestronidase alfa treatment showed a sustained urinary GAG reduction and clinical response evaluated using a multi-domain responder index that includes assessments in pulmonary function, motor function, range of motion, mobility, and visual acuity. Reduction in fatigue was also maintained in the overall population. As ERT is not expected to cross the blood brain barrier, limiting the impact on neurological signs of disease, and not all subjects presented with neurological symptoms, outcomes related to central nervous system pathology are not focused on in this report. Results from this study show the long-term safety and durability of clinical efficacy in subjects with MPS VII with long-term vestronidase alfa treatment.This work was supported by Ultragenyx Pharmaceutical Inc. LZ, TC, DM, and AJ, authors of this manuscript, are employees of Ultragenyx Pharmaceutical and contributed to the conduct of the research; the study design; data collection, analysis and interpretation; development of this manuscript; and the decision to submit this article.info:eu-repo/semantics/publishedVersio