GPs’ implicit prioritization through clinical choices – evidence from three national health services

We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors’ experience. In general there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs’ two conflicting agency roles and what we know about the incentive structures and cultures in the different countries

Adapting robot paths for automated NDT of complex structures using ultrasonic alignment

Automated inspection systems using industrial robots have been available for several years. The IntACom robot inspection system was developed at TWI Wales and utilizes phased array ultrasonic probes to inspect complex geometries, in particular aerospace composite components. To increase inspection speed and accuracy, off-line path planning is employed to define a series of robotic movements following the surface of a component. To minimize influences of refraction at the component interface and effects of anisotropy, the ultrasonic probe must be kept perpendicular to the surface throughout the inspection. Deviations between the actual component and computer model used for path-planning result in suboptimal alignment and a subsequent reduction in the quality of the ultrasonic echo signal. In this work we demonstrate methods for using the ultrasonic echo signals to adapt a robotic path to achieve a minimal variation in the reflected surface echo. The component surface is imaged using phased array probes to calculate a sparse 3D point cloud with estimated normal directions. This is done through a preliminary alignment path covering approximately 25% of the total surface to minimize the impact on overall inspection time. The data is then compared to the expected geometry and deviations are minimized using least-squares optimization. Compared to manual alignment techniques, this method shows a reduction in surface amplitude variation of up to 32%, indicating that the robot is following the surface of the component more accurately

Introducing a new method for efficient visualization of complex shape 3D ultrasonic phased-array C-scans

Automated robotic inspection systems allow the collection of large data volumes, compared to existing inspection systems. To maximize the throughput associated with the nondestructive evaluation phase, it is crucial that the reconstructed inspection data sets are generated and examined rapidly without a loss of detail. Data analysis often becomes the bottleneck of automated inspections. Therefore, new data visualization tools, suitable to screen the NDT information obtained through robotic systems, are urgently required. This paper presents a new approach, for the generation of three-dimensional ultrasonic C-scans of large and complex parts, suitable for application to high data throughput ultrasonic phased array inspection. This approach produces 3D C-scan presented as colored tessellated surfaces and the approach works efficiently on challenging geometry, with concave and convex regions. Qualitative and quantitative results show that the approach runs up to 500 times faster than other C-scan visualization techniques

Assessing the accuracy of industrial robots through metrology for the enhancement of automated non-destructive testing

This work presents the study of the accuracy of an industrial robot KR5 arc HW, used to perform quality inspections of components with complex shapes. Metrology techniques such as laser tracking and large volume photogrammetry were deployed to quantify both pose and dynamic path accuracies of the robot in accordance with ISO 9283:1998. The overall positioning pose inaccuracy of the robot is found to be almost 1 mm and path inaccuracy at 100% of the robot rated velocity is 4.5 mm. The maximum pose orientation inaccuracy is found to be 14 degrees and the maximum path orientation inaccuracy is 5 degrees. Despite of the significant maximum inaccuracies, uncertainty of a robotic scanning application is estimated to be 0.5mm. Local positional errors manifest pronounced dependence on the position of the robot end effector in the working envelope. The uncertainties of the measurements are discussed and deemed to be caused by the tool center point calibration, the reference coordinate system transformation and the low accuracy of the photogrammetry system

Thin superconducting disk with B-dependent Jc: Flux and current distributions

The critical state in a superconducting thin circular disk with an arbitrary magnetic field dependence of the critical sheet current, Jc(B), is analyzed. With an applied field Ba perpendicular to the disk, a set of coupled integral equations for the flux and current distributions is derived. The equations are solved numerically, and flux and current profiles are presented graphically for several commonly used Jc(B) dependences. It is shown that for small Ba the flux penetration depth can be described by an effective Bean model with a renormalized Jc entering the leading term. We argue that these results are qualitatively correct for thin superconductors of any shape. The results contrast the parallel geometry behavior, where at small Ba the B-dependence of the critical current can be ignored.Comment: RevTeX, 7 pages including 8 figure

Late Quaternary paleoceanography of Vestnesa Ridge, Fram Strait: Ostracode species as a potential indicator of cold seep activity

Past intensity of methane release from deep-ocean methane hydrates continues to be challenging to reconstruct reliably. Here, we used fossil ostracode fauna paired with foraminiferal δ13C values in a marine sediment core from Vestnesa Ridge, western Svalbard margin, to reconstruct methane seepage activity during the late Quaternary and to examine faunal response to deglacial climatic changes. Benthic foraminiferal δ13C values indicate methane seepage activity was relatively strong during marine isotope stage 2, corresponding to a high percentage of the ostracode Rosaliella svalbardensis in the assemblage. In contrast, this species was absent under conditions of no or very strong seepage of methane. Faunal changes in other taxa were more related to global climate changes regardless of the seepage activity. This result indicates that Rosaliella svalbardensis is a potential new useful proxy for past methane release

Evaluation of immune responses in HIV infected patients with pleural tuberculosis by the QuantiFERON® TB-Gold interferon-gamma assay

<p>Abstract</p> <p>Background</p> <p>Diagnosis of tuberculous (TB) pleuritis is difficult and better diagnostic tools are needed. New blood based interferon-gamma (IFN-γ) tests are promising, but sensitivity could be low in HIV positive patients. The IFN-γ tests have not yet been validated for use in pleural fluid, a compartment with higher level of immune activation than in blood.</p> <p>Methods</p> <p>The QuantiFERON TB^®-Gold (QFT-TB) test was analysed in blood and pleural fluid from 34 patients presenting with clinically suspected pleural TB. Clinical data, HIV status and CD4 cell counts were recorded. Adenosine deaminase activity (ADA) analysis and TB culture were performed on pleural fluid.</p> <p>Results</p> <p>The patients were categorised as 'confirmed TB' (n = 12), 'probable TB' (n = 16) and 'non-TB' pleuritis (n = 6) based on TB culture results and clinical and biochemical criteria. The majority of the TB patients were HIV infected (82%). The QFT-TB in pleural fluid was positive in 27% and 56% of the 'confirmed TB' and 'probable TB' cases, respectively, whereas the corresponding sensitivities in blood were 58% and 83%. Indeterminate results in blood (25%) were caused by low phytohemagglutinin (PHA = positive control) IFN-γ responses, significantly lower in the TB patients as compared to the 'non-TB' cases (p = 0.02). Blood PHA responses correlated with CD4 cell count (r = 0.600, p = 0.028). In contrast, in pleural fluid indeterminate results (52%) were caused by high Nil (negative control) IFN-γ responses in both TB groups. Still, the Nil IFN-γ responses were lower than the TB antigen responses (p < 0.01), offering a conclusive test for half of the patients. We did not find any correlation between blood CD4 cell count and IFN-γ responses in pleural fluid.</p> <p>Conclusion</p> <p>The QFT-TB test in blood could contribute to the diagnosis of TB pleuritis in the HIV positive population. Still, the number of inconclusive results is too high to recommend the commercial QFT-TB test for routine use in pleural fluid in a TB/HIV endemic resource-limited setting.</p

A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Copyright © 2022. Published by Elsevier Inc.Bread is a major source of grain-derived carbohydrates worldwide. High intakes of refined grains, low in dietary fiber and high in glycemic index, are linked with increased risk for type 2 diabetes mellitus (T2DM) and other chronic diseases. Hence, improvements in the composition of bread could influence population health. This systematic review evaluated the effect of regular consumption of reformulated breads on glycemic control among healthy adults, adults at cardiometabolic risk or with manifest T2DM. A literature search was performed using MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials. Eligible studies employed a bread intervention (≥2 wk) in adults (healthy, at cardiometabolic risk or manifest T2DM) and reported glycemic outcomes (fasting blood glucose, fasting insulin, HOMA-IR, HbA1c, and postprandial glucose responses). Data were pooled using generic inverse variance with random-effects model and presented as mean difference (MD) or standardized MD between treatments with 95% CIs. Twenty-two studies met the inclusion criteria (n = 1037 participants). Compared with "regular" or comparator bread, consumption of reformulated intervention breads yielded lower fasting blood glucose concentrations (MD: -0.21 mmol/L; 95% CI: -0.38, -0.03; I2 = 88%, moderate certainty of evidence), yet no differences in fasting insulin (MD: -1.59 pmol/L; 95% CI: -5.78, 2.59; I2 = 38%, moderate certainty of evidence), HOMA-IR (MD: -0.09; 95% CI: -0.35, 0.23; I2 = 60%, moderate certainty of evidence), HbA1c (MD: -0.14; 95% CI: -0.39, 0.10; I2 = 56%, very low certainty of evidence), or postprandial glucose response (SMD: -0.46; 95% CI: -1.28, 0.36; I2 = 74%, low certainty of evidence). Subgroup analyses revealed a beneficial effect for fasting blood glucose only among people with T2DM (low certainty of evidence). Our findings suggest a beneficial effect of reformulated breads high in dietary fiber, whole grains, and/or functional ingredients on fasting blood glucose concentrations in adults, primarily among those with T2DM. This trial was registered at PROSPERO as CRD42020205458.publishersversionpublishe

Hyperpolarized [1,4-13C2]Fumarate Enables Magnetic Resonance-Based Imaging of Myocardial Necrosis.

OBJECTIVES: The aim of this study was to determine if hyperpolarized [1,4-13C2]malate imaging could measure cardiomyocyte necrosis after myocardial infarction (MI). BACKGROUND: MI is defined by an acute burst of cellular necrosis and the subsequent cascade of structural and functional adaptations. Quantifying necrosis in the clinic after MI remains challenging. Magnetic resonance-based detection of the conversion of hyperpolarized [1,4-13C2]fumarate to [1,4-13C2]malate, enabled by disrupted cell membrane integrity, has measured cellular necrosis in vivo in other tissue types. Our aim was to determine whether hyperpolarized [1,4-13C2]malate imaging could measure necrosis after MI. METHODS: Isolated perfused hearts were given hyperpolarized [1,4-13C2]fumarate at baseline, immediately after 20 min of ischemia, and after 45 min of reperfusion. Magnetic resonance spectroscopy measured conversion into [1,4-13C2]malate. Left ventricular function and energetics were monitored throughout the protocol, buffer samples were collected and hearts were preserved for further analyses. For in vivo studies, magnetic resonance spectroscopy and a novel spatial-spectral magnetic resonance imaging sequence were implemented to assess cardiomyocyte necrosis in rats, 1 day and 1 week after cryo-induced MI. RESULTS: In isolated hearts, [1,4-13C2]malate production became apparent after 45 min of reperfusion, and increased 2.7-fold compared with baseline. Expression of dicarboxylic acid transporter genes were negligible in healthy and reperfused hearts, and lactate dehydrogenase release and infarct size were significantly increased in reperfused hearts. Nonlinear regression revealed that [1,4-13C2]malate production was induced when adenosine triphosphate was depleted by >50%, below 5.3 mmol/l (R2 = 0.904). In vivo, the quantity of [1,4-13C2]malate visible increased 82-fold over controls 1 day after infarction, maintaining a 31-fold increase 7 days post-infarct. [1,4-13C2]Malate could be resolved using hyperpolarized magnetic resonance imaging in the infarct region one day after MI; [1,4-13C2]malate was not visible in control hearts. CONCLUSIONS: Malate production in the infarcted heart appears to provide a specific probe of necrosis acutely after MI, and for at least 1 week afterward. This technique could offer an alternative noninvasive method to measure cellular necrosis in heart disease, and warrants further investigation in patients

Heart failure in women with hypertensive disorders of pregnancy: Insights from the cardiovascular disease in Norway project

Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84–2.35], P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50–2.68, P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (Pinteraction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.acceptedVersio